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ELIGIBILITY RULES

Eligible employees or their dependents may not be denied coverage under a group health plan or insurance policy due to:

health status

medical condition (including both physical and mental illness)

claims experience

receipt of health care

medical history

genetic information

evidence of insurability (including conditions arising from acts of domestic violence)

disability

An eligible employee or dependent may not be charged higher premiums or plan contributions based on his or her health condition.

These rules do not:

prohibit premium or plan contribution discounts for wellness or health promotion incentives. Note: for this purpose, the wellness incentive is based on participation in a program and not on specific outcomes such as weight loss or cholesterol level.

require a group plan to provide particular benefits.

prevent a group plan from limiting or restricting benefits for like individuals.

restrict what an insurer can charge a group plan for premium.

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