---
kind: "section"
citation: "42 U.S.C. § 300gg–41"
title: "42"
title_heading: "The Public Health and Welfare"
number: "300gg–41"
heading: "Guaranteed availability of individual health insurance coverage to certain individuals with prior group coverage"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/300gg-41"
units:
  - "Chapter 6A — Public Health Service"
  - "Subchapter XXV — Requirements Relating to Health Insurance Coverage"
  - "Part B — Individual Market Rules"
  - "Subpart 1 — portability, access, and renewability requirements"
---

# §300gg–41. Guaranteed availability of individual health insurance coverage to certain individuals with prior group coverage

- (a) **Guaranteed availability—**
  - (1) **In general—** Subject to the succeeding subsections of this section and [section 300gg–44 of this title](/usc/42/300gg–44.md), each [health insurance issuer](/usc/42/300gg–91.md?p=b-2) that offers [health insurance coverage](/usc/42/300gg–91.md?p=b-1) (as defined in [section 300gg–91(b)(1) of this title](/usc/42/300gg–91.md?p=b-1)) in the [individual market](/usc/42/300gg–91.md?p=e-1-A) in a [State](/usc/42/201.md?p=f) may not, with respect to an eligible individual (as defined in [subsection (b)](#b)) desiring to enroll in [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5)—
    - (A) decline to offer such coverage to, or deny enrollment of, such individual; or
    - (B) impose any preexisting condition exclusion (as defined in [section 2701(b)(1)(A)](/usc/42/2701.md))[^1] with respect to such coverage.
  - (2) **Substitution by State of acceptable alternative mechanism—** The requirement of [paragraph (1)](#a-1) shall not apply to [health insurance coverage](/usc/42/300gg–91.md?p=b-1) offered in the [individual market](/usc/42/300gg–91.md?p=e-1-A) in a [State](/usc/42/201.md?p=f) in which the [State](/usc/42/201.md?p=f) is implementing an acceptable alternative mechanism under [section 300gg–44 of this title](/usc/42/300gg–44.md).
- (b) **“Eligible individual” defined—** In this part, the term “eligible individual” means an individual—
  - (1)
    - (A) for whom, as of the date on which the individual seeks coverage under this section, the aggregate of the periods of creditable coverage (as defined in [section 2701(c)](/usc/42/2701.md))[^1] is 18 or more months and (B) whose most recent prior creditable coverage was under a [group health plan](/usc/42/300bb–8.md?p=1), [governmental plan](/usc/42/300gg–91.md?p=d-8-A), or [church plan](/usc/42/300gg–91.md?p=d-7) (or [health insurance coverage](/usc/42/300gg–91.md?p=b-1) offered in connection with any such plan);
  - (2) who is not eligible for coverage under (A) a [group health plan](/usc/42/300bb–8.md?p=1), (B) part A or part B of title XVIII of the Social Security Act [[42 U.S.C. 1395c](/usc/42/1395c.md) et seq., 1395j et seq.], or (C) a [State plan](/usc/42/300d–31.md?p=2) under title XIX of such Act [[42 U.S.C. 1396](/usc/42/1396.md) et seq.] (or any successor [program](/usc/42/274l–1.md?p=4)), and does not have other [health insurance coverage](/usc/42/300gg–91.md?p=b-1);
  - (3) with respect to whom the most recent coverage within the coverage period described in [paragraph (1)(A)](#b-1-A) was not terminated based on a factor described in paragraph (1) or (2) of section 2712(b)[^1] (relating to nonpayment of premiums or fraud);
  - (4) if the individual had been offered the option of continuation coverage under a [COBRA continuation provision](/usc/42/300gg–91.md?p=d-4) or under a similar [State](/usc/42/201.md?p=f) [program](/usc/42/274l–1.md?p=4), who elected such coverage; and
  - (5) who, if the individual elected such continuation coverage, has exhausted such continuation coverage under such provision or [program](/usc/42/274l–1.md?p=4).
- (c) **Alternative coverage permitted where no State mechanism—**
  - (1) **In general—** In the case of [health insurance coverage](/usc/42/300gg–91.md?p=b-1) offered in the [individual market](/usc/42/300gg–91.md?p=e-1-A) in a [State](/usc/42/201.md?p=f) in which the [State](/usc/42/201.md?p=f) is not implementing an acceptable alternative mechanism under [section 300gg–44 of this title](/usc/42/300gg–44.md), the [health insurance issuer](/usc/42/300gg–91.md?p=b-2) may elect to limit the coverage offered under [subsection (a)](#a) so long as it offers at least two different policy forms of [health insurance coverage](/usc/42/300gg–91.md?p=b-1) both of which—
    - (A) are designed for, made generally available to, and actively marketed to, and enroll both eligible and other individuals by the issuer; and
    - (B) meet the requirement of paragraph [(2)](#c-2) or [(3)](#c-3), as elected by the issuer.

    For purposes of this subsection, policy forms which have different cost-sharing arrangements or different riders shall be considered to be different policy forms.

  - (2) **Choice of most popular policy forms—** The requirement of this paragraph is met, for [health insurance coverage](/usc/42/300gg–91.md?p=b-1) policy forms offered by an issuer in the [individual market](/usc/42/300gg–91.md?p=e-1-A), if the issuer offers the policy forms for [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) with the largest, and next to largest, premium volume of all such policy forms offered by the issuer in the [State](/usc/42/201.md?p=f) or applicable marketing or [service](/usc/42/201.md?p=a) area (as may be prescribed in regulation) by the issuer in the [individual market](/usc/42/300gg–91.md?p=e-1-A) in the period involved.
  - (3) **Choice of 2 policy forms with representative coverage—**
    - (A) **In general—** The requirement of this paragraph is met, for [health insurance coverage](/usc/42/300gg–91.md?p=b-1) policy forms offered by an issuer in the [individual market](/usc/42/300gg–91.md?p=e-1-A), if the issuer offers a lower-level coverage policy form (as defined in [subparagraph (B)](#c-3-B)) and a higher-level coverage policy form (as defined in [subparagraph (C)](#c-3-C)) each of which includes benefits substantially similar to other [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) offered by the issuer in that [State](/usc/42/201.md?p=f) and each of which is covered under a method described in [section 300gg–44(c)(3)(A) of this title](/usc/42/300gg–44.md?p=c-3-A) (relating to risk adjustment, risk spreading, or financial subsidization).
    - (B) **Lower-level of coverage described—** A policy form is described in this subparagraph if the actuarial value of the benefits under the coverage is at least 85 percent but not greater than 100 percent of a weighted average (described in [subparagraph (D)](#c-3-D)).
    - (C) **Higher-level of coverage described—** A policy form is described in this subparagraph if—
      - (i) the actuarial value of the benefits under the coverage is at least 15 percent greater than the actuarial value of the coverage described in [subparagraph (B)](#c-3-B) offered by the issuer in the area involved; and
      - (ii) the actuarial value of the benefits under the coverage is at least 100 percent but not greater than 120 percent of a weighted average (described in [subparagraph (D)](#c-3-D)).
    - (D) **Weighted average—** For purposes of this paragraph, the weighted average described in this subparagraph is the average actuarial value of the benefits provided by all the [health insurance coverage](/usc/42/300gg–91.md?p=b-1) issued (as elected by the issuer) either by that issuer or by all issuers in the [State](/usc/42/201.md?p=f) in the [individual market](/usc/42/300gg–91.md?p=e-1-A) during the previous year (not including coverage issued under this section), weighted by enrollment for the different coverage.
  - (4) **Election—** The issuer elections under this subsection shall apply uniformly to all eligible individuals in the [State](/usc/42/201.md?p=f) for that issuer. Such an election shall be effective for policies offered during a period of not shorter than 2 years.
  - (5) **Assumptions—** For purposes of [paragraph (3)](#c-3), the actuarial value of benefits provided under [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) shall be calculated based on a standardized population and a set of standardized utilization and cost factors.
- (d) **Special rules for network plans—**
  - (1) **In general—** In the case of a [health insurance issuer](/usc/42/300gg–91.md?p=b-2) that offers [health insurance coverage](/usc/42/300gg–91.md?p=b-1) in the [individual market](/usc/42/300gg–91.md?p=e-1-A) through a [network plan](/usc/42/300gg–91.md?p=d-10), the issuer may—
    - (A) limit the individuals who may be enrolled under such coverage to those who live, reside, or work within the [service](/usc/42/201.md?p=a) area for such [network plan](/usc/42/300gg–91.md?p=d-10); and
    - (B) within the [service](/usc/42/201.md?p=a) area of such plan, deny such coverage to such individuals if the issuer has demonstrated, if required, to the [applicable State authority](/usc/42/300gg–91.md?p=d-1) that—
      - (i) it will not have the capacity to deliver [services](/usc/42/201.md?p=a) adequately to additional individual enrollees because of its obligations to existing group contract holders and enrollees and individual enrollees, and
      - (ii) it is applying this paragraph uniformly to individuals without regard to any [health status-related factor](/usc/42/300gg–91.md?p=d-9) of such individuals and without regard to whether the individuals are eligible individuals.
  - (2) **180-day suspension upon denial of coverage—** An issuer, upon denying [health insurance coverage](/usc/42/300gg–91.md?p=b-1) in any [service](/usc/42/201.md?p=a) area in accordance with [paragraph (1)(B)](#d-1-B), may not offer coverage in the [individual market](/usc/42/300gg–91.md?p=e-1-A) within such [service](/usc/42/201.md?p=a) area for a period of 180 days after such coverage is denied.
- (e) **2 Application of financial capacity limits—**
  - (1) **In general—** A [health insurance issuer](/usc/42/300gg–91.md?p=b-2) may deny [health insurance coverage](/usc/42/300gg–91.md?p=b-1) in the [individual market](/usc/42/300gg–91.md?p=e-1-A) to an eligible individual if the issuer has demonstrated, if required, to the [applicable State authority](/usc/42/300gg–91.md?p=d-1) that—
    - (A) it does not have the financial reserves necessary to underwrite additional coverage; and
    - (B) it is applying this paragraph uniformly to all individuals in the [individual market](/usc/42/300gg–91.md?p=e-1-A) in the [State](/usc/42/201.md?p=f) consistent with applicable [State](/usc/42/201.md?p=f) law and without regard to any [health status-related factor](/usc/42/300gg–91.md?p=d-9) of such individuals and without regard to whether the individuals are eligible individuals.
  - (2) **180-day suspension upon denial of coverage—** An issuer upon denying [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) in any [service](/usc/42/201.md?p=a) area in accordance with [paragraph (1)](#e-1) may not offer such coverage in the [individual market](/usc/42/300gg–91.md?p=e-1-A) within such [service](/usc/42/201.md?p=a) area for a period of 180 days after the date such coverage is denied or until the issuer has demonstrated, if required under applicable [State](/usc/42/201.md?p=f) law, to the [applicable State authority](/usc/42/300gg–91.md?p=d-1) that the issuer has sufficient financial reserves to underwrite additional coverage, whichever is later. A [State](/usc/42/201.md?p=f) may provide for the application of this paragraph on a [service](/usc/42/201.md?p=a)-area-specific basis.
- (e) **2 Market requirements—**
  - (1) **In general—** The provisions of [subsection (a)](#a) shall not be construed to require that a [health insurance issuer](/usc/42/300gg–91.md?p=b-2) offering [health insurance coverage](/usc/42/300gg–91.md?p=b-1) only in connection with [group health plans](/usc/42/300bb–8.md?p=1) or through one or more [bona fide associations](/usc/42/300gg–91.md?p=d-3), or both, offer such [health insurance coverage](/usc/42/300gg–91.md?p=b-1) in the [individual market](/usc/42/300gg–91.md?p=e-1-A).
  - (2) **Conversion policies—** A [health insurance issuer](/usc/42/300gg–91.md?p=b-2) offering [health insurance coverage](/usc/42/300gg–91.md?p=b-1) in connection with [group health plans](/usc/42/300bb–8.md?p=1) under this subchapter shall not be deemed to be a [health insurance issuer](/usc/42/300gg–91.md?p=b-2) offering [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) solely because such issuer offers a conversion policy.
- (f) **Construction—** Nothing in this section shall be construed—
  - (1) to restrict the amount of the premium rates that an issuer may charge an individual for [health insurance coverage](/usc/42/300gg–91.md?p=b-1) provided in the [individual market](/usc/42/300gg–91.md?p=e-1-A) under applicable [State](/usc/42/201.md?p=f) law; or
  - (2) to prevent a [health insurance issuer](/usc/42/300gg–91.md?p=b-2) offering [health insurance coverage](/usc/42/300gg–91.md?p=b-1) in the [individual market](/usc/42/300gg–91.md?p=e-1-A) from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to [programs](/usc/42/274l–1.md?p=4) of health promotion and disease prevention.

## Footnotes

[^1]: See References in Text note below.
[^2]: So in original. Two subsecs. (e) have been enacted.

## Source credit

(July 1, 1944, ch. 373, title XXVII, § 2741, as added Pub. L. 104–191, title I, § 111(a), Aug. 21, 1996, 110 Stat. 1978.)

## Notes

### Editorial Notes

### References in Text

Section 2701 of this Act, referred to in subsecs. (a)(1)(B) and (b)(1)(A), is a reference to section 2701 of act July 1, 1944. Section 2701, which was classified to section 300gg of this title, was renumbered section 2704, effective for plan years beginning on or after Jan. 1, 2014, with certain exceptions, and amended, by Pub. L. 111–148, title I, §§ 1201(2), 1563(c)(1), formerly § 1562(c)(1), title X, § 10107(b)(1), Mar. 23, 2010, 124 Stat. 154, 264, 911, and was transferred to section 300gg–3 of this title. A new section 2701 of act July 1, 1944, related to fair health insurance premiums, was added, effective for plan years beginning on or after Jan. 1, 2014, and amended, by Pub. L. 111–148, title I, § 1201(4), title X, § 10103(a), Mar. 23, 2010, 124 Stat. 155, 892, and is classified to section 300gg of this title.

The Social Security Act, referred to in subsec. (b)(2), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Parts A and B of title XVIII of the Act are classified generally to parts A (§ 1395c et seq.) and B (§ 1395j et seq.) of subchapter XVIII of chapter 7 of this title. Title XIX of the Act is classified generally to subchapter XIX (§ 1396 et seq.) of chapter 7 of this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables.

Section 2712, referred to in subsec. (b)(3), is a reference to section 2712 of act July 1, 1944. Section 2712, which was classified to section 300gg–12 of this title, was renumbered section 2732 and amended and transferred to subsecs. (b) to (e) of section 300gg–2 of this title by Pub. L. 111–148, title I, §§ 1001(3), 1563(c)(9), formerly § 1562(c)(9), title X, § 10107(b)(1), Mar. 23, 2010, 124 Stat. 130, 267, 911. A new section 2712 of act July 1, 1944, related to prohibition on rescissions, was added by Pub. L. 111–148, title I, § 1001(5), Mar. 23, 2010, 124 Stat. 131, effective for plan years beginning on or after the date that is 6 months after Mar. 23, 2010, and is classified to section 300gg–12 of this title.

### Statutory Notes and Related Subsidiaries

### Effective Date

Pub. L. 104–191, title I, § 111(b), Aug. 21, 1996, 110 Stat. 1987, provided that: In general.—Except as provided in this subsection, part B of title XXVII of the Public Health Service Act [42 U.S.C. 300gg–41 et seq.] (as inserted by subsection (a)) shall apply with respect to health insurance coverage offered, sold, issued, renewed, in effect, or operated in the individual market after June 30, 1997, regardless of when a period of creditable coverage occurs. Application of certification rules.—The provisions of section 102(d)(2) [102(c)(2)] of this Act [42 U.S.C. 300gg note] shall apply to section 2743 of the Public Health Service Act [42 U.S.C. 300gg–43] in the same manner as it applies to section 2701(e) [now 2704(e)] of such Act [42 U.S.C. 300gg–3(e)].”