idm140457765331632

Employee Benefits Security Administration

29 CFR Chapter XXV

For the reasons stated in the preamble, the Department of Labor proposes to amend 29 CFR part 2590 as set forth below:

PART 2590—RULES AND REGULATIONS FOR GROUP HEALTH PLANS

6. The authority citation for part 2590 continues to read as follows:

Authority: 29 U.S.C. 1027, 1059, 1135, 1161-1168, 1169, 1181-1183, 1181 note, 1185, 1185a, 1185b, 1191, 1191a, 1191b, and 1191c; sec. 101(g), Pub. L. 104-191, 110 Stat. 1936; sec. 401(b), Pub. L. 105-200, 112 Stat. 645 (42 U.S.C. 651 note); sec. 512(d), Pub. L. 110-343, 122 Stat. 3881; sec. 1001, 1201, and 1562(e), Pub. L. 111-148, 124 Stat. 119, as amended by Pub. L. 111-152, 124 Stat. 1029; Division M, Pub. L. 113-235, 128 Stat. 2130; Secretary of Labor’s Order 1-2011, 77 FR 1088 (Jan. 9, 2012).

7. Section 2590.701-2 is amended by revising the definition of “short-term, limited-duration insurance” to read as follows:

§ 2590.701-2 Definitions.

* * * * *

Short-term, limited-duration insurance means health insurance coverage provided pursuant to a policy, certificate, or contract of insurance with an issuer that:

(1) Has an expiration date specified in the policy, certificate, or contract of insurance that is no more than 3 months after the original effective date of the policy, certificate, or contract of insurance, and taking into account any renewals or extensions, has a duration no longer than 4 months in total. For purposes of this paragraph (1), a renewal or extension includes the term of a new short-term, limited-duration insurance policy, certificate, or contract of insurance issued by the same issuer to the same policyholder within the 12-month period beginning on the original effective date of the initial policy, certificate, or contract of insurance; and

(2) Displays prominently on the first page (in either paper or electronic form, including on a website) of the policy, certificate, or contract of insurance, and in any marketing, application, and enrollment materials (including reenrollment materials) provided to individuals at or before the time an individual has the opportunity to enroll (or reenroll) in the coverage, in at least 14-point font, the language in the following notice:

“Notice to Consumers About Short-Term, Limited-Duration Insurance

IMPORTANT: This is short-term, limited-duration insurance. This is temporary insurance. It isn’t comprehensive health insurance. Review your policy carefully to make sure you understand what is covered and any limitations on coverage.

Visit HealthCare.gov online or call 1-800-318-2596 (TTY: 1-855-889-4325) to review your options for comprehensive health insurance. If you’re eligible for coverage through your employer or a family member’s employer, contact the employer for more information. Contact your State department of insurance if you have questions or complaints about this policy.”

(3) If any provision of this definition of “short-term, limited-duration insurance” is held to be invalid or unenforceable by its terms, or as applied to any entity or circumstance, or stayed pending further agency action, the provision shall be construed so as to continue to give the maximum effect to the provision permitted by law, along with other provisions not found invalid or unenforceable, including as applied to entities not similarly situated or to dissimilar circumstances, unless such holding is that the provision is invalid and unenforceable in all circumstances, in which event the provision shall be severable from the remainder of the definition and shall not affect the remainder thereof.

* * * * *

8. Section 2590.732 is amended by:

a. Revising paragraph (c)(4)(i);

b. Adding paragraph (c)(4)(ii)(D);

c. Revising paragraph (c)(4)(iii); and

d. Adding paragraphs (c)(4)(iv) and (c)(4)(v).

The revisions and additions read as follows:

§ 2590.732 Special rules relating to group health plans.

* * * * *

(c) * * *

(4) * * *

(i) Excepted benefits that are not coordinated. Coverage for only a specified disease or illness (for example, cancer-only policies) or hospital indemnity or other fixed indemnity insurance is excepted only if it meets each of the applicable conditions specified in paragraph (c)(4)(ii) of this section.

(ii) * * *

(D) With respect to hospital indemnity or other fixed indemnity insurance –

(1) The benefits are paid in a fixed dollar amount per day (or per other time period) of hospitalization or illness (for example, $100/day) regardless of the actual or estimated amount of expenses incurred, services or items received, severity of illness or injury experienced by a covered participant or beneficiary, or other characteristics particular to a course of treatment received by a covered participant or beneficiary, and not on any other basis (such as on a per-item or per-service basis).

(2) The plan or issuer displays prominently on the first page (in either paper or electronic form, including on a website) of any marketing, application, and enrollment materials that are provided to participants at or before the time participants are given the opportunity to enroll in the coverage, in at least 14-point font, the language in the following notice:

“Notice to Consumers About Fixed Indemnity Insurance

IMPORTANT: This is fixed indemnity insurance. This isn’t comprehensive health insurance coverage and doesn’t have to include most Federal consumer protections for health insurance.

Visit HealthCare.gov online or call 1-800-318-2596 (TTY: 1-855-889-4325) to review your options for comprehensive health insurance. If you’re eligible for coverage through your employer or a family member’s employer, contact the employer for more information. Contact your State department of insurance if you have questions or complaints about this policy.”

(3) If participants are required to reenroll (in either paper or electronic form) for purposes of renewal or reissuance of the insurance, the notice described in paragraph (c)(4)(ii)(D)(2) of this section is displayed in any marketing and reenrollment materials provided at or before the time participants are given the opportunity to reenroll in coverage.

(4) If a plan or issuer provides a notice satisfying the requirements in paragraph (c)(4)(ii)(D)(2) and (3) of this section to a participant, the obligation to provide the notice is considered to be satisfied for both the plan and issuer.

(iii) Examples. The rules of this paragraph (c)(4) are illustrated by the following examples:

(A) Example 1—

(1) Facts. An employer sponsors a group health plan that provides coverage through an insurance policy. The policy provides benefits only related to hospital stays at a fixed percentage of hospital expenses up to a maximum of $100 a day.

(2) Conclusion. Even if the other conditions in paragraph (c)(4)(ii) of this section are satisfied, because benefits are paid based on a percentage of expenses incurred rather than a fixed dollar amount per day (or per other time period, such as per week), the policy does not qualify as an excepted benefit under this paragraph (c)(4). This is the result even if, in practice, the policy pays the maximum of $100 for every day of hospitalization.

(B) Example 2—

(1) Facts. An employer sponsors a group health plan that provides coverage through an insurance policy. The policy provides benefits when a person receives certain specific items and services in a fixed amount, such as $50 per blood test or $100 per visit. The fixed amounts apply to each specific item or service and are not paid per day or per other time period of hospitalization or illness.

(2) Conclusion. Even if the other conditions in paragraph (c)(4)(ii) of this section are satisfied, the policy does not qualify as an excepted benefit under this paragraph (c)(4) because the benefits are not paid in a fixed dollar amount per day (or per other time period) of hospitalization or illness, and are not paid without regard to the services or items received. The conclusion would be the same even if the policy added a per day (or per other time period) term to the benefit description (for example, “$50 per blood test per day”), because the benefits are not paid regardless of the services or items received.

(C) Example 3—

(1) Facts. An employer sponsors a group health plan that provides two benefit packages. The first benefit package includes benefits only for preventive services and excludes benefits for all other services. The second benefit package provides coverage through an insurance policy that pays a fixed dollar amount per day of hospitalization for a wide variety of illnesses that are not preventive services covered under the first benefit package. The two benefit packages are offered to employees at the same time and can be elected together. The benefit packages are not subject to a formal coordination of benefits arrangement.

(2) Conclusion. Even if the other conditions in paragraph (c)(4)(ii) of this section are satisfied, the second benefit package’s insurance policy does not qualify as an excepted benefit under this paragraph (c)(4) because the benefits under the second benefit package are coordinated with an exclusion of benefits under another group health plan maintained by the same plan sponsor (that is, the preventive-services-only benefit package). The conclusion would be the same even if the benefit packages were not offered to employees at the same time or if the second benefit package’s insurance policy did not pay benefits associated with a wide variety of illnesses.

(iv) Applicability dates.

(A) For hospital indemnity or other fixed indemnity insurance sold or issued on or after [THE DATE THAT IS 75 DAYS AFTER THE DATE OF PUBLICATION OF THESE REGULATIONS AS FINAL], the requirements of this paragraph (c)(4) apply for plans beginning on or after [THE DATE THAT IS 75 DAYS AFTER THE DATE OF PUBLICATION OF THESE REGULATIONS AS FINAL].

(B) For hospital indemnity or other fixed indemnity insurance sold or issued before [THE DATE THAT IS 75 DAYS AFTER THE DATE OF PUBLICATION OF THESE REGULATIONS AS FINAL], the requirements of this paragraph (c)(4) apply for plan years beginning on or after January 1, 2027, except that the requirements of paragraphs (c)(4)(ii)(D)(2)-(4) and (c)(4)(iii)(A) of this section, apply for plan years beginning on or after [THE DATE THAT IS 75 DAYS AFTER THE DATE OF PUBLICATION OF THESE REGULATIONS AS FINAL].

(C) Until the relevant applicability date for the requirements of this paragraph (c)(4), plans and issuers are required to continue to comply with the corresponding section of § 2590.732(c)(4) contained in the 29 CFR, parts 1927 to end, edition revised as of July 1, 2022.

(v) Severability. If any provision of this paragraph (c)(4) is held to be invalid or unenforceable by its terms, or as applied to any entity or circumstance, or stayed pending further agency action, the provision shall be construed so as to continue to give the maximum effect to the provision permitted by law, along with other provisions not found invalid or unenforceable, including as applied to entities not similarly situated or to dissimilar circumstances, unless such holding is that the provision is invalid and unenforceable in all circumstances, in which event the provision shall be severable from the remainder of this paragraph (c)(4) and shall not affect the remainder thereof.

* * * * *

9. Section 2590.736 is revised to read as follows:

§ 2590.736 Applicability dates.

Sections 2590.701–1 through 2590.701–8 and 2590.731 through 2590.736 are applicable for plan years beginning on or after July 1, 2005. Until the applicability date for this regulation, plans and issuers are required to continue to comply with the corresponding sections of 29 CFR part 2590, contained in the 29 CFR, parts 1927 to end, edition revised as of July 1, 2022. Notwithstanding the previous sentence, for short-term, limited-duration insurance sold or issued on or after [THE DATE THAT IS 75 DAYS AFTER THE DATE OF PUBLICATION OF THESE REGULATIONS AS FINAL], the definition of “short-term, limited-duration insurance” in § 2590.701–2 applies for coverage periods beginning on or after [THE DATE THAT IS 75 DAYS AFTER THE DATE OF PUBLICATION OF THESE REGULATIONS AS FINAL]. For short-term, limited-duration insurance sold or issued before [THE DATE THAT IS 75 DAYS AFTER THE DATE OF PUBLICATION OF THESE REGULATIONS AS FINAL] (including any subsequent renewal or extension consistent with applicable law), the definition of “short-term, limited-duration insurance” in the corresponding section of § 2590.701–2 of this subchapter contained in the 29 CFR, parts 1927 to end, edition revised as of July 1, 2022, continues to apply, except that paragraph (2) of the definition of short-term, limited-duration insurance in § 2590.701–2 of this subchapter applies for coverage periods beginning on or after [THE DATE THAT IS 75 DAYS AFTER THE DATE OF PUBLICATION OF THESE REGULATIONS AS FINAL].

DEPARTMENT OF HEALTH AND HUMAN SERVICES

For the reasons stated in the preamble, the Department of Health and Human Services proposes to amend 45 CFR parts 144, 146, and 148 as set forth below:

PART 144—REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE

10. The authority citation for part 144 continues to read as follows:

Authority: Secs. 2701 through 2763, 2791, and 2792 of the Public Health Service Act, 42 U.S.C. 300gg through 300gg–63, 300gg–91, and 300gg–92.

11. Section 144.103 is amended by revising the definition of “short-term, limited-duration insurance” to read as follows:

§ 144.103 Definitions.

* * * * *

Short-term, limited-duration insurance means health insurance coverage provided pursuant to a policy, certificate, or contract of insurance with an issuer that:

(1) Has an expiration date specified in the policy, certificate, or contract of insurance that is no more than 3 months after the original effective date of the policy, certificate, or contract of insurance, and taking into account any renewals or extensions, has a duration no longer than 4 months in total. For purposes of this paragraph (1), a renewal or extension includes the term of a new short-term, limited-duration insurance policy, certificate, or contract of insurance issued by the same issuer to the same policyholder within the 12-month period beginning on the original effective date of the initial policy, certificate, or contract of insurance; and

(2) Displays prominently on the first page (in either paper or electronic form, including on a website) of the policy, certificate, or contract of insurance, and in any marketing, application, and enrollment materials (including reenrollment materials) provided to individuals at or before the time an individual has the opportunity to enroll (or reenroll) in the coverage, in at least 14-point font, the language in the following notice:

“Notice to Consumers About Short-Term, Limited-Duration Insurance

IMPORTANT: This is short-term, limited-duration insurance. This is temporary insurance. It isn’t comprehensive health insurance. Review your policy carefully to make sure you understand what is covered and any limitations on coverage.

Visit HealthCare.gov online or call 1-800-318-2596 (TTY: 1-855-889-4325) to review your options for comprehensive health insurance. If you’re eligible for coverage through your employer or a family member’s employer, contact the employer for more information. Contact your State department of insurance if you have questions or complaints about this policy.”

(3) If any provision of this definition of “short-term, limited-duration insurance” is held to be invalid or unenforceable by its terms, or as applied to any entity or circumstance, or stayed pending further agency action, the provision shall be construed so as to continue to give the maximum effect to the provision permitted by law, along with other provisions not found invalid or unenforceable, including as applied to entities not similarly situated or to dissimilar circumstances, unless such holding is that the provision is invalid and unenforceable in all circumstances, in which event the provision shall be severable from the remainder of the definition and shall not affect the remainder thereof.

* * * * *

PART 146—REQUIREMENTS FOR THE GROUP HEALTH INSURANCE MARKET

12. The authority citation for part 146 continues to read as follows:

Authority: Secs. 2702 through 2705, 2711 through 2723, 2791, and 2792 of the Public Health Service Act (42 U.S.C. 300gg–1 through 300gg–5, 300gg–11 through 300gg– 23, 300gg–91, and 300gg–92).

13. Section 146.125 is revised to read as follows:

§ 146.125 Applicability dates.

Section 144.103, §§ 146.111 through 146.119, 146.143, and 146.145 are applicable for plan years beginning on or after July 1, 2005 (But see § 146.145(b)(4)(iv) for the applicability dates for hospital indemnity or other fixed indemnity insurance offered in the group market). Notwithstanding the previous sentence, for short-term, limited-duration insurance sold or issued on or after [THE DATE THAT IS 75 DAYS AFTER THE DATE OF PUBLICATION OF THESE REGULATIONS AS FINAL], the definition of “short-term, limited-duration insurance” in § 144.103 of this subchapter applies for coverage periods beginning on or after [THE DATE THAT IS 75 DAYS AFTER THE DATE OF PUBLICATION OF THESE REGULATIONS AS FINAL]. For short-term, limited-duration insurance sold or issued before [THE DATE THAT IS 75 DAYS AFTER THE DATE OF PUBLICATION OF THESE REGULATIONS AS FINAL] (including any subsequent renewal or extension consistent with applicable law), the definition of “short-term, limited-duration insurance” in the corresponding section of § 144.103 of this subchapter contained in the 45 CFR, parts 1 to 199, edition revised as of October 1, 2021, continues to apply, except that paragraph (2) of the definition of short-term, limited-duration insurance in § 144.103 of this subchapter applies for coverage periods beginning on or after [THE DATE THAT IS 75 DAYS AFTER THE DATE OF PUBLICATION OF THESE REGULATIONS AS FINAL].

14. Section 146.145 is amended by—

a. Revising paragraph (b)(4)(i);

b. Adding paragraph (b)(4)(ii)(D);

c. Revising paragraph (b)(4)(iii); and

d. Adding paragraphs (b)(4)(iv) and (b)(4)(v).

The revisions and additions read as follows:

§ 146.145 Special rules relating to group health plans.

* * * * *

(b) * * *

(4) * * *

(i) Excepted benefits that are not coordinated. Coverage for only a specified disease or illness (for example, cancer-only policies) or hospital indemnity or other fixed indemnity insurance is excepted only if it meets each of the applicable conditions specified in paragraph (b)(4)(ii) of this section.

(ii) * * *

(D) With respect to hospital indemnity or other fixed indemnity insurance –

(1) The benefits are paid in a fixed dollar amount per day (or per other time period) of hospitalization or illness (for example, $100/day) regardless of the actual or estimated amount of expenses incurred, services or items received, severity of illness or injury experienced by a covered participant or beneficiary, or other characteristics particular to a course of treatment received by a covered participant or beneficiary, and not on any other basis (such as on a per-item or per-service basis).

(2) The plan or issuer displays prominently on the first page (in either paper or electronic form, including on a website) of any marketing, application, and enrollment materials that are provided to participants at or before the time participants are given the opportunity to enroll in the coverage, in at least 14-point font, the language in the following notice:

“Notice to Consumers About Fixed Indemnity Insurance

IMPORTANT: This is fixed indemnity insurance. This isn’t comprehensive health insurance coverage and doesn’t have to include most Federal consumer protections for health insurance.

Visit HealthCare.gov online or call 1-800-318-2596 (TTY: 1-855-889-4325) to review your options for comprehensive health insurance. If you’re eligible for coverage through your employer or a family member’s employer, contact the employer for more information. Contact your State department of insurance if you have questions or complaints about this policy.”

(3) If participants are required to reenroll (in either paper or electronic form) for purposes of renewal or reissuance of the insurance, the notice described in paragraph (b)(4)(ii)(D)(2) of this section is displayed in any marketing and reenrollment materials provided at or before the time participants are given the opportunity to reenroll in coverage.

(4) If a plan or issuer provides a notice satisfying the requirements in paragraph (b)(4)(ii)(D)(2) and (3) of this section to a participant, the obligation to provide the notice is considered to be satisfied for both the plan and issuer.

(iii) Examples. The rules of this paragraph (b)(4) are illustrated by the following examples:

(A) Example 1—

(1) Facts. An employer sponsors a group health plan that provides coverage through an insurance policy. The policy provides benefits only related to hospital stays at a fixed percentage of hospital expenses up to a maximum of $100 a day.

(2) Conclusion. Even if the other conditions in paragraph (b)(4)(ii) of this section are satisfied, because benefits are paid based on a percentage of expenses incurred rather than a fixed dollar amount per day (or per other time period, such as per week), the policy does not qualify as an excepted benefit under this paragraph (b)(4). This is the result even if, in practice, the policy pays the maximum of $100 for every day of hospitalization.

(B) Example 2—

(1) Facts. An employer sponsors a group health plan that provides coverage through an insurance policy. The policy provides benefits when a person receives certain specific items and services in a fixed amount, such as $50 per blood test or $100 per visit. The fixed amounts apply to each specific item or service and are not paid per day or per other time period of hospitalization or illness.

(2) Conclusion. Even if the other conditions in paragraph (b)(4)(ii) of this section are satisfied, the policy does not qualify as an excepted benefit under this paragraph (b)(4) because the benefits are not paid in a fixed dollar amount per day (or per other time period) of hospitalization or illness, and are not paid without regard to the services or items received. The conclusion would be the same even if the policy added a per day (or per other time period) term to the benefit description (for example, “$50 per blood test per day”), because the benefits are not paid regardless of the services or items received.

(C) Example 3—

(1) Facts. An employer sponsors a group health plan that provides two benefit packages. The first benefit package includes benefits only for preventive services and excludes benefits for all other services. The second benefit package provides coverage through an insurance policy that pays a fixed dollar amount per day of hospitalization for a wide variety of illnesses that are not preventive services covered under the first benefit package. The two benefit packages are offered to employees at the same time and can be elected together. The benefit packages are not subject to a formal coordination of benefits arrangement.

(2) Conclusion. Even if the other conditions in paragraph (b)(4)(ii) of this section are satisfied, the second benefit package’s insurance policy does not qualify as an excepted benefit under this paragraph (b)(4) because the benefits under the second benefit package are coordinated with an exclusion of benefits under another group health plan maintained by the same plan sponsor (that is, the preventive-services-only benefit package). The conclusion would be the same even if the benefit packages were not offered to employees at the same time or if the second benefit package’s insurance policy did not pay benefits associated with a wide variety of illnesses.

(iv) Applicability dates.

(A) For hospital indemnity or other fixed indemnity insurance sold or issued on or after [THE DATE THAT IS 75 DAYS AFTER THE DATE OF PUBLICATION OF THESE REGULATIONS AS FINAL], the requirements of this paragraph (b)(4) apply for plan years beginning on or after [THE DATE THAT IS 75 DAYS AFTER THE DATE OF PUBLICATION OF THESE REGULATIONS AS FINAL].

(B) For hospital indemnity or other fixed indemnity insurance sold or issued before [THE DATE THAT IS 75 DAYS AFTER THE DATE OF PUBLICATION OF THESE REGULATIONS AS FINAL], the requirements of this paragraph (b)(4) apply for plan years beginning on or after January 1, 2027, except that the requirements of paragraphs (b)(4)(ii)(D)(2)-(4) of this section apply for plan years beginning on or after [THE DATE THAT IS 75 DAYS AFTER THE DATE OF PUBLICATION OF THESE REGULATIONS AS FINAL].

(C) Until the relevant applicability date for the requirements of this paragraph (b)(4), plans and issuers are required to continue to comply with the corresponding section of § 146.145(b)(4) contained in the 45 CFR, parts 1 to 199, edition revised as of October 1, 2021.

(v) Severability. If any provision of this paragraph (b)(4) is held to be invalid or unenforceable by its terms, or as applied to any entity or circumstance, or stayed pending further agency action, the provision shall be construed so as to continue to give the maximum effect to the provision permitted by law, along with other provisions not found invalid or unenforceable, including as applied to entities not similarly situated or to dissimilar circumstances, unless such holding is that the provision is invalid and unenforceable in all circumstances, in which event the provision shall be severable from the remainder of this paragraph (b)(4) and shall not affect the remainder thereof.

* * * * *

PART 148—REQUIREMENTS FOR THE INDIVIDUAL HEALTH INSURANCE MARKET

15. The authority citation for part 148 continues to read as follows:

Authority: Secs. 2701 through 2763, 2791, and 2792 of the Public Health Service Act (42 U.S.C. 300gg through 300gg–63, 300gg–91, and 300gg–92), as amended.

16. Section 148.102 is amended by revising paragraph (b) to read as follows:

§ 148.102 Scope and applicability dates.

* * * * *

(b) Applicability dates. Except as provided in § 148.124 (certificate of creditable coverage), § 148.170 (standards relating to benefits for mothers and newborns), and § 148.180 (prohibition of health discrimination based on genetic information), the requirements of this part apply to health insurance coverage offered, sold, issued, renewed, in effect, or operated in the individual market after June 30, 1997. Notwithstanding the previous sentence, for short-term, limited-duration insurance sold or issued on or after [THE DATE THAT IS 75 DAYS AFTER THE DATE OF PUBLICATION OF THESE REGULATIONS AS FINAL], the definition of “short-term, limited-duration insurance” in § 144.103 of this subchapter applies for coverage periods beginning on or after [THE DATE THAT IS 75 DAYS AFTER THE DATE OF PUBLICATION OF THESE REGULATIONS AS FINAL]. For short-term, limited-duration insurance sold or issued before [THE DATE THAT IS 75 DAYS AFTER THE DATE OF PUBLICATION OF THESE REGULATIONS AS FINAL] (including any subsequent renewal or extension consistent with applicable law), the definition of “short-term, limited-duration insurance” in the corresponding section of § 144.103 of this subchapter contained in the 45 CFR, parts 1 to 199, edition revised as of October 1, 2021, continues to apply, except that paragraph (2) of the definition of “short-term, limited-duration insurance” in § 144.103 of this subchapter applies for coverage periods beginning on or after [THE DATE THAT IS 75 DAYS AFTER THE DATE OF PUBLICATION OF THESE REGULATIONS AS FINAL].

17. Section 148.220 is amended by revising paragraph (b)(4) to read as follows:

§ 148.220 Excepted benefits.

* * * * *

(b) * * *

(4) Hospital indemnity or other fixed indemnity insurance only if -

(i) There is no coordination between the provision of benefits and an exclusion of benefits under any other health coverage maintained by the same issuer with respect to the same policyholder.

(ii) The benefits are paid in a fixed dollar amount per day (or per other time period) of hospitalization or illness (for example, $100/day) regardless of the actual or estimated amount of expenses incurred, services or items received, severity of illness or injury experienced by a covered individual, or any other characteristics particular to a course of treatment received by the covered individual and not on any other basis (such as on a per-item or per-service basis), and without regard to whether benefits are provided with respect to the event under any other health insurance coverage maintained by the same health insurance issuer with respect to the same policyholder.

(iii) The issuer displays prominently on the first page of any marketing, application, and enrollment or reenrollment materials that are provided at or before the time an individual has the opportunity to apply, enroll or reenroll in coverage, and on the first page of the policy, certificate, or contract of insurance, in at least 14-point font, the language in the following notice:

“Notice to Consumers About Fixed Indemnity Insurance

IMPORTANT: This is fixed indemnity insurance. This isn’t comprehensive health insurance coverage and doesn’t have to include most Federal consumer protections for health insurance.

Visit HealthCare.gov online or call 1-800-318-2596 (TTY: 1-855-889-4325) to review your options for comprehensive health insurance. If you’re eligible for coverage through your employer or a family member’s employer, contact the employer for more information. Contact your State department of insurance if you have questions or complaints about this policy.”

(iv)(A) For hospital indemnity or other fixed indemnity insurance sold or issued on or after [THE DATE THAT IS 75 DAYS AFTER THE DATE OF PUBLICATION OF THESE REGULATIONS AS FINAL], the requirements of this paragraph (b)(4) apply for coverage periods beginning on or after [THE DATE THAT IS 75 DAYS AFTER THE DATE OF PUBLICATION OF THESE REGULATIONS AS FINAL].

(B) For hospital indemnity or other fixed indemnity insurance sold or issued before [THE DATE THAT IS 75 DAYS AFTER THE DATE OF PUBLICATION OF THESE REGULATIONS AS FINAL], the requirements of this paragraph (b)(4) apply for coverage periods beginning on or after January 1, 2027, except that the requirements of paragraph (b)(4)(iii) of this section apply for coverage periods beginning on or after [THE DATE THAT IS 75 DAYS AFTER THE DATE OF PUBLICATION OF THESE REGULATIONS AS FINAL].

(C) Until the relevant applicability date for the requirements of this paragraph (b)(4), issuers are required to continue to comply with the corresponding section of § 148.220(b)(4) contained in the 45 CFR, parts 1 to 199, edition revised as of October 1, 2021.

(v) Severability. If any provision of this paragraph (b)(4) is held to be invalid or unenforceable by its terms, or as applied to any entity or circumstance, or stayed pending further agency action, the provision shall be construed so as to continue to give the maximum effect to the provision permitted by law, along with other provisions not found invalid or unenforceable, including as applied to entities not similarly situated or to dissimilar circumstances, unless such holding is that the provision is invalid and unenforceable in all circumstances, in which event the provision shall be severable from the remainder of this paragraph (b)(4) and shall not affect the remainder thereof.

* * * * *