45 C.F.R. § 156.125
Prohibition on discrimination
(a) An issuer does not provide EHB if its benefit design, or the implementation of its benefit design, discriminates based on an individual's age, expected length of life, present or predicted disability, degree of medical dependency, quality of life, or other health conditions. Beginning on the earlier of January 1, 2023 (the start of the 2023 plan year) or upon renewal of any plan subject to this rule, a non-discriminatory benefit design that provides EHB is one that is clinically-based.
(b) An issuer providing EHB must comply with the requirements of § 156.200(e) of this subchapter; and
(c) Nothing in this section shall be construed to prevent an issuer from appropriately utilizing reasonable medical management techniques.
Notes of Decisions
Cited in 2
cases, 2015–2020 · leading case: Andrea Schmitt v. Kaiser Found. Health Plan, 965 F.3d 945 (9th Cir. 2020).
Andrea Schmitt v. Kaiser Found. Health Plan, 965 F.3d 945 (9th Cir. 2020). “HEALTH PLAN 17 45 C.F.R. § 156.125 (a). Another regulation prohibits health insurers from “[having] or implement[ing] .”
Ctr. for the Study of Servs., Also Dba Consumers' Checkbook v. United States Dep't of Health & Human Servs., 130 F. Supp. 3d 1 (D.D.C. 2015). “§ 300gg-6(b); not discriminate in benefit design, 45 C.F.R. § 156.125 ; and “[n]ot employ .”
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