republic-os/legal/us/code/title-42/chapter-6a/section-300gg-11.md

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LegalText	42 U.S.C. § 300gg–11	No lifetime or annual limits	us	united_states_code	code_section	42	THE PUBLIC HEALTH AND WELFARE	6A	PUBLIC HEALTH SERVICE	300gg–11	42 U.S.C. § 300gg–11	current	119-100	2026-06-26	official	https://uscode.house.gov/download/releasepoints/us/pl/119/100/xml_usc42@119-100.zip	/us/usc/t42/s300gg–11	data/legal/raw/us/code/title-42/usc42.xml	afbec250403d143f6b427cbbc2cb4ef81ca10910531b6893269bc4d0cf1efa4b	644321055a08eb1f260a6a3e31ac157fa024756abf612a9fd6857e7e400cf24e	12223362b6e85cb46b8917494bdf0e5f74b27a706f2ea12c7ea6b294b3b04439	2026-07-04	official	legal us-code

42 U.S.C. § 300gg–11 - No lifetime or annual limits

Text

(a) Prohibition (1) In general A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish—

(A) lifetime limits on the dollar value of benefits for any participant or beneficiary; or

(B) except as provided in paragraph (2), annual limits on the dollar value of benefits for any participant or beneficiary.

(2) Annual limits prior to 2014 With respect to plan years beginning prior to January 1, 2014, a group health plan and a health insurance issuer offering group or individual health insurance coverage may only establish a restricted annual limit on the dollar value of benefits for any participant or beneficiary with respect to the scope of benefits that are essential health benefits under section 18022(b) of this title, as determined by the Secretary. In defining the term “restricted annual limit” for purposes of the preceding sentence, the Secretary shall ensure that access to needed services is made available with a minimal impact on premiums.

(b) Per beneficiary limits Subsection (a) shall not be construed to prevent a group health plan or health insurance coverage from placing annual or lifetime per beneficiary limits on specific covered benefits that are not essential health benefits under section 18022(b) of this title, to the extent that such limits are otherwise permitted under Federal or State law.

(July 1, 1944, ch. 373, title XXVII, § 2711, as added and amended Pub. L. 111–148, title I, § 1001(5), title X, § 10101(a), Mar. 23, 2010, 124 Stat. 131, 883.)

Notes

Editorial Notes

Prior ProvisionsA prior section 300gg–11, act July 1, 1944, ch. 373, title XXVII, § 2711, as added Pub. L. 104–191, title I, § 102(a), Aug. 21, 1996, 110 Stat. 1962, which related to guaranteed availability of coverage for employers in a group market, was renumbered section 2731 of act July 1, 1944, amended, and transferred to subsecs. (c) and (d) of section 300gg–1 of this title, by Pub. L. 111–148, title I, §§ 1001(3), 1563(c)(8), formerly § 1562(c)(8), title X, § 10107(b)(1), Mar. 23, 2010, 124 Stat. 130, 266, 911. Another prior section 2711 of act July 1, 1944, was successively renumbered by subsequent acts and transferred, see section 238j of this title.

Amendments2010—Pub. L. 111–148, § 10101(a), amended section generally. Prior to amendment, text read as follows: “(a) In General.—A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish— “(1) lifetime limits on the dollar value of benefits for any participant or beneficiary; or “(2) unreasonable annual limits (within the meaning of section 223 of title 26) on the dollar value of benefits for any participant or beneficiary. “(b) Per Beneficiary Limits.—Subsection (a) shall not be construed to prevent a group health plan or health insurance coverage that is not required to provide essential health benefits under section 18022(b) of this title from placing annual or lifetime per beneficiary limits on specific covered benefits to the extent that such limits are otherwise permitted under Federal or State law.”

Statutory Notes and Related Subsidiaries

Effective DatePub. L. 111–148, title I, § 1004, Mar. 23, 2010, 124 Stat. 140, provided that: “(a) In General.—Except as provided for in subsection (b), this subtitle [subtitle A (§§ 1001–1004) of title I of Pub. L. 111–148, enacting this section and sections 300gg–12 to 300gg–15, 300gg–16 to 300gg–19, 300gg–93, and 300gg–94 of this title, amending former sections 300gg–11 and 300gg–12 of this title and sections 300gg–21 to 300gg–23 of this title, and transferring section 300gg–13 of this title to section 300gg–9 of this title and sections 300gg–4 to 300gg–7 of this title to sections 300gg–25 to 300gg–28 of this title, respectively] (and the amendments made by this subtitle) shall become effective for plan years beginning on or after the date that is 6 months after the date of enactment of this Act [Mar. 23, 2010], except that the amendments made by sections 1002 and 1003 [enacting sections 300gg–93 and 300gg–94 of this title] shall become effective for fiscal years beginning with fiscal year 2010. “(b) Special Rule.—The amendments made by sections 1002 and 1003 [enacting sections 300gg–93 and 300gg–94 of this title] shall take effect on the date of enactment of this Act [Mar. 23, 2010].”