(b)(1)(ii)(B) The effective date of coverage; (b)(1)(ii)(C) Waiting (or affiliation) periods; (b)(1)(ii)(D) Late and special enrollment; (b)(1)(ii)(E) Eligibility for benefit packages (including rules for individuals to change their selection among benefit packages); (b)(1)(ii)(F) Benefits (including rules relating to covered benefits, benefit restrictions, and cost-sharing) (b)(1)(ii)(G) Continued eligibility; and (b)(1)(ii)(H) Terminating coverage (including disenrollment) of any individual. 45 CFR Plan may not establish rules for the eligibility (including continued 148.180(b)(1) eligibility) of any individual to enroll based on genetic information. In 45 Benefits CFR Prohibited discrimination in benefits: §146.121 General rule: Issuer is not required to provide coverage for any (b)(2)(i)(A) particular benefit to any group of similarly situated individuals. (b)(2)(i)(B) However, benefits that are provided must be uniformly available to all similarly situated individuals. Discrimination 45 CFR Any restriction on a benefit must apply uniformly to all similarly on the Basis of §146.121 situated individuals. Must not be directed at individual participants a Health Factor (b)(2)(i)(B) based on any health factor. Prohibited – Issuer may limit or exclude benefits in relation to a specific disease or condition, limit or exclude benefits for certain types In Benefits of treatments or drugs, or limit or exclude benefits based on a (Cont’d) determination of whether the benefits are experimental or not medically necessary, but only if the benefit limitation or exclusion applies uniformly to all similarly situated individuals and is not directed at individual participants based on any health factor of the participants.
(b)(1)(ii)(B) The effective date of coverage; (b)(1)(ii)(C) Waiting (or affiliation) periods; (b)(1)(ii)(D) Late and special enrollment; (b)(1)(ii)(E) Eligibility for benefit packages (including rules for individuals to change their selection among benefit packages); (b)(1)(ii)(F) Benefits (including rules relating to covered benefits, benefit restrictions, and cost-sharing) (b)(1)(ii)(G) Continued eligibility; and (b)(1)(ii)(H) Terminating coverage (including disenrollment) of any individual. 45 CFR 148.180(b)(1) Plan may not establish rules for the eligibility (including continued eligibility) of any individual to enroll based on genetic information. In Benefits Discrimination on the Basis of a Health Factor Prohibited – In Benefits (Cont’d) 45 CFR §146.121 (b)(2)(i)(A) Prohibited discrimination in benefits: General rule: Issuer is not required to provide coverage for any particular benefit to any group of similarly situated individuals. (b)(2)(i)(B) However, benefits that are provided must be uniformly available to all similarly situated individuals. 45 CFR §146.121 (b)(2)(i)(B) Any restriction on a benefit must apply uniformly to all similarly situated individuals. Must not be directed at individual participants based on any health factor. Issuer may limit or exclude benefits in relation to a specific disease or condition, limit or exclude benefits for certain types of treatments or drugs, or limit or exclude benefits based on a determination of whether the benefits are experimental or not medically necessary, but only if the benefit limitation or exclusion applies uniformly to all similarly situated individuals and is not directed at individual participants based on any health factor of the participants.
checklist-forms-2018-hcsc-small-group-analyst-checklist.docx