Section 2702 of PHS Act
§ 300gg-1. Prohibiting discrimination against individual
participants and beneficiaries based on health status
(a) In eligibility to enroll.
(1)
In general. Subject to paragraph (2), a group health plan, and a health
insurance issuer offering group health insurance coverage in connection
with a group health plan, may not establish rules for eligibility
(including continued eligibility) of any individual to enroll under the
terms of the plan based on any of the following health status-related
factors in relation to the individual or a dependent of the individual:
(A) Health status.
(B) Medical condition (including both
physical and mental illnesses).
(C) Claims experience.
(D) Receipt of health care.
(E) Medical history.
(F) Genetic information.
(G) Evidence of insurability (including
conditions arising out of acts of domestic violence).
(H) Disability.
(2)
No application to benefits or exclusions. To the extent consistent with
section 701, paragraph (1) shall not be construed--
(A) to require a group health plan, or group health insurance coverage,
to provide particular benefits other than those provided under the
terms of such plan or coverage, or
(B) to prevent
such a plan or coverage from establishing limitations or restrictions
on the amount, level, extent, or nature of the benefits or coverage for
similarly situated individuals enrolled in the plan or coverage.
(3)
Construction. For purposes of paragraph (1), rules for eligibility to
enroll under a plan include rules defining any applicable waiting
periods for such enrollment.
(b) In premium contributions.
(1)
In general. A group health plan, and a health insurance issuer offering
health insurance coverage in connection with a group health plan, may
not require any individual (as a condition of enrollment or continued
enrollment under the plan) to pay a premium or contribution which is
greater than such premium or contribution for a similarly situated
individual enrolled in the plan on the basis of any health
status-related factor in relation to the individual or to an individual
enrolled under the plan as a dependent of the individual.
(2) Construction. Nothing in paragraph (1) shall be
construed--
(A) to restrict the amount that an
employer may be charged for coverage under a group health plan; or
(B) to prevent a group health plan, and a health insurance issuer
offering group health insurance coverage, from establishing premium
discounts or rebates or modifying otherwise applicable copayments or
deductibles in return for adherence to programs of health promotion and
disease prevention.