42 U.S.C. § 18024 — Related definitions

1. (a)Definitions relating to marketsIn this title: 1 See References in Text note below.
   1. (1)Group marketThe term “group market” means the health insurance market under which individuals obtain health insurance coverage (directly or through any arrangement) on behalf of themselves (and their dependents) through a group health plan maintained by an employer.
   2. (2)Individual marketThe term “individual market” means the market for health insurance coverage offered to individuals other than in connection with a group health plan.
   3. (3)Large and small group marketsThe terms “large group market” and “small group market” mean the health insurance market under which individuals obtain health insurance coverage (directly or through any arrangement) on behalf of themselves (and their dependents) through a group health plan maintained by a large employer (as defined in subsection (b)(1)) or by a small employer (as defined in subsection (b)(2)), respectively.
2. (b)EmployersIn this title: 1
   1. (1)Large employerThe term “large employer” means, in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least 51 employees on business days during the preceding calendar year and who employs at least 1 employee on the first day of the plan year.
   2. (2)Small employerThe term “small employer” means, in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least 1 but not more than 50 employees on business days during the preceding calendar year and who employs at least 1 employee on the first day of the plan year.
   3. (3)State option to extend definition of small employerNotwithstanding paragraphs (1) and (2), nothing in this section shall prevent a State from applying this subsection by treating as a small employer, with respect to a calendar year and a plan year, an employer who employed an average of at least 1 but not more than 100 employees on business days during the preceding calendar year and who employs at least 1 employee on the first day of the plan year.
   4. (4)Rules for determining employer sizeFor purposes of this subsection—
      1. (A)Application of aggregation rule for employersAll persons treated as a single employer under subsection (b), (c), (m), or (o) of section 414 of title 26 shall be treated as 1 employer.
      2. (B)Employers not in existence in preceding yearIn the case of an employer which was not in existence throughout the preceding calendar year, the determination of whether such employer is a small or large employer shall be based on the average number of employees that it is reasonably expected such employer will employ on business days in the current calendar year.
      3. (C)PredecessorsAny reference in this subsection to an employer shall include a reference to any predecessor of such employer.
      4. (D)Continuation of participation for growing small employersIf—the employer shall continue to be treated as a small employer for purposes of this subchapter for the period beginning with the increase and ending with the first day on which the employer does not make such enrollment available to its employees.
         1. (i)a qualified employer that is a small employer makes enrollment in qualified health plans offered in the small group market available to its employees through an Exchange; and
         2. (ii)the employer ceases to be a small employer by reason of an increase in the number of employees of such employer;
3. (c)SecretaryIn this title,1 the term “Secretary” means the Secretary of Health and Human Services.
4. (d)StateIn this title,1 the term “State” means each of the 50 States and the District of Columbia.
5. (e)Educated health care consumersThe term “educated health care consumer” means an individual who is knowledgeable about the health care system, and has background or experience in making informed decisions regarding health, medical, and scientific matters.