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DOL/EBSA

RIN: 1210-AA77

Publication ID: Fall 2004

Title: Prohibiting Discrimination Against Participants and Beneficiaries Based on Health Status
Abstract: Section 702 of the Employee Retirement Income Security Act of 1974, amended by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), establishes that a group health plan or a health insurance issuer may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan based on any health status-related factor. These provisions are also contained in the Internal Revenue Code under the jurisdiction of the Department of the Treasury, and the Public Health Service Act under the jurisdiction of the Department of Health and Human Services. On April 8, 1997, the Department, in conjunction with the Departments of the Treasury and Health and Human Services (collectively, the Departments) published interim final regulations implementing the nondiscrimination provisions of HIPAA. These regulations can be found at 26 CFR 54.9802-1 (Treasury), 29 CFR 2590.702 (Labor), and 45 CFR 146.121 (HHS). That notice of rulemaking also solicited comments on the nondiscrimination provisions and indicated that the Departments intend to issue further regulations on the nondiscrimination rules. This rulemaking contains additional regulatory interim guidance under HIPAA's nondiscrimination provisions. In addition, the rulemaking contains proposed guidance on bona fide wellness programs.
Agency: Department of Labor(DOL)	Priority: Other Significant
RIN Status: Previously published in the Unified Agenda	Agenda Stage of Rulemaking: Final Rule Stage
Major: Undetermined	Unfunded Mandates: No
CFR Citation: 29 CFR 2590.702
Legal Authority: 29 USC 1027 29 USC 1059 29 USC 1135 29 USC 1182 29 USC 1191c 29 USC 1194

Legal Deadline: None

Statement of Need: Part 7 of ERISA provides that group health plans and health insurance issuers may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan based on any health status-related factor. Plan sponsors, administrators, and participants need additional guidance from the Department with regard to how they can fulfill their respective obligations under these statutory provisions.

Summary of the Legal Basis: Section 702 of ERISA specifies the respective nondiscrimination requirements for group health plans and health insurance issuers. Section 734 of ERISA provides that the Secretary may promulgate such regulations as may be necessary or appropriate to carry out the provisions of part 7 ERISA. In addition, section 505 of ERISA authorizes the Secretary to issue regulations clarifying the provisions of title I of ERISA.

Risks: Failure to provide guidance concerning part 7 of ERISA may impede compliance with the law.

Timetable:

Action	Date	FR Cite
Interim Final Rule	04/08/1997	62 FR 16894
Interim Final Rule Comment Period End	07/07/1997
NPRM	01/08/2001	66 FR 1421
NPRM Comment Period End	04/09/2001
Second Interim Final Rule	01/08/2001	66 FR 1378
Interim Final Rule Comment Period End	04/09/2001
Final Rule	03/00/2005

Additional Information: This item has been split off from RIN 1210-AA54.
Regulatory Flexibility Analysis Required: No	Government Levels Affected: Undetermined
Federalism: No
Included in the Regulatory Plan: Yes
Agency Contact: Amy J. Turner Director, Office of Health Plan Standards and Compliance Assistance Department of Labor Employee Benefits Security Administration Room N5677, 200 Constitution Avenue NW., FP Building, Room N-5653, Washington, DC 20210 Phone:202 693-8335 Fax:202 219-1942