[Code of Federal Regulations]
[Title 45, Volume 1]
[Revised as of October 1, 2003]
From the U.S. Government Printing Office via GPO Access
[CITE: 45CFR144.102]

[Page 574-575]
 
                        TITLE 45--PUBLIC WELFARE
 
                           AND HUMAN SERVICES
 
PART 144--REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE
--Table of Contents
 
                      Subpart A--General Provisions
 
Sec. 144.102   Scope and applicability.

    (a) For purposes of 45 CFR parts 144 through 148, all health 
insurance coverage is generally divided into two markets--the group 
market (set forth in 45 CFR part 146) and the individual market (set 
forth in 45 CFR part 148). 45 CFR part 146 limits the group market to 
insurance sold to employment-related group health plans and further 
divides the group market into the large group market and the small group 
market. Federal law further defines the small group market as insurance 
sold to employer plans with 2 to 50 employees. State law, however, may 
expand the definition of the small group market to include certain 
coverage that would otherwise, under the Federal law, be considered 
coverage in the large group market or the individual market.
    (b) The protections afforded under 45 CFR parts 144 through 148 to 
individuals and employers (and other sponsors of health insurance 
offered in connection with a group health plan) are determined by 
whether the coverage involved is obtained in the small group market, the 
large group market, or the

[[Page 575]]

individual market. Small employers, and individuals who are eligible to 
enroll under the employer's plan, are guaranteed availability of 
insurance coverage sold in the small group market. Small and large 
employers are guaranteed the right to renew their group coverage, 
subject to certain exceptions. Eligible individuals are guaranteed 
availability of coverage sold in the individual market, and all coverage 
in the individual market must be guaranteed renewable. All coverage 
issued in the small or large group market, and in the individual market, 
must provide certain protections for mothers and newborns with respect 
to coverage for hospital stays in connection with childbirth.
    (c) Coverage that is provided to associations, but is not related to 
employment, is not considered group coverage under 45 CFR parts 144 
through 148. The coverage is considered coverage in the individual 
market, regardless of whether it is considered group coverage under 
State law.
    (d) Provisions relating to CMS enforcement of one or more provisions 
of part 146 or the requirements of part 148, or both, are contained in 
part 150 of this subchapter.

[62 FR 16955, Apr. 8, 1997, as amended at 63 FR 57558, Oct. 27, 1998; 64 
FR 45795, Aug. 20, 1999]