Evidence of insurability; or Discrimination 45 CFR of Insurability” includes conditions arising out of acts of domestic violence “Evidence on basis of §146.121(a)(2) health factor and participation in activities such as motorcycling, snowmobiling, all-terrain vehicle Unfair and prohibited – riding, horseback riding, skiing, and other similar activities. Discriminatory In general Disability. Practices (Cont’d) The decision whether health coverage is elected for an individual (including whether the (Cont’d) 45 CFR individual enrolls during special enrollment or late enrollment) is not, itself, within the scope §146.121(a)(3) of any health factor. However, a plan or issuer must treat special enrollees the same as 45 CFR §146.117 similarly situated individuals who are enrolled when first eligible. Discrimination 42 U.S.C. Prohibited discrimination in for eligibility: on the of a §300gg-4 (a) health factor May not have any rule for eligibility (including continued eligibility) of any individual to 45 CFR prohibited §146.121(b)(1)(i) enroll that discriminates on any health factor that relates to that individual or a dependent of that individual, subject to the provisions below regarding how this rule applies to benefits, allows establishment of groups of similarly situated individuals, provides for wellness programs, and permits favorable treatment of individuals with adverse health factors. 42 U.S.C. Rules for eligibility include, but are not limited to, rules relating to— 45 CFR §146.121(b)(1)(ii)(A) Enrollment; The effective date of coverage; (B) Waiting (or affiliation) periods; (C) (D) Late and special enrollment; Eligibility for benefit packages (including for individuals to change their selection (E) among benefit packages); (F) Benefits (including rules relating to covered benefits, benefit restrictions, and (G) Continued eligibility; and
Unfair and Discriminatory Practices (Cont’d) Discrimination on basis of health factor prohibited – In general (Cont’d) 45 CFR §146.121(a)(2) 45 CFR §146.121(a)(3) 45 CFR §146.117 Evidence of insurability; or “Evidence of Insurability” includes conditions arising out of acts of domestic violence and participation in activities such as motorcycling, snowmobiling, all-terrain vehicle riding, horseback riding, skiing, and other similar activities. Disability. The decision whether health coverage is elected for an individual (including whether the individual enrolls during special enrollment or late enrollment) is not, itself, within the scope of any health factor. However, a plan or issuer must treat special enrollees the same as similarly situated individuals who are enrolled when first eligible. Discrimination on the of a health factor prohibited 42 U.S.C. §300gg-4 (a) 45 CFR §146.121(b)(1)(i) 42 U.S.C. 45 CFR §146.121(b)(1)(ii)(A) (B) (C) (D) (E) (F) (G) Prohibited discrimination in for eligibility: May not have any rule for eligibility (including continued eligibility) of any individual to enroll that discriminates on any health factor that relates to that individual or a dependent of that individual, subject to the provisions below regarding how this rule applies to benefits, allows establishment of groups of similarly situated individuals, provides for wellness programs, and permits favorable treatment of individuals with adverse health factors. Rules for eligibility include, but are not limited to, rules relating to— Enrollment; The effective date of coverage; Waiting (or affiliation) periods; Late and special enrollment; Eligibility for benefit packages (including for individuals to change their selection among benefit packages); Benefits (including rules relating to covered benefits, benefit restrictions, and Continued eligibility; and