ABNORMAL structures of body causes by congenital defects, developmental abnormalities, trauma, infection, tumors or disease ; Term treatment including reconstructive surgical procedures performed on
Index of Sec 163. ...ABNORMAL structures of body causes by congenital defects, developmental abnormalities, trauma, infection, tumors or disease ; Treatment including reconstructive surgical procedures performed on
Index of Sec 163. ...ABORTION ; Sec 156, application of State and federal laws regarding
Index of Sec 156. ...ABORTION ; No preemption of State laws regarding
Index of Sec 156. ...ABORTION ; No Effect on federal laws regarding
Index of Sec 156. ...ABORTION ; Willingness or refusal to provide
Index of Sec 156. ...ABORTION or providing or participating in training to provide abortion ; Cover or referring for
Index of Sec 156. ...ABORTION on minor ; Coverage or procedural requirements on abortions including parental notification or consent for performance of
Index of Sec 156. ...ACCEPTABLE coverage under division ; Subject to succeeding provisions of section for purposes of establishing
Index of Sec 102. ...ACCEPTABLE coverage under division ; Subject to succeeding provisions of section for purposes of establishing
Index of Sec 102. ...ACCEPTABLE coverage under division ; Subject to succeeding provisions of section for purposes of establishing
Index of Sec 102. ...ACCEPTABLE coverage under division ; Employment-based health plan described in paragraph to be treated as
Index of Sec 102. ...ACCEPTABLE coverage under division ; Employment-based health plan described in paragraph to be treated as
Index of Sec 102. ...ACCEPTABLE coverage under division ; Employment-based health plan described in paragraph to be treated as
Index of Sec 102. ...ACCEPTABLE coverage under current group health plan for purposes of division ; Group health plan to be treated as
Index of Sec 102. ...ACCEPTABLE coverage in same manner as provisions applying with respect to qualified health benefits planing under section ; Provisions of section applying with respect to
Index of 0ACCEPTABLE coverage so long as Secretary of Labor determining that coverage for employees being substantially equivalent or greater than coverage provided for employees pursuant to essential benefits packaging ; Coverage provided pursuant to Hawaii Prepaid Health Care Act to be treated as qualified health benefits planning providing
Index of Sec 156. ...ACCEPTABLE coverage described in subparagraph or subsection being eligible to obtain coverage through enrollment in Exchange-participating health benefits planning offered through Health Insurance Exchange ; Individual with
Index of Sec 202. ...ACCEPTABLE coverage ; Time of birth being not otherwise covered under
Index of Sec 205. ...ACCEPTABLE coverage ; Time of birth being not otherwise covered under
Index of Sec 205. ...ACCEPTABLE coverage ; Time of birth being not otherwise covered under
Index of Sec 205. ...ACCEPTABLE coverage ; End of period referred in subparagraph being not otherwise covered under
Index of Sec 205. ...ACCEPTABLE coverage ; End of period referred in subparagraph being not otherwise covered under
Index of Sec 205. ...ACCEPTABLE coverage ; End of period referred in subparagraph being not otherwise covered under
Index of Sec 205. ...ACCEPTABLE coverage ; Individual's responsibility to obtain
Index of Sec 301. ...ACCEPTABLE coverage ; Individual's responsibility to obtain
Index of Sec 301. ...ACCEPTABLE coverage ; Individual's responsibility to obtain
Index of Sec 301. ...ACCEPTABLE coverage during period described in subparagraph or section 911(d)(1) ; Qualified individual to be treated for purposes of section as covered by
Index of Sec 401. ...ACCEPTABLE coverage during taxable year ; Individual being bona fide resident of possession of United States for taxable year to be treated for purposes of section as covered by
Index of Sec 401. ...ACCEPTABLE coverage at times during period ; Requirements of subsection being met with respect to individual for perioding if individual covered by
Index of Sec 401. ...ACCEPTABLE coverage to individual during calendar year making return described in subsection with respect to individual ; Every person providing
Index of Sec 401. ...ACCEPTABLE coverage ; Term qualified health coverage meaning
Index of Sec 421. ...ACCEPTABLE coverage ; Exemption from tax imposed under subsection in cases of de minimis lapses of
Index of Sec 401. ...ACCEPTABLE coverage ; Individuals being eligible to obtain coverage through enrollment in Exchange-participating health benefits planning offered through Health Insurance Exchange unless individuals enrolled in another qualified health benefits planning or other
Index of Sec 202. ...ACCEPTABLE coverage ; Individuals being eligible to obtain coverage through enrollment in Exchange-participating health benefits planning offered through Health Insurance Exchange unless individuals enrolled in another qualified health benefits planning or other
Index of Sec 202. ...ACCEPTABLE coverage ; Individuals being eligible to obtain coverage through enrollment in Exchange-participating health benefits planning offered through Health Insurance Exchange unless individuals enrolled in another qualified health benefits planning or other
Index of Sec 202. ...ACCEPTABLE coverage having meaning given term in section 202(d)(2) ; Term
Index of Sec 100. ...ACCEPTABLE coverage having meaning given term in section 202(d)(2) ; Term
Index of Sec 100. ...ACCEPTABLE coverage having meaning given term in section 202(d)(2) ; Term
Index of Sec 100. ...ACCIDENT benefits to members association and dependents ; Purposes of providing for payment of sick and
Index of Sec 461. ...ACCOMMODATE payments for services ; Secretary modifying payment rates described in paragraph in order to
Index of Sec 223. ...ACCOMMODATE payments for services ; Secretary modifying payment rates described in paragraph in order to
Index of Sec 223. ...ACCOUNT special circumstances of smaller and newer plans ; Methodolology to be designed to take into
Index of Sec 116. ...ACCOUNT as of time of entity's determination ; External appeal entity determining whether plan or issuer's decision in accordance with medical needs of patient involved taking into
Index of 0ACCOUNT special circumstances of smaller plans, different types of plans and newer plans ; Methodolology to be designed to take into
Index of Sec 161. ...ACCOUNT special circumstances of smaller plans, different types of plans and newer plans ; Methodolology to be designed to take into
Index of Sec 161. ...ACCOUNT development of operating rules developed by nonprofit entity meeting following criteria ; Secretary taking into
Index of Sec 164. ...ACCOUNT rules developed by entity under subsection and ensured consulations with providers ; Taking into
Index of Sec 164. ...ACCOUNT ; Participating employment-based plan taking into
Index of Sec 164. ...ACCOUNT ; Participating employment-based plan taking into
Index of Sec 164. ...ACCOUNT for purposes of budget enforcement procedures including allocations under section 302(a) and Balanced Budget and Emergency Deficit Control Act and budget resolutions for fiscal years during that appropriations being made from Trust Fund ; Taken into
Index of Sec 164. ...ACCOUNT for purposes of budget enforcement procedures including allocations under section 302(a) and Balanced Budget and Emergency Deficit Control Act and budget resolutions for fiscal years during that appropriations being made from Trust Fund ; Taken into
Index of Sec 164. ...ACCOUNT ; Participating employment-based plan taking into
Index of Sec 166. ...ACCOUNT for purposes of budget enforcement procedures including allocations under section 302(a) and Balanced Budget and Emergency Deficit Control Act and budget resolutions for fiscal years during that appropriations being made from Trust Fund ; Taken into
Index of Sec 166. ...ACCOUNT special circumstances of individuals and employers ; Commissioner providing for special enrollment periods to take into
Index of Sec 205. ...ACCOUNT special circumstances of individuals and employers ; Commissioner providing for special enrollment periods to take into
Index of Sec 205. ...ACCOUNT special circumstances of individuals and employers ; Commissioner providing for special enrollment periods to take into
Index of Sec 205. ...ACCOUNT health care providers used by individual involved or other relevant factors as Commissioner specifying ; Process involving random assignment or other form of assignment taking into
Index of Sec 205. ...ACCOUNT health care providers used by individual involved or other relevant factors as Commissioner specifying ; Process involving random assignment or other form of assignment taking into
Index of Sec 205. ...ACCOUNT health care providers used by individual involved or other relevant factors as Commissioner specifying ; Process involving random assignment or other form of assignment taking into
Index of Sec 205. ...ACCOUNT differences in risk characteristics of individuals and employers enrolled under different Exchange-participating health benefits planing offered by entities so as to minimizing impact of adverse selection of enrollees among plans offered by entities ; Commissioner establishing mechanism whereby being adjustment making of premium amounting payable among QHBP offering entities offering Exchange-participating health benefits planing of premiums collected for plans taking into
Index of Sec 206. ...ACCOUNT differences in risk characteristics of individuals and employers enrolled under different Exchange-participating health benefits planing offered by entities so as to minimizing impact of adverse selection of enrollees among plans offered by entities ; Commissioner establishing mechanism whereby being adjustment making of premium amounting payable among QHBP offering entities offering Exchange-participating health benefits planing of premiums collected for plans taking into
Index of Sec 206. ...ACCOUNT differences in risk characteristics of individuals and employers enrolled under different Exchange-participating health benefits planing offered by entities so as to minimizing impact of adverse selection of enrollees among plans offered by entities ; Commissioner establishing mechanism whereby being adjustment making of premium amounting payable among QHBP offering entities offering Exchange-participating health benefits planing of premiums collected for plans taking into
Index of Sec 206. ...ACCOUNT costs of additional benefits ; Annual increase permitted under subsection with respect to first year to which benefits required to be increased to take into
Index of Sec 209. ...ACCOUNT provisions of section 221(a) and amounts paid for similar health care providers and services under other Exchange-participating health benefits planing ; Taking into
Index of Sec 223. ...ACCOUNT provisions of section 221(a) and amounts paid for similar health care providers and services under other Exchange-participating health benefits planing ; Taking into
Index of Sec 223. ...ACCOUNT only wages paid to employees being not subject to election ; Paragraph to be applied for period by taking into
Index of Sec 412. ...ACCOUNT only wages paid to employees being not subject to election ; Subsection to be applied for period by taking into
Index of Sec 412. ...ACCOUNT under subparagraph ; Aggregate reductions in Federal expenditures to be achieved as result of provisions and amendments during so period beginning with fiscal year 2010 and ending with fiscal year 2019 as not taken into
Index of Sec 441. ...ACCOUNT in connection with tax imposed under section 871(b) to be taken into account under section ; Only amounts taking into
Index of Sec 441. ...ACCOUNT economic relationships among entities ; Treatment of member of foreign controlled group of entities as common parent of group if treatment being appropriate taking into
Index of Sec 451. ...ACCOUNT in determining whether requirements of subparagraphs and paragraph being met with respect to transaction only if present value of reasonably expected pre-tax profit from transaction being substantial in relation to present value of expected net tax benefits to be allowed if transaction respected ; Potential for profit of transaction to be taken into
Index of Sec 452. ...ACCOUNT as expenses in determining pre-tax profit under subparagraph ; Fees and other transaction expenses and foreign taxes to be taken into
Index of Sec 452. ...ACCOUNT as purpose for entering into transaction if origin of financial accounting benefit being reduction of Federal income tax ; Achieving financial accounting benefit not to be taken into
Index of Sec 452. ...ACCOUNT for purposes of subsection if amendment or supplement filed after earlier of date taxpayer being first contacted by Secretary regarding examination of return or other date as specified by Secretary ; No event amending or supplementing to return of tax to be taken into
Index of Sec 453. ...ACCOUNT innovation in health care and considering standards reducing health disparities ; Committee taking into
Index of Sec 123. ...ACCOUNT innovation in health care and considering standards reducing health disparities ; Committee taking into
Index of Sec 123. ...ACCOUNTABILITY of QHBP offering entities in meeting Federal health insurance requirements ; Commissioner undertaking activities in accordance with subtitle to promote
Index of Sec 142. ...ACCOUNTABILITY of QHBP offering entities in meeting Federal health insurance requirements ; Commissioner undertaking activities in accordance with subtitle to promote
Index of Sec 142. ...ACCOUNTABILITY of QHBP offering entities in meeting Federal health insurance requirements ; Commissioner undertaking activities in accordance with subtitle to promote
Index of Sec 142. ...ACTUARIAL basis for including coverage under basic plan of services described in section 122(d)(4)(a) ; Commissioner estimating basic per enrollee determined on average
Index of Sec 113. ...ACTUARIAL value described in section 113(b) used for purpose ; Only premium amounting attributable to
Index of Sec 203. ...ACTUARIAL value of benefits providing under reference benefiting package described in section 122(c)(3)(b) ; Level of cost-sharing for enhanced plans to be designed so that plans having benefits being actuarially equivalent to approximately 85 percent of
Index of Sec 123. ...ACTUARIAL value of benefits providing under reference benefiting package described in section 122(c)(3)(b) ; Level of cost-sharing for enhanced plans to be designed so that plans having benefits being actuarially equivalent to approximately 85 percent of
Index of Sec 123. ...ACTUARIAL value of benefits providing under reference benefiting package described in section 122(c)(3)(b) ; Level of cost-sharing for premium plans to be designed so that plans having benefits being actuarially equivalent to approximately 95 percent of
Index of Sec 123. ...ACTUARIAL value of benefits providing under reference benefiting package described in section 122(c)(3)(b) ; Level of cost-sharing for premium plans to be designed so that plans having benefits being actuarially equivalent to approximately 95 percent of
Index of Sec 123. ...ACTUARIAL value of benefits providing under reference benefiting package described in section 122(c)(3)(b) ; Level of cost-sharing for enhanced plans to be designed so that plans having benefits being actuarially equivalent to approximately 85 percent of
Index of Sec 123. ...ACTUARIAL value of benefits providing under reference benefiting package described in section 122(c)(3)(b) ; Level of cost-sharing for premium plans to be designed so that plans having benefits being actuarially equivalent to approximately 95 percent of
Index of Sec 123. ...ACTUARIAL value of benefits under plan provided under section 203(c)(2)(b) resulting from reduction in cost-sharing described in subsection ; Commissioner providing for payment to offering entity of amount equivalent to increased
Index of Sec 244. ...ACTUARIAL value of benefits under plan provided under section 203(c)(2)(b) resulting from reduction in cost-sharing described in subsection ; Commissioner providing for payment to offering entity of amount equivalent to increased
Index of Sec 244. ...ACTUARIAL value of benefits under plan provided under section 203(c)(2)(b) resulting from reduction in cost-sharing described in subsection ; Commissioner providing for payment to offering entity of amount equivalent to increased
Index of Sec 244. ...ACTUARIAL Value percentages based on income Tier ; Table of premium percentage Limits and
Index of Sec 243. ...ACTUARIAL Value percentages based on income Tier ; Table of premium percentage Limits and
Index of Sec 243. ...ACTUARIAL Value percentages based on income Tier ; Table of premium percentage Limits and
Index of Sec 243. ...ACTUARIAL value percentages to be determined with respect to individual ; Two
Index of Sec 243. ...ACTUARIAL value percentages to be determined with respect to individual ; Two
Index of Sec 243. ...ACTUARIAL value percentages to be determined with respect to individual ; Two
Index of Sec 243. ...PAYMENTS and amount of payments shared with plan and description of percentage of prescriptions For which PBM receiving payments ; Administrative and other payments from pharmaceutical manufacturers and description of types of
Index of Sec 133. ...ADMINISTRATIVE costs related to operating public health insurance option ;
Index of Sec 222. ...ADMINISTRATIVE costs related to operating public health insurance option ;
Index of Sec 222. ...ADMINISTRATIVE costs related to operating public health insurance option ;
Index of Sec 222. ...ADMINISTRATIVE functions of section 1874a of Social Security Act with respect to public health insurance option in same manner as Secretary entering into contracts under subsection of section ; Secretary entering into contracts for purpose of performing
Index of Sec 221. ...ADMINISTRATIVE functions of section 1874a of Social Security Act with respect to public health insurance option in same manner as Secretary entering into contracts under subsection of section ; Secretary entering into contracts for purpose of performing
Index of Sec 221. ...ADMINISTRATIVE functions of section 1874a of Social Security Act with respect to public health insurance option in same manner as Secretary entering into contracts under subsection of section ; Secretary entering into contracts for purpose of performing
Index of Sec 221. ...PAYMENT rate or methodolology established under section or section 224 ; No administrative or judicial review of
Index of Sec 223. ...PAYMENT rate or methodolology established under section or section 224 ; No administrative or judicial review of
Index of Sec 223. ...PAYMENT rate or methodolology established under section or section 224 ; No administrative or judicial review of
Index of Sec 223. ...ADMINISTRATIVE process to set rates in order to promote payment accuracy to ensure adequate beneficiary access to providers and promoting affordablility and efficient delivery of medical care consistent with section 221(a) ; Secretary continuing to use
Index of Sec 223. ...ADMINISTRATIVE process to set rates in order to promote payment accuracy to ensure adequate beneficiary access to providers and promoting affordability and efficient delivery of medical care consistent with section 221(a) ; Secretary continuing to use
Index of Sec 223. ...ADMINISTRATIVE simplification as identified by Secretary in consulations with stakeholders ; Providing for other requirements relating to
Index of Sec 163. ...ADMINISTRATIVE simplification as identified by Secretary in consulations with stakeholders ; Providing for other requirements relating to
Index of Sec 164. ...ADMINISTRATIVE simplification ; Entity focusing mission on
Index of Sec 164. ...ADOPTION of recommending and providing Committee with further opportunity to modify previous recommendations and submitting new recommendations to Secretary on timely basis ; Secretary notifying Health benefiting Advisory Committee in writing of determining and reasons for not proposing
Index of Sec 124. ...ADOPTION of recommending and providing Committee with further opportunity to modify previous recommendations and submitting new recommendations to Secretary on timely basis ; Secretary notifying Health benefiting Advisory Committee in writing of determining and reasons for not proposing
Index of Sec 124. ...ADOPTION of recommending and providing Committee with further opportunity to modify previous recommendations and submitting new recommendations to Secretary on timely basis ; Secretary notifying Health benefiting Advisory Committee in writing of determining and reasons for not proposing
Index of Sec 124. ...ADOPTION of benefit standards so recommended as package ; Proposing
Index of Sec 124. ...ADOPTION of benefit standards so recommended as package ; Proposing
Index of Sec 124. ...ADOPTION of benefit standards so recommended as package ; Proposing
Index of Sec 124. ...ADOPTION of recommended standards by deadline specified in subsection ; Secretary otherwise to be unable to propose initial
Index of Sec 124. ...ADOPTION of recommended standards by deadline specified in subsection ; Secretary otherwise to be unable to propose initial
Index of Sec 124. ...ADOPTION of recommended standards by deadline specified in subsection ; Secretary otherwise to be unable to propose initial
Index of Sec 124. ...AFFIRMATIVE election to opt out of plan or electing coverage under employment-based health benefits planning offered by employer ; No case employer automatically enrolling employee in plan under paragraph if employee making
Index of Sec 312. ...AFFIRMATIVE election to opt out of plan or electing coverage under employment-based health benefits planning offered by employer ; No case employer automatically enrolling employee in plan under paragraph if employee making
Index of Sec 312. ...AFFIRMATIVE election to opt out of plan or electing coverage under employment-based health benefits planning offered by employer ; No case employer automatically enrolling employee in plan under paragraph if employee making
Index of Sec 312. ...AFFORDABILITY and efficient delivery of medical care consistent with section 221(a) ; Secretary continuing to use administrative process to set rates in order to promote payment accuracy to ensure adequate beneficiary access to providers and promoting
Index of Sec 223. ...AFFORDABILITY crediting equivalent to amount so estimated ; Commissioner providing for appropriate increase in initial and final premium percentages in table specified in paragraph in manner designed to result in increase in aggregate
Index of Sec 243. ...AFFORDABILITY if making eligible for coverage in Exchange ; Improving benefits and
Index of Sec 202. ...AFFORDABILITY if making eligible for coverage in Exchange ; Improving benefits and
Index of Sec 202. ...AFFORDABILITY if making eligible for coverage in Exchange ; Improving benefits and
Index of Sec 202. ...AFFORDABILITY cost-sharing credit under section 244 to be applied as reduction of cost-sharing otherwise applicable to plan ;
Index of Sec 241. ...AFFORDABILITY cost-sharing credit under section 244 to be applied as reduction of cost-sharing otherwise applicable to plan ;
Index of Sec 241. ...AFFORDABILITY cost-sharing credit under section 244 to be applied as reduction of cost-sharing otherwise applicable to plan ;
Index of Sec 241. ...AFFORDABILITY cost-sharing credit under section for affordable credit eligible individual enrolled in Exchange-participating health benefits planning in form of cost-sharing reduction described in subsection provided under section for income tier in which individual classified based on individual's family income ;
Index of Sec 244. ...AFFORDABILITY cost-sharing credit under section for affordable credit eligible individual enrolled in Exchange-participating health benefits planning in form of cost-sharing reduction described in subsection provided under section for income tier in which individual classified based on individual's family income ;
Index of Sec 244. ...AFFORDABILITY cost-sharing credit under section for affordable credit eligible individual enrolled in Exchange-participating health benefits planning in form of cost-sharing reduction described in subsection provided under section for income tier in which individual classified based on individual's family income ;
Index of Sec 244. ...AFFORDABILITY credits under subtitle C ; Secretary of Health and Human Services submitting to Congress report comparing benefits packaging offered in 2011 to average State child health plan under title XXI of Social Security Act and benefit standards adopted under section 124 for essential benefits packaging and
Index of Sec 202. ...AFFORDABILITY credits provided under subtitle C of title II not used for purposes of paying for services ;
Index of Sec 203. ...AFFORDABILITY credits under subtitle C periods to be during September through November of year or other time maximizing timeliness of income verification for purposes of subtitle ; Commissioner establishing annual open enrollment period during that Exchange-eligible individual or employer electing to enroll in Exchange-participating health benefits planning for following plan year and enrollment period for
Index of Sec 205. ...AFFORDABILITY credits under subtitle C periods to be during September through November of year or other time maximizing timeliness of income verification for purposes of subtitle ; Commissioner establishing annual open enrollment period during that Exchange-eligible individual or employer electing to enroll in Exchange-participating health benefits planning for following plan year and enrollment period for
Index of Sec 205. ...AFFORDABILITY credits under subtitle C periods to be during September through November of year or other time maximizing timeliness of income verification for purposes of subtitle ; Commissioner establishing annual open enrollment period during that Exchange-eligible individual or employer electing to enroll in Exchange-participating health benefits planning for following plan year and enrollment period for
Index of Sec 205. ...AFFORDABILITY credits under subtitle B using same methodologies ; Administering
Index of Sec 208. ...AFFORDABILITY credits under subtitle B using same methodologies ; Administering
Index of Sec 208. ...AFFORDABILITY credits under subtitle B using same methodologies ; Administering
Index of Sec 208. ...AFFORDABILITY credits under subtitle ; Commissioner through Health Insurance Exchange or another public entity under arrangement making with Commissioner making determination as to eligibility of individual for
Index of Sec 241. ...AFFORDABILITY credits under subtitle ; Commissioner through Health Insurance Exchange or another public entity under arrangement making with Commissioner making determination as to eligibility of individual for
Index of Sec 241. ...AFFORDABILITY credits under subtitle ; Commissioner through Health Insurance Exchange or another public entity under arrangement making with Commissioner making determination as to eligibility of individual for
Index of Sec 241. ...AFFORDABILITY credits under subtitle and same standards as used by Commissioner ; Commissioner determining that State Medicaid agency having capacity to make determination of eligibility for
Index of Sec 241. ...AFFORDABILITY credits under subtitle and same standards as used by Commissioner ; Commissioner determining that State Medicaid agency having capacity to make determination of eligibility for
Index of Sec 241. ...AFFORDABILITY credits under subtitle and same standards as used by Commissioner ; Commissioner determining that State Medicaid agency having capacity to make determination of eligibility for
Index of Sec 241. ...AFFORDABILITY credits under subtitle not to be treated to be benefit provided under section 403 of title ;
Index of Sec 242. ...AFFORDABILITY credits under subtitle not to be treated to be benefit provided under section 403 of title ;
Index of Sec 242. ...AFFORDABILITY credits on behalf of individuals being not lawfully present in United States ; Nothing in subtitle allowing Federal payments for
Index of Sec 246. ...AFFORDABILITY credits on behalf of individuals being not lawfully present in United States ; Nothing in subtitle allowing Federal payments for
Index of Sec 246. ...AFFORDABILITY credits on behalf of individuals being not lawfully present in United States ; Nothing in subtitle allowing Federal payments for
Index of Sec 246. ...AFFORDABILITY credits for affordable credit eligible individuals enrolled in plan ; Commissioner paying QHBP offering entity offering plan from Health Insurance Exchange Trust Fund aggregate amount of
Index of Sec 241. ...AFFORDABILITY credits for affordable credit eligible individuals enrolled in plan ; Commissioner paying QHBP offering entity offering plan from Health Insurance Exchange Trust Fund aggregate amount of
Index of Sec 241. ...AFFORDABILITY credits for affordable credit eligible individuals enrolled in plan ; Commissioner paying QHBP offering entity offering plan from Health Insurance Exchange Trust Fund aggregate amount of
Index of Sec 241. ...AFFORDABILITY credits under subtitle C of title II including determination of eligibility for credits ; Administration of individual
Index of Sec 142. ...AFFORDABILITY credits under subtitle C of title II including determination of eligibility for credits ; Administration of individual
Index of Sec 142. ...AFFORDABILITY credits under subtitle C of title II including determination of eligibility for credits ; Administration of individual
Index of Sec 142. ...AFFORDABILITY premium or cost-sharing credits under subtitle C of title II of division ; Increase in rates under paragraph not resulting in increase in
Index of Sec 157. ...AFFORDABILITY premium credits under subtitle C as result of increase in premium in basic plans as result of application of requirement ; State entering into arrangement satisfactory to Commissioner to reimburse Commissioner for amount of net increase in
Index of Sec 203. ...AFFORDABILITY premium credits under subtitle C as result of increase in premium in basic plans as result of application of requirement ; State entering into arrangement satisfactory to Commissioner to reimburse Commissioner for amount of net increase in
Index of Sec 203. ...AFFORDABILITY premium credits under subtitle C as result of increase in premium in basic plans as result of application of requirement ; State entering into arrangement satisfactory to Commissioner to reimburse Commissioner for amount of net increase in
Index of Sec 203. ...AFFORDABLILITY and efficient delivery of medical care consistent with section 221(a) ; Secretary continuing to use administrative process to set rates in order to promote payment accuracy to ensure adequate beneficiary access to providers and promoting
Index of Sec 223. ...APPOINTMENT, practice in rural area and practicing in rural area for 5-year period preceding date ; Date of
Index of Sec 123. ...APPOINTMENT members ; Excepting that terms of initial members to be adjusted in order to provide for staggered term of
Index of Sec 123. ...APPOINTMENT members ; Excepting that terms of initial members to be adjusted in order to provide for staggered term of
Index of Sec 123. ...APPOINTMENT members ; Excepting that terms of initial members to be adjusted in order to provide for staggered term of
Index of Sec 123. ...APPOINTMENTS to be made not later than 60 days after date of enactment of Act ; Initial
Index of Sec 123. ...APPOINTMENTS to be made not later than 60 days after date of enactment of Act ; Initial
Index of Sec 123. ...APPOINTMENTS to be made not later than 60 days after date of enactment of Act ; Initial
Index of Sec 123. ...ASSESSMENT of penalties under section in connection with failures to satisfy health coverage participation requirements with imposition of excise taxes on failures under section 4980h(b) of Internal Revenue Code of 1986 so as to avoiding duplication of penalties with respect to failures ; Secretary and Secretary of Treasury coordinating
Index of Sec 321. ...ASSESSMENT of penalties under section in connection with failures to satisfy health coverage participation requirements with imposition of excise taxes on failures under section 4980h(b) of Internal Revenue Code of 1986 so as to avoiding duplication of penalties with respect to failures ; Secretary and Secretary of Treasury coordinating
Index of Sec 321. ...ASSESSMENT of penalties under paragraph in connection with failures to satisfy health coverage participation requirements with imposition of excise taxes on failures under section 4980h(b) of Internal Revenue Code of 1986 so as to avoiding duplication of penalties with respect to failures ; Secretary and Secretary of Treasury coordinating
Index of Sec 323. ...ASSESSMENT of penalties under paragraph in connection with failures to satisfy health coverage participation requirements with imposition of excise taxes on failures under section 4980h(b) of Internal Revenue Code of 1986 so as to avoiding duplication of penalties with respect to failures ; Secretary and Secretary of Treasury coordinating
Index of Sec 323. ...AT-risk populations and covered individuals with chronic conditions or severe illnesses including gender-specific criteria and pediatric-specific criteria where available and appropriate ; Criteria including written clinical review criteria based on valid clinical evidence where available and directed specifically at meeting needs of
Index of Sec 139. ...HEALTH care ; Term advanced directive including living or durable power of attorney for
Index of Sec 138. ...INFORMATION relating to violation ; Attorney general of State
Index of Sec 153. ...INFORMATION relating to violation ; Attorney general of State
Index of Sec 153. ...INFORMATION relating to violation ; Attorney general of State
Index of Sec 153. ...ATTORNEY'S fee and other reasonable costs relating to prosecution of action on charges on which plaintiff prevailing ; Paying to plaintiff reasonable
Index of 0ATTORNEYS fees or imposing caps on damages ; Without limiting
Index of Sec 208. ...AUTHORIZATION and providing notice of determination to individual or individual's designee and individual's health care provider by telephone and printed form ; Utilization review program making determination concerning
Index of Sec 139. ...AUTHORIZATION or pre-certification as required by plan or issuer and coverage including surgical treatment in opinion of treating physician ; Coverage provided under paragraph to be subject to pre-
Index of Sec 163. ...AUTHORIZATION or pre-certification as required by insurance issuer offering coverage and coverage including surgical treatment in opinion of treating physician ; Coverage provided under paragraph to be subject to pre-
Index of Sec 163. ...AUTHORIZATION ; Deadline specified in subparagraph being 14 days after date of receipt of request for prior
Index of Sec 139. ...AUTHORIZATION ; Deadline specified in subparagraph being 72 hours after time of request for prior
Index of Sec 139. ...AUTOMATIC enrollment for Employer sponsored health Benefits ;
Index of Sec 312. ...AUTOMATIC enrollment for Employer sponsored health Benefits ;
Index of Sec 312. ...AUTOMATIC enrollment for Employer sponsored health Benefits ;
Index of Sec 312. ...AUTOMATIC enrollment requirement under paragraph ; Writing notice of employees' rights and obligations relating to
Index of Sec 312. ...AUTOMATIC enrollment requirement under paragraph ; Writing notice of employees' rights and obligations relating to
Index of Sec 312. ...AUTOMATIC enrollment requirement under paragraph ; Writing notice of employees' rights and obligations relating to
Index of Sec 312. ...BACK ; Providers participating in Medicare choosing to opt out of participating in public health insurance option opting
Index of Sec 223. ...HEALTH care professional or evaluating effectiveness of professional pharmaceutical detailing sales forcing ; Influencing or evaluating prescribing behavior of individual
Index of Sec 138. ...BEHAVIORAL health treatments ; Mental health and substance use disorder services including
Index of Sec 122. ...HEALTH care professional ; Determining by plan or issuer or certified in writing by treating
Index of 0INTERNAL review under subsection ; Plan or entity waiving rights for
Index of 0PAYMENT of filing fee in case of individual participant, beneficiary or enrollee certifying that individual being indigent ; Plan or issuer not requiring
Index of 0CONTRACT providing that costs of process to be paid by plan or entity and not by participant, beneficiary or enrollee ;
Index of 0CIVIL penalty in amount of up to $1,000 day from date on which determination transmitted to plan by external review entity until date refusal to provide benefit corrected ; Refusal to be liable to aggrieved participant, beneficiary or enrollee for
Index of 0HEALTH benefits planning ; Action described in paragraph bringing by participant, beneficiary or enrollee with respect to qualified
Index of 0CONTRACT or arrangement for health care with health care provider ; Nothing in Act to be construed to preclude participant or beneficiary in group health plan from entering into
Index of Sec 158. ...RETIREMENT unless reduction being made with respect to active participants ; Reduction affecting benefits provided to participant or beneficiary as of date participant retired for purposes of plan and reduction occuring after participant's
Index of Sec 165. ...COBRA continations coverage extended under section to State health benefits risking pool recognized by Commissioner for purposes of section solely by reason of extension of coverage beyond date on which coverage otherwise to have expired ; Provision having effect of limiting or precluding access by qualified beneficiary whose
Index of Sec 167. ...ACCIDENT or health plan ; Term eligible beneficiary meaning individual being eligible to receive benefits or coverage under
Index of Sec 461. ...AFFORDABLILITY and efficient delivery of medical care consistent with section 221(a) ; Secretary continuing to use administrative process to set rates in order to promote payment accuracy to ensure adequate beneficiary access to providers and promoting
Index of Sec 223. ...AFFORDABILITY and efficient delivery of medical care consistent with section 221(a) ; Secretary continuing to use administrative process to set rates in order to promote payment accuracy to ensure adequate beneficiary access to providers and promoting
Index of Sec 223. ...EMPLOYEES' beneficiary association or committee or board of individuals appointed to administer plan ; Maintaining by one or more employers, former employers or employee associations or voluntary
Index of Sec 164. ...EMPLOYEES' beneficiary association or committee or board of individuals appointed to administer plan ; Maintaining by one or more employers, former employers or employee associations or voluntary
Index of Sec 164. ...EMPLOYEES' beneficiary association or committee or board of individuals appointed to administer plan ; Maintaining by one or more employers, former employers or employee associations or voluntary
Index of Sec 166. ...BENEFICIARY identification card ; Including whether individual being eligible for specific service with specific physician at specific facility including utilization of machine-readable health plan
Index of Sec 163. ...BENEFICIARY identification card ; Including whether individual being eligible for specific service with specific physician at specific facility including utilization of machine-readable health plan
Index of Sec 164. ...CIVIL monetary and programmatic penalties for non-compliance consistent with existing laws and regulations and fair and reasonable appeals processing building off of enforcement provisions under part ; Enforcement process including timely investigation of complaints, random audits to ensure compliance,
Index of Sec 163. ...CIVIL monetary and programmatic penalties for non-compliance consistent with existing laws and regulations and fair and reasonable appeals processing building off of enforcement provisions under part ; Enforcement process including timely investigation of complaints, random audits to ensure compliance,
Index of Sec 164. ...CAPITATION and direct contracting with providers ; Bundling of services, differential payment rates, performance or utilization based payments, partial
Index of Sec 224. ...CAPITATION and direct contracting with providers ; Bundling of services, differential payment rates, performance or utilization based payments, partial
Index of Sec 224. ...CAPITATION and direct contracting with providers ; Bundling of services, differential payment rates, performance or utilization based payments, partial
Index of Sec 224. ...CERTIFICATION of external review entities ; Secretary of Labor providing for process for certification of qualified private standard-setting organizations providing for
Index of 0CERTIFICATION of external review entities ; Secretary of Health and Human Services providing for process for certification of qualified private standard-setting organizations providing for
Index of 0CERTIFICATION as required by plan or issuer and coverage including surgical treatment in opinion of treating physician ; Coverage provided under paragraph to be subject to pre-authorization or pre-
Index of Sec 163. ...CERTIFICATION as required by insurance issuer offering coverage and coverage including surgical treatment in opinion of treating physician ; Coverage provided under paragraph to be subject to pre-authorization or pre-
Index of Sec 163. ...CERTIFICATION criteria messaging formating, coding and code sets adopted or established by Secretary for electronic exchange and use of information ;
Index of Sec 163. ...CERTIFICATION criteria messaging formating, coding and code sets adopted or established by Secretary for electronic exchange and use of information ;
Index of Sec 164. ...CERTIFICATION entity by Secretary under subparagraph ; Organization only to be certified if organization not certifying external review entity unless meeting standards required for
Index of 0CERTIFICATION entity by Secretary under subparagraph ; Organization only to be certified if organization not certifying external review entity unless meeting standards required for
Index of 0HEALTH benefits planning until Secretary of Health and Human Services ; No child to be eligible for coverage under title XXI of Social Security Act to be enrolled in Exchange participating
Index of Sec 202. ...CHILD health assistance under title XXI of Social Security Act deemed as of first day to be Exchange-eligible individual unless individual being traditional Medicaid eligible individual as of day ; Child being eligible for
Index of Sec 205. ...CHILD health assistance under title XXI of Social Security Act deemed as of first day to be Exchange-eligible individual unless individual being traditional Medicaid eligible individual as of day ; Child being eligible for
Index of Sec 205. ...CHILD health assistance under title XXI of Social Security Act deemed as of first day to be Exchange-eligible individual unless individual being traditional Medicaid eligible individual as of day ; Child being eligible for
Index of Sec 205. ...CHILD'S congenital or developmental deformity or disorder ; Sec 2708, standards relating to Benefits for minor
Index of Sec 163. ...CHILD'S congenital or developmental deformity, disease or injury ; Group health plan and health insurance issuer offering group health insurance coverage providing coverage for surgical benefits providing coverage for outpatient and inpatient diagnosis and treatment of minor
Index of Sec 163. ...CHILD'S congenital or developmental deformity or disorder ; Sec 2755, standards relating to Benefits for minor
Index of Sec 163. ...CHILD'S congenital or developmental deformity, disease or injury ; Health insurance issuer offering health insurance coverage in individual market providing coverage for surgical benefits providing coverage for outpatient and inpatient diagnosis and treatment of minor
Index of Sec 163. ...CHILD health assistance under title XXI of Social Security Act deemed as of first day to be Exchange-eligible individual unless individual being traditional Medicaid eligible individual as of day ; Child being eligible for
Index of Sec 205. ...CHILD health assistance under title XXI of Social Security Act deemed as of first day to be Exchange-eligible individual unless individual being traditional Medicaid eligible individual as of day ; Child being eligible for
Index of Sec 205. ...CHILD health assistance under title XXI of Social Security Act deemed as of first day to be Exchange-eligible individual unless individual being traditional Medicaid eligible individual as of day ; Child being eligible for
Index of Sec 205. ...AFFORDABILITY credits under subtitle C ; Secretary of Health and Human Services submitting to Congress report comparing benefits packaging offered in 2011 to average State child health plan under title XXI of Social Security Act and benefit standards adopted under section 124 for essential benefits packaging and
Index of Sec 202. ...CHILD health plan under titling as in effect in 2011 ; Basing on findings in report under paragraph and changes making pursuant to recommendations in report that coverage being comparable to coverage provided to children under average State
Index of Sec 202. ...CHILD support order ; Respect to period during that health coverage for child to be provided by individual pursuant to
Index of Sec 401. ...CHRONIC conditions or severe illnesses including gender-specific criteria and pediatric-specific criteria where available and appropriate ; Criteria including written clinical review criteria based on valid clinical evidence where available and directed specifically at meeting needs of at-risk populations and covered individuals with
Index of Sec 139. ...CIVIL action in District Court of United States to collect civil penalty under subsection ; Secretary bringing
Index of Sec 323. ...CIVIL action in District Court of United States to collect civil penalty under subsection ; Secretary bringing
Index of Sec 323. ...CIVIL penalty in amount of up to $1,000 day from date on which determination transmitted to plan by external review entity until date refusal to provide benefit corrected ; Refusal to be liable to aggrieved participant, beneficiary or enrollee for
Index of 0CIVIL penalty against person acting in capacity of authorizing benefit determined by external review entity for one or more qualified health benefits planing ; Appropriate Secretary assessing
Index of 0CIVIL penalty against employer of $100 for day in period beginning on date ; Secretary assessing
Index of Sec 321. ...CIVIL penalty against employer of $100 for day in period beginning on date ; Secretary assessing
Index of Sec 321. ...CIVIL penalty against employer of $100 for day in period beginning on date ; Secretary assessing
Index of Sec 323. ...CIVIL penalty against employer of $100 for day in period beginning on date ; Secretary assessing
Index of Sec 323. ...CIVIL penalty under subsection ; Secretary bringing civil action in District Court of United States to collect
Index of Sec 323. ...CIVIL penalty under subsection ; Secretary bringing civil action in District Court of United States to collect
Index of Sec 323. ...CIVIL penalty collected under section 502(c) of Employee Retirement Income Security Act of 1974 or sectioning 2793(g) of Public Health Service Act with respect to failure ; Tax imposed under paragraph with respect to failure to be reduced by amount of
Index of Sec 411. ...CLINICAL appropriateness on coverage of health care items and services ; Qualified health benefits planning not imposing restriction unrelated to
Index of Sec 121. ...CLINICAL appropriateness on coverage of health care items and services ; Qualified health benefits planning not imposing restriction unrelated to
Index of Sec 121. ...CLINICAL appropriateness on coverage of health care items and services ; Qualified health benefits planning not imposing restriction unrelated to
Index of Sec 121. ...CLINICAL appropriateness of sample of denials of claims for benefits ; Program providing for evaluation of
Index of Sec 139. ...AT-risk populations and covered individuals with chronic conditions or severe illnesses including gender-specific criteria and pediatric-specific criteria where available and appropriate ; Criteria including written clinical review criteria based on valid clinical evidence where available and directed specifically at meeting needs of
Index of Sec 139. ...CLINICAL necessity, appropriateness, efficacy or efficiency of health care services, procedures or settings and including prospective review, concurrent review, second opinions ; Terms utilization review and utilization review activities mean procedures used to monitor or evaluate use or coverage,
Index of Sec 139. ...CLINICAL peer or other entity meeting independence requirements of paragraph ;
Index of 0CLINICAL peers ; Entity conducting external appeal activities through panel of not fewer than 3
Index of 0CLINICAL practice of integrative health care services ; Membership of Committee including one or more experts in scientific evidence and
Index of Sec 123. ...CLINICAL review criteria relied to make denial ; Request of individual of
Index of Sec 139. ...CLINICAL review criteria developed with input from range of appropriate actively practicing health care professionals as determined by plan ; Program utilizing written
Index of Sec 139. ...COBRA continations coverage after date of enactment of Act ; Cobra continations coverage provision covered under
Index of Sec 167. ...COBRA continations coverage to individuals under paragraph ; Secretary of Labor providing rules setting forth form and manner in which prompt notice to individuals of continued availability of
Index of Sec 167. ...COBRA continations coverage extended under subsection terminating upon occurrence of terminating event specified in applicable continations coverage provision other than expiration of period of specified number of months ; Required period of
Index of Sec 167. ...COBRA continations coverage meaning continations coverage provided pursuant to part 6 of subtitle B of title I of Employee Retirement Income Security Act of 1974 ; Term
Index of Sec 167. ...COBRA continations coverage extended under section to State health benefits risking pool recognized by Commissioner for purposes of section solely by reason of extension of coverage beyond date on which coverage otherwise to have expired ; Provision having effect of limiting or precluding access by qualified beneficiary whose
Index of Sec 167. ...COBRA continations coverage after date of enactment of Act ; Cobra continations coverage provision covered under
Index of Sec 167. ...COBRA continations provision meaning provisions of law described in paragraph ; Term
Index of Sec 167. ...COERCIVE practices to force providers not to contract with other entities offering coverage through Health Insurance Exchange ; Entity complying with other applicable requirements of title that including standards regarding billing and collection practices for premiums and related grace periods and including standards to ensure that entity not using
Index of Sec 204. ...COERCIVE practices to force providers not to contract with other entities offering coverage through Health Insurance Exchange ; Entity complying with other applicable requirements of title that including standards regarding billing and collection practices for premiums and related grace periods and including standards to ensure that entity not using
Index of Sec 204. ...COERCIVE practices to force providers not to contract with other entities offering coverage through Health Insurance Exchange ; Entity complying with other applicable requirements of title that including standards regarding billing and collection practices for premiums and related grace periods and including standards to ensure that entity not using
Index of Sec 204. ...COINSURANCE, copayments and similar charges but not including premiums or network payment differential for covered services or spending for non-covered services ; Term cost-sharing including deductibles,
Index of Sec 100. ...COINSURANCE, copayments and similar charges but not including premiums or network payment differential for covered services or spending for non-covered services ; Term cost-sharing including deductibles,
Index of Sec 100. ...COINSURANCE, copayments and similar charges but not including premiums or network payment differential for covered services or spending for non-covered services ; Term cost-sharing including deductibles,
Index of Sec 100. ...COLLECTIVE bargaining ; Construction regarding
Index of Sec 154. ...COLLECTIVE bargaining ; Construction regarding
Index of Sec 154. ...COLLECTIVE bargaining ; Construction regarding
Index of Sec 154. ...COLLECTIVE bargaining agreement ; Plan amendment making pursuant to collective bargaining agreement relating to plan amending plan solely to conform to requirement added by amendments making by paragraphs and subsection not to be treated as termination of
Index of Sec 166. ...COLLECTIVE bargaining agreement ; Plan amendment making pursuant to collective bargaining agreement relating to plan amending plan solely to conform to requirement added by amendments making by section not to be treated as termination of
Index of Sec 167. ...COLLECTIVE bargaining agreements relating to plan terminating ; Date on which last of
Index of Sec 166. ...COLLECTIVE bargaining agreements relating to plan terminating ; Date on which last of
Index of Sec 167. ...COLLECTIVE bargaining agreements between employee representatives and one or more employers ratified before date of enactment of Act ; Case of group health plan maintained pursuant to one or more
Index of Sec 166. ...COLLECTIVE bargaining agreements between employee representatives and one or more employers ratified before date of enactment of Act ; Case of group health plan maintained pursuant to one or more
Index of Sec 167. ...ROBUST requiring minimal augmentation by paper transactions or clarifiations by further communications ; Efficient and
Index of Sec 163. ...ROBUST requiring minimal augmentation by paper transactions or clarifiations by further communications ; Efficient and
Index of Sec 164. ...COMPARATIVE analysis ; Reports containing sufficient documentation regarding effectiveness of laws to enable objective
Index of Sec 208. ...COMPARATIVE manner and including information on benefits premiums, cost-sharing, quality, provider networks and consumer satisfaction ; Information to be provided in
Index of Sec 205. ...COMPARATIVE manner and including information on benefits premiums, cost-sharing, quality, provider networks and consumer satisfaction ; Information to be provided in
Index of Sec 205. ...COMPARATIVE manner and including information on benefits premiums, cost-sharing, quality, provider networks and consumer satisfaction ; Information to be provided in
Index of Sec 205. ...COMPENSATION received by peer or entity in connection with external review being reasonable and not contingent on decision rendered by peer or entity ;
Index of 0COMPENSATION of employee not to be treated as amount paid by employer ; Corresponding reduction in
Index of Sec 312. ...COMPENSATION of employee not to be treated as amount paid by employer ; Corresponding reduction in
Index of Sec 312. ...COMPENSATION of employee not to be treated as amount paid by employer ; Corresponding reduction in
Index of Sec 312. ...COMPENSATION from employer for services performed in trade or business of employer during taxable year ; Term qualified employee meaning employee of employer for taxable year of employer if employee received $5,000 of
Index of Sec 421. ...COMPENSATION paid by employer to employee during taxable year exceeding $80,000 ; No credit to be allowed under subsection with respect to qualified employee health coverage expensing paid or incurred with respect to employee for taxable year if aggregate
Index of Sec 421. ...COMPENSATION of Employees ; Phaseout based on Average
Index of Sec 421. ...COMPENSATION paid by employer to qualified employees of employer during taxable year ; Average amount of
Index of Sec 421. ...COMPENSATION having meaning given term in section 408(p)(6)(a) ; Term
Index of Sec 421. ...COMPENSATION or anything of value to employees, agents or contractors in manner encouraging denials of claims for benefits ; Program not permitting or providing
Index of Sec 139. ...COMPETITIVE disadvantage ; Secretary delaying implementation reform in geographic areas in which implementation placing public health insurance option at
Index of Sec 224. ...COMPLIANCE with Federal requirements ; Commissioner conducting audits of qualified health benefits planning
Index of Sec 142. ...COMPLIANCE with Federal requirements ; Commissioner conducting audits of qualified health benefits planning
Index of Sec 142. ...COMPLIANCE with Federal requirements ; Commissioner conducting audits of qualified health benefits planning
Index of Sec 142. ...CIVIL monetary and programmatic penalties for non-compliance consistent with existing laws and regulations and fair and reasonable appeals processing building off of enforcement provisions under part ; Enforcement process including timely investigation of complaints, random audits to ensure compliance,
Index of Sec 163. ...CIVIL monetary and programmatic penalties for non-compliance consistent with existing laws and regulations and fair and reasonable appeals processing building off of enforcement provisions under part ; Enforcement process including timely investigation of complaints, random audits to ensure compliance,
Index of Sec 164. ...COMPLIANCE with standards for approval under section ; Commissioner establishing process to work with State described in subparagraph to provide assistance necessary to assure that State's Exchange coming into
Index of Sec 208. ...COMPLIANCE ; Secretary taking timely enforcement action as appropriate to achieve
Index of Sec 321. ...COMPLIANCE ; Secretary taking timely enforcement action as appropriate to achieve
Index of Sec 321. ...COMPLIANCE with health coverage participation requirements ; Periodic investigations to determine
Index of Sec 323. ...COMPLIANCE with health coverage participation requirements ; Periodic investigations to determine
Index of Sec 323. ...COMPLIANCE audits and targeted audits in response to complaints or other suspected non-compliance ; Audits including random
Index of Sec 142. ...COMPLIANCE audits and targeted audits in response to complaints or other suspected non-compliance ; Audits including random
Index of Sec 142. ...COMPLIANCE audits and targeted audits in response to complaints or other suspected non-compliance ; Audits including random
Index of Sec 142. ...COMPLIANCE with entity's determination and subparagraph ; Submitting information to entity documenting
Index of 0COMPLIANCE procedures established by Commissioner ; Determination by Commissioner to terminate contract to be made in accordance with formal investigation and
Index of Sec 204. ...COMPLIANCE procedures established by Commissioner ; Determination by Commissioner to terminate contract to be made in accordance with formal investigation and
Index of Sec 204. ...COMPLIANCE procedures established by Commissioner ; Determination by Commissioner to terminate contract to be made in accordance with formal investigation and
Index of Sec 204. ...CONFIRATIONS of Special Inspector General and annually Special Inspector General submitting to appropriate committees of Congress report summarizing activities of Special Inspector General during one year period ending on date ; Not later than one year after
Index of Sec 206. ...CONFIRATIONS of Special Inspector General and annually Special Inspector General submitting to appropriate committees of Congress report summarizing activities of Special Inspector General during one year period ending on date ; Not later than one year after
Index of Sec 206. ...CONFIRATIONS of Special Inspector General and annually Special Inspector General submitting to appropriate committees of Congress report summarizing activities of Special Inspector General during one year period ending on date ; Not later than one year after
Index of Sec 206. ...CHILD'S congenital or developmental deformity, disease or injury ; Group health plan and health insurance issuer offering group health insurance coverage providing coverage for surgical benefits providing coverage for outpatient and inpatient diagnosis and treatment of minor
Index of Sec 163. ...CHILD'S congenital or developmental deformity, disease or injury ; Health insurance issuer offering health insurance coverage in individual market providing coverage for surgical benefits providing coverage for outpatient and inpatient diagnosis and treatment of minor
Index of Sec 163. ...CHILD'S congenital or developmental deformity or disorder ; Sec 2708, standards relating to Benefits for minor
Index of Sec 163. ...CHILD'S congenital or developmental deformity or disorder ; Sec 2755, standards relating to Benefits for minor
Index of Sec 163. ...CONGENITAL defects, developmental abnormalities, trauma, infection, tumors or disease ; Term treatment including reconstructive surgical procedures performed on abnormal structures of body causes by
Index of Sec 163. ...CONGENITAL defects, developmental abnormalities, trauma, infection, tumors or disease ; Treatment including reconstructive surgical procedures performed on abnormal structures of body causes by
Index of Sec 163. ...CONSTRAINTS for electronic transactions including companion guides ; Permitting no additions or
Index of Sec 163. ...CONSTRAINTS for electronic transactions including companion guides ; Permitting no additions or
Index of Sec 164. ...HEALTH plan or arrangement ; Case of group health plan consisting of consumer-directed
Index of Sec 102. ...ETHNIC disparities ; Membership of Health benefiting Advisory Committee reflecting providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and
Index of Sec 123. ...ETHNIC disparities ; Membership of Health benefiting Advisory Committee reflecting providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and
Index of Sec 123. ...HEALTH benefits to residents of State and providing measures to assure free choice of providers for covered services to promote quality and helping resolve complaints and disputes between consumers and providers ; Providing comprehensive
Index of Sec 253. ...CONSUMER focus including timeliness ; Cooperative operating with strong
Index of Sec 252. ...CONSUMER protections ; Purpose of title to establish standards to ensure that new health insurance coverage and employment-based health plans offered meet standards guaranteeing access to affordable coverage, essential benefits and other
Index of Sec 101. ...CONSUMER protections ; Purpose of title to establish standards to ensure that new health insurance coverage and employment-based health plans offered meet standards guaranteeing access to affordable coverage, essential benefits and other
Index of Sec 101. ...CONSUMER protections ; Purpose of title to establish standards to ensure that new health insurance coverage and employment-based health plans offered meet standards guaranteeing access to affordable coverage, essential benefits and other
Index of Sec 101. ...CONSUMER protections under subtitle D of title I ; Includ establishment of risk pooling mechanism under section 206 and
Index of Sec 201. ...CONSUMER protections under subtitle D of title I ; Includ establishment of risk pooling mechanism under section 206 and
Index of Sec 201. ...CONSUMER protections under subtitle D of title I ; Includ establishment of risk pooling mechanism under section 206 and
Index of Sec 201. ...CONSUMER satisfaction ; Information to be provided in comparative manner and including information on benefits premiums, cost-sharing, quality, provider networks and
Index of Sec 205. ...CONSUMER satisfaction ; Information to be provided in comparative manner and including information on benefits premiums, cost-sharing, quality, provider networks and
Index of Sec 205. ...CONSUMER satisfaction ; Information to be provided in comparative manner and including information on benefits premiums, cost-sharing, quality, provider networks and
Index of Sec 205. ...CONTRACT with pharmacy benefit managers to manage prescription drug coverage provided under plan or controlling costs of prescription drug coverage ; Qualified health benefits planning entering into
Index of Sec 133. ...CONTRACT filled via mail order and retail pharmacies ; Information on volume of prescriptions under
Index of Sec 133. ...CONTRACT received from pharmaceutical manufacturers including rebates ; Estimate of aggregate average payment per prescription under
Index of Sec 133. ...CONTRACT at retail and mail order pharmacies and percentage of cases in which generic drug dispensed when available ; Information on overall percentage of generic drugs dispensed under
Index of Sec 133. ...CONTRACT in which individuals switched from prescribed drug being less expensive to drug being more expensive ; Information on percentage and number of cases under
Index of Sec 133. ...CONTRACT or otherwise for persons or entities to conduct utilization review activities on behalf of plan entity ; Nothing in section to be construed as preventing qualified health benefits planning or QHBP offering entity from arranging through
Index of Sec 139. ...CONTRACT between plan or issuer and one or more qualified external appeal entities ; External appeal process under section of plan or entity to be conducted under
Index of 0CONTRACT providing that costs of process to be paid by plan or entity and not by participant, beneficiary or enrollee ;
Index of 0CONTRACT with qualified health benefits planning under part and no person employed entitying or furnishing professional services to entity ; No qualified external appeal entity having
Index of 0CONTRACT with QHBP offering entity under section 204(c) for offering of Exchange-participating health benefits planning in service area unless following requirements being met ; Commissioner not entering into
Index of Sec 203. ...CONTRACT with QHBP offering entity under section 204(c) for offering of Exchange-participating health benefits planning in service area unless following requirements being met ; Commissioner not entering into
Index of Sec 203. ...CONTRACT with QHBP offering entity under section 204(c) for offering of Exchange-participating health benefits planning in service area unless following requirements being met ; Commissioner not entering into
Index of Sec 203. ...CONTRACT with QHBP offering entity under section for term of not less than one year ;
Index of Sec 204. ...CONTRACT with QHBP offering entity under section for term of not less than one year ;
Index of Sec 204. ...CONTRACT with QHBP offering entity under section for term of not less than one year ;
Index of Sec 204. ...CONTRACT with QHBP offering entity under section for offering of Exchange-participating health benefits planning if entity failing to comply with applicable requirements of title ; Commissioner terminating
Index of Sec 204. ...CONTRACT with QHBP offering entity under section for offering of Exchange-participating health benefits planning if entity failing to comply with applicable requirements of title ; Commissioner terminating
Index of Sec 204. ...CONTRACT with QHBP offering entity under section for offering of Exchange-participating health benefits planning if entity failing to comply with applicable requirements of title ; Commissioner terminating
Index of Sec 204. ...CONTRACT ; Commissioner providing entity with reasonable notice and opportunity for hearing before terminating
Index of Sec 204. ...CONTRACT ; Commissioner providing entity with reasonable notice and opportunity for hearing before terminating
Index of Sec 204. ...CONTRACT ; Commissioner providing entity with reasonable notice and opportunity for hearing before terminating
Index of Sec 204. ...CONTRACT or arrangement for health care with health care provider ; Nothing in Act to be construed to preclude participant or beneficiary in group health plan from entering into
Index of Sec 158. ...CONTRACT with Commissioner ; Plans to be offered under single
Index of Sec 203. ...CONTRACT with Commissioner ; Plans to be offered under single
Index of Sec 203. ...CONTRACT with Commissioner ; Plans to be offered under single
Index of Sec 203. ...CONTRACT under paragraph to be consistent with standards appropriate Secretary establishing to assure being no real or apparent conflict of interest in conduct of external appeal activities ; Terms and conditions of
Index of 0CONTRACTS with entities for offering of plans through Health Insurance Exchange under terms negotiated between Commissioner and entities ; Entering into
Index of Sec 204. ...CONTRACTS with entities for offering of plans through Health Insurance Exchange under terms negotiated between Commissioner and entities ; Entering into
Index of Sec 204. ...CONTRACTS with entities for offering of plans through Health Insurance Exchange under terms negotiated between Commissioner and entities ; Entering into
Index of Sec 204. ...CONTRACTS between Commissioner and QHBP offering entities for offering of Exchange-participating health benefits planing under title ; Provisions of Federal Acquisition Regulation not applying to
Index of Sec 204. ...CONTRACTS between Commissioner and QHBP offering entities for offering of Exchange-participating health benefits planing under title ; Provisions of Federal Acquisition Regulation not applying to
Index of Sec 204. ...CONTRACTS between Commissioner and QHBP offering entities for offering of Exchange-participating health benefits planing under title ; Provisions of Federal Acquisition Regulation not applying to
Index of Sec 204. ...CONSUMER information, outreach and assistance in enrollment of small employers being members arrangement under Exchange participating health benefits planing ; Commissioner entering into contracts with small employer benefit arrangements to provide
Index of Sec 209. ...ADMINISTRATIVE functions of section 1874a of Social Security Act with respect to public health insurance option in same manner as Secretary entering into contracts under subsection of section ; Secretary entering into contracts for purpose of performing
Index of Sec 221. ...ADMINISTRATIVE functions of section 1874a of Social Security Act with respect to public health insurance option in same manner as Secretary entering into contracts under subsection of section ; Secretary entering into contracts for purpose of performing
Index of Sec 221. ...ADMINISTRATIVE functions of section 1874a of Social Security Act with respect to public health insurance option in same manner as Secretary entering into contracts under subsection of section ; Secretary entering into contracts for purpose of performing
Index of Sec 221. ...CONTRIBUTION described in section 313(a) ; Individual to be treated in same manner as employee of employer making
Index of Sec 242. ...CONTRIBUTION specified in subsection for coverage ; Employer timely paying to issuer of coverageing amount not less than employer required
Index of Sec 312. ...CONTRIBUTION specified in subsection for coverage ; Employer timely paying to issuer of coverageing amount not less than employer required
Index of Sec 312. ...CONTRIBUTION specified in subsection for coverage ; Employer timely paying to issuer of coverageing amount not less than employer required
Index of Sec 312. ...CONTRIBUTION being equal to amount equal to 8 percent of average wages paid by employer during period of enrollment ; Contribution being made in accordance with section with respect to employee if
Index of Sec 313. ...CONTRIBUTION being equal to amount equal to 8 percent of average wages paid by employer during period of enrollment ; Contribution being made in accordance with section with respect to employee if
Index of Sec 313. ...CONTRIBUTION being equal to amount equal to 8 percent of average wages paid by employer during period of enrollment ; Contribution being made in accordance with section with respect to employee if
Index of Sec 313. ...CONTRIBUTIONS to fund plan ; Active employee of employer maintaining plan or employer making making substantial
Index of Sec 164. ...CONTRIBUTIONS to fund plan ; Active employee of employer maintaining plan or employer making making substantial
Index of Sec 164. ...CONTRIBUTIONS to fund plan ; Active employee of employer maintaining plan or employer making making substantial
Index of Sec 166. ...TITLE II ; Health insurance coverage including cooperative under subtitle D of
Index of Sec 100. ...COOPERATIVE ; No member having more than 5 percent voting interest in
Index of Sec 209. ...LOAN not to be awarded under section with respect to cooperative unless following conditions being met ; Grant or
Index of Sec 252. ...COOPERATIVE ; Membership of cooperative to be making up entirely of beneficiaries of insurance coverage offered by
Index of Sec 252. ...COOPERATIVE ; Governing documents of cooperatives incorporating ethical and conflict of interest standards designed to protect against insurance industry involvement and interference in governance of
Index of Sec 252. ...COOPERATIVE consisting of issuance of qualified health benefit plans through Health Insurance Exchange or State-based health insurance exchange ; Activities of
Index of Sec 252. ...CONSUMER focus including timeliness ; Cooperative operating with strong
Index of Sec 252. ...COOPERATIVE used to lowing premiums ; Profits making by
Index of Sec 252. ...COOPERATIVE established in another State administration, issuance of coverage or other activities related to acting as QHBP offering entity ; Nothing in subtitle to be construed to prevent cooperative established in one State from integrating with
Index of Sec 252. ...COOPERATIVE violating terms of co-op program and failing to correct violation within reasonable period of time, determined by Commissioner ;
Index of Sec 252. ...COOPERATIVE offers or issuing insurance coverage ; Grants to cooperatives to assist cooperatives in meeting State solvency requirements in States in which
Index of Sec 252. ...FOREIGN parent corporation ; Withholding tax imposed under chapter 3 with respect to payment not to be reduced under treaty of United States unless withholding tax to be reduced under treaty of United States if payment being made directly to
Index of Sec 451. ...COSMETIC surgery performed to reshape normal structures of body to improve appearance or self-esteem ; Term not including
Index of Sec 163. ...COSMETIC surgery performed to reshape normal structures of body to improve appearance or self-esteem ; Term not including
Index of Sec 163. ...CREDIT determined under subsection to be reduced by amount ;
Index of Sec 421. ...AFFORDABILITY credit only with respect to basic plan ; Y1 and Y2 affordable credit eligible individual using
Index of Sec 241. ...AFFORDABILITY credit only with respect to basic plan ; Y1 and Y2 affordable credit eligible individual using
Index of Sec 241. ...AFFORDABILITY credit only with respect to basic plan ; Y1 and Y2 affordable credit eligible individual using
Index of Sec 241. ...AFFORDABILITY credit to be used for enrollees in enhanced or premium plans ; Commissioner establishing process to allow
Index of Sec 241. ...AFFORDABILITY credit to be used for enrollees in enhanced or premium plans ; Commissioner establishing process to allow
Index of Sec 241. ...AFFORDABILITY credit to be used for enrollees in enhanced or premium plans ; Commissioner establishing process to allow
Index of Sec 241. ...AFFORDABILITY credit not to be used for payment for services described in section 122(d)(4)(a) ;
Index of Sec 241. ...AFFORDABILITY credit based upon significant change in family income described in subparagraph ; Initial application of individual for affordability credit under subtitle or application for change in
Index of Sec 245. ...AFFORDABILITY credit based upon significant change in family income described in subparagraph ; Initial application of individual for affordability credit under subtitle or application for change in
Index of Sec 245. ...AFFORDABILITY credit based upon significant change in family income described in subparagraph ; Initial application of individual for affordability credit under subtitle or application for change in
Index of Sec 245. ...AFFORDABILITY credit described in subtitle C of title II of America's Affordable Health Choices acting of 2009 ; Return information of taxpayer whose income being relevant in determining
Index of Sec 431. ...CREDIT under section 243 to be applied against premium for Exchange-participating health benefits planning in which individual enrolled ; Affordability premium
Index of Sec 241. ...CREDIT under section 243 to be applied against premium for Exchange-participating health benefits planning in which individual enrolled ; Affordability premium
Index of Sec 241. ...CREDIT under section 243 to be applied against premium for Exchange-participating health benefits planning in which individual enrolled ; Affordability premium
Index of Sec 241. ...CREDIT eligible individual enrolled in Exchange-participating health benefits planning in amount equal to amount by which premium for plan if less ; Affordability premium credit under section for affordable
Index of Sec 243. ...CREDIT eligible individual enrolled in Exchange-participating health benefits planning in amount equal to amount by which premium for plan if less ; Affordability premium credit under section for affordable
Index of Sec 243. ...CREDIT eligible individual enrolled in Exchange-participating health benefits planning in amount equal to amount by which premium for plan if less ; Affordability premium credit under section for affordable
Index of Sec 243. ...CREDIT eligible individual enrolled in Exchange-participating health benefits planning ; Case of affordable
Index of Sec 241. ...CREDIT eligible individual enrolled in Exchange-participating health benefits planning ; Case of affordable
Index of Sec 241. ...CREDIT eligible individual enrolled in Exchange-participating health benefits planning ; Case of affordable
Index of Sec 241. ...CREDIT eligible individuals enrolled in plan ; Commissioner paying QHBP offering entity offering plan from Health Insurance Exchange Trust Fund aggregate amount of affordability credits for affordable
Index of Sec 241. ...CREDIT eligible individuals enrolled in plan ; Commissioner paying QHBP offering entity offering plan from Health Insurance Exchange Trust Fund aggregate amount of affordability credits for affordable
Index of Sec 241. ...CREDIT eligible individuals enrolled in plan ; Commissioner paying QHBP offering entity offering plan from Health Insurance Exchange Trust Fund aggregate amount of affordability credits for affordable
Index of Sec 241. ...AFFORDABILITY credit only with respect to basic plan ; Y1 and Y2 affordable credit eligible individual using
Index of Sec 241. ...AFFORDABILITY credit only with respect to basic plan ; Y1 and Y2 affordable credit eligible individual using
Index of Sec 241. ...AFFORDABILITY credit only with respect to basic plan ; Y1 and Y2 affordable credit eligible individual using
Index of Sec 241. ...CREDIT eligible individual enrolling in enhanced or premium plan ; Case of affordable
Index of Sec 241. ...CREDIT eligible individual enrolling in enhanced or premium plan ; Case of affordable
Index of Sec 241. ...CREDIT eligible individual enrolling in enhanced or premium plan ; Case of affordable
Index of Sec 241. ...CREDIT eligible individual receiving cash payment as result of application of subtitle ; No case affordable
Index of Sec 241. ...CREDIT eligible individual receiving cash payment as result of application of subtitle ; No case affordable
Index of Sec 241. ...CREDIT eligible individual receiving cash payment as result of application of subtitle ; No case affordable
Index of Sec 241. ...CREDIT eligible individuals to be treated as single affordable credit individual eligible for applicable credit family under subtitle ; Members of same family being affordable
Index of Sec 242. ...CREDIT eligible individuals to be treated as single affordable credit individual eligible for applicable credit family under subtitle ; Members of same family being affordable
Index of Sec 242. ...CREDIT eligible individuals to be treated as single affordable credit individual eligible for applicable credit family under subtitle ; Members of same family being affordable
Index of Sec 242. ...CONTRIBUTION under plan meet requirements of section 312 ; Term affordable credit eligible individual not including full-time employee of employer if employer offering employee coverage as full-time employee under group health plan if coverage and employer
Index of Sec 242. ...CONTRIBUTION under plan meet requirements of section 312 ; Term affordable credit eligible individual not including full-time employee of employer if employer offering employee coverage as full-time employee under group health plan if coverage and employer
Index of Sec 242. ...CONTRIBUTION under plan meet requirements of section 312 ; Term affordable credit eligible individual not including full-time employee of employer if employer offering employee coverage as full-time employee under group health plan if coverage and employer
Index of Sec 242. ...CREDIT eligible individual enrolled in Exchange-participating health benefits planning in amount equal to amount by which premium for plan if less ; Affordability premium credit under section for affordable
Index of Sec 243. ...CREDIT eligible individual enrolled in Exchange-participating health benefits planning in amount equal to amount by which premium for plan if less ; Affordability premium credit under section for affordable
Index of Sec 243. ...CREDIT eligible individual enrolled in Exchange-participating health benefits planning in amount equal to amount by which premium for plan if less ; Affordability premium credit under section for affordable
Index of Sec 243. ...CREDIT eligible individual enrolled in Exchange-participating health benefits planning in form of cost-sharing reduction described in subsection provided under section for income tier in which individual classified based on individual's family income ; Affordability cost-sharing credit under section for affordable
Index of Sec 244. ...CREDIT eligible individual enrolled in Exchange-participating health benefits planning in form of cost-sharing reduction described in subsection provided under section for income tier in which individual classified based on individual's family income ; Affordability cost-sharing credit under section for affordable
Index of Sec 244. ...CREDIT eligible individual enrolled in Exchange-participating health benefits planning in form of cost-sharing reduction described in subsection provided under section for income tier in which individual classified based on individual's family income ; Affordability cost-sharing credit under section for affordable
Index of Sec 244. ...CREDIT eligible individual in tier enrolled in Exchange-participating health benefits planning offered by QHBP offering entity ; Case of affordable
Index of Sec 244. ...CREDIT eligible individual in tier enrolled in Exchange-participating health benefits planning offered by QHBP offering entity ; Case of affordable
Index of Sec 244. ...CREDIT eligible individual in tier enrolled in Exchange-participating health benefits planning offered by QHBP offering entity ; Case of affordable
Index of Sec 244. ...CREDIT eligible individual to be required to inform Commissioner ; Commissioner establishing rules under which individual determined to be affordable
Index of Sec 245. ...CREDIT eligible individual to be required to inform Commissioner ; Commissioner establishing rules under which individual determined to be affordable
Index of Sec 245. ...CREDIT eligible individual to be required to inform Commissioner ; Commissioner establishing rules under which individual determined to be affordable
Index of Sec 245. ...AFFORDABILITY credit exceeding correct amount ; Case of individual intentionally misrepresenting family income or individual failing to disclose to Commissioner significant change in family income under subsection in manner resulting in individual becoming affordable credit eligible individual when individual being not or amount of
Index of Sec 245. ...AFFORDABILITY credit exceeding correct amount ; Case of individual intentionally misrepresenting family income or individual failing to disclose to Commissioner significant change in family income under subsection in manner resulting in individual becoming affordable credit eligible individual when individual being not or amount of
Index of Sec 245. ...AFFORDABILITY credit exceeding correct amount ; Case of individual intentionally misrepresenting family income or individual failing to disclose to Commissioner significant change in family income under subsection in manner resulting in individual becoming affordable credit eligible individual when individual being not or amount of
Index of Sec 245. ...CREDIT under chapter or purposes of section 55 ; Tax imposed under section not to be treated as tax imposed by chapter for purposes of determining amount of
Index of Sec 401. ...CREDIT determined under section ; Deduction otherwise allowable with respect to amounts paid or incurred for health insurance coverage to which subsection applying to be reduced by amount of
Index of Sec 421. ...CREDIT under chapter or purposes of section 55 ; Tax imposed under section not to be treated as tax imposed by chapter for purposes of determining amount of
Index of Sec 441. ...AFFORDABILITY credit exceeding correct amount ; Case of individual intentionally misrepresenting family income or individual failing to disclose to Commissioner significant change in family income under subsection in manner resulting in individual becoming affordable credit eligible individual when individual being not or amount of
Index of Sec 245. ...AFFORDABILITY credit exceeding correct amount ; Case of individual intentionally misrepresenting family income or individual failing to disclose to Commissioner significant change in family income under subsection in manner resulting in individual becoming affordable credit eligible individual when individual being not or amount of
Index of Sec 245. ...AFFORDABILITY credit exceeding correct amount ; Case of individual intentionally misrepresenting family income or individual failing to disclose to Commissioner significant change in family income under subsection in manner resulting in individual becoming affordable credit eligible individual when individual being not or amount of
Index of Sec 245. ...CREDIT family under subtitle ; Members of same family being affordable credit eligible individuals to be treated as single affordable credit individual eligible for applicable
Index of Sec 242. ...CREDIT family under subtitle ; Members of same family being affordable credit eligible individuals to be treated as single affordable credit individual eligible for applicable
Index of Sec 242. ...CREDIT family under subtitle ; Members of same family being affordable credit eligible individuals to be treated as single affordable credit individual eligible for applicable
Index of Sec 242. ...AFFORDABILITY credit described in subtitle C of title II of America's Affordable Health Choices acting of 2009 and providing for repayment credit in excess of appropriate amount ; Establishing and verifying appropriate amount of
Index of Sec 431. ...COMPENSATION paid by employer to employee during taxable year exceeding $80,000 ; No credit to be allowed under subsection with respect to qualified employee health coverage expensing paid or incurred with respect to employee for taxable year if aggregate
Index of Sec 421. ...CREDIT in excess of appropriate amount ; Establishing and verifying appropriate amount of affordability credit described in subtitle C of title II of America's Affordable Health Choices acting of 2009 and providing for repayment
Index of Sec 431. ...CREDIT under section 244 to be applied as reduction of cost-sharing otherwise applicable to plan ; Affordability cost-sharing
Index of Sec 241. ...CREDIT under section 244 to be applied as reduction of cost-sharing otherwise applicable to plan ; Affordability cost-sharing
Index of Sec 241. ...CREDIT under section 244 to be applied as reduction of cost-sharing otherwise applicable to plan ; Affordability cost-sharing
Index of Sec 241. ...CREDIT eligible individual enrolled in Exchange-participating health benefits planning in form of cost-sharing reduction described in subsection provided under section for income tier in which individual classified based on individual's family income ; Affordability cost-sharing credit under section for affordable
Index of Sec 244. ...CREDIT eligible individual enrolled in Exchange-participating health benefits planning in form of cost-sharing reduction described in subsection provided under section for income tier in which individual classified based on individual's family income ; Affordability cost-sharing credit under section for affordable
Index of Sec 244. ...CREDIT eligible individual enrolled in Exchange-participating health benefits planning in form of cost-sharing reduction described in subsection provided under section for income tier in which individual classified based on individual's family income ; Affordability cost-sharing credit under section for affordable
Index of Sec 244. ...CREDIT family under subtitle ; Members of same family being affordable credit eligible individuals to be treated as single affordable credit individual eligible for applicable
Index of Sec 242. ...CREDIT family under subtitle ; Members of same family being affordable credit eligible individuals to be treated as single affordable credit individual eligible for applicable
Index of Sec 242. ...CREDIT family under subtitle ; Members of same family being affordable credit eligible individuals to be treated as single affordable credit individual eligible for applicable
Index of Sec 242. ...AFFORDABILITY credit amount otherwise applicable if individual enrolling in basic plan ; Individual to be responsible for difference between premium for planning and
Index of Sec 241. ...CREDIT amount otherwise applicable if individual enrolling in basic plan ; Individual to be responsible for difference between premium for planning and affordable
Index of Sec 241. ...CREDIT amount otherwise applicable if individual enrolling in basic plan ; Individual to be responsible for difference between premium for planning and affordable
Index of Sec 241. ...CRIMINAL law being civilly liable under law of United States or State if due care exercised in performance of dutying, functioning or activity and no actual malice or gross misconduct in performance of dutying, functioning or activity ; Violating
Index of 0DENTAL only or vision only coverage ; Nothing in subtitle to be construed as requiring individual being 21 years of age or older to be provided stand alone
Index of Sec 122. ...VISION carrier ; Offer coverage of excepted benefits described in section 2791(c)(2)(a) of Public Health Service Act for individuals and families from State licensed dental and
Index of Sec 102. ...DEVELOPMENTAL abnormalities, trauma, infection, tumors or disease ; Term treatment including reconstructive surgical procedures performed on abnormal structures of body causes by congenital defects,
Index of Sec 163. ...DEVELOPMENTAL abnormalities, trauma, infection, tumors or disease ; Treatment including reconstructive surgical procedures performed on abnormal structures of body causes by congenital defects,
Index of Sec 163. ...COINSURANCE, copayments and similar charges but not including premiums or network payment differential for covered services or spending for non-covered services ; Term cost-sharing including deductibles,
Index of Sec 100. ...COINSURANCE, copayments and similar charges but not including premiums or network payment differential for covered services or spending for non-covered services ; Term cost-sharing including deductibles,
Index of Sec 100. ...COINSURANCE, copayments and similar charges but not including premiums or network payment differential for covered services or spending for non-covered services ; Term cost-sharing including deductibles,
Index of Sec 100. ...DISABILITIES, representatives of relevant governmental agencies and one practicing physician or other health professional and expert on children's health and representing balance among various sectors of health care system so ;
Index of Sec 123. ...DISABILITIES, representatives of relevant governmental agencies and one practicing physician or other health professional and expert on children's health and representing balance among various sectors of health care system so ;
Index of Sec 123. ...DISABILITIES, representatives of relevant governmental agencies and one practicing physician or other health professional and expert on children's health and representing balance among various sectors of health care system so ;
Index of Sec 123. ...DISABILITY, socioeconomic status, rural, urban or other geographic setting and other population or subpopulation as determined appropriate by Secretary ; Primary language, sex, sexual orientation, gender identity,
Index of Sec 221. ...DISALLOWANCE of claimed tax benefits by reason of transaction lacking economic substance or failing to meet requirements of similar rule of law ;
Index of Sec 453. ...DISCLOSURE to be provided in plain language ; Commissioner requiring that
Index of Sec 133. ...DISCLOSURE to be provided in plain language ; Commissioner requiring that
Index of Sec 133. ...DISCLOSURE to be provided in plain language ; Commissioner requiring that
Index of Sec 133. ...DISCLOSURE required under subsection identification to enrollees of providers of services under plan trained and accredited in integrative health medicine ; Qualified health benefit plan including in
Index of Sec 133. ...DISCLOSURE of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other information as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely
Index of Sec 133. ...DISCLOSURE of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other information as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely
Index of Sec 133. ...DISCLOSURE of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other information as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely
Index of Sec 133. ...DISCLOSURE, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other information as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial
Index of Sec 133. ...DISCLOSURE, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other information as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial
Index of Sec 133. ...DISCLOSURE, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other information as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial
Index of Sec 133. ...DISCLOSURE of individually identifiable health information ; Part C of title XI of Social Security Act relating to standards for protections against wrongful
Index of Sec 228. ...DISCLOSURES ; Procedures and recordkeeping related to
Index of Sec 431. ...DISCRIMINATION in health benefits or benefit structures for qualifing health benefits ; Qualified health benefits planning complying with standards established by Commissioner to prohibit
Index of Sec 114. ...DISCRIMINATION in health benefits or benefit structures for qualified health benefits ; Qualified health benefits planning complying with standards established by Commissioner to prohibit
Index of Sec 114. ...DISCRIMINATION in health benefits or benefit structures for qualifing health benefits ; Qualified health benefits planning complying with standards established by Commissioner to prohibit
Index of Sec 114. ...DISCRIMINATION in health Care ; Sec 152 prohibiting
Index of Sec 152. ...DISCRIMINATION in health Care ; Sec 152 prohibiting
Index of Sec 152. ...DISCRIMINATION in health Care ; Sec 152 prohibiting
Index of Sec 152. ...DISCRIMINATION by employer in violation of subsection bringing action governed by rules, procedures, legal burdens of proof and remedies setting forth in section 40(b) of Consumer Product Safety Act 15 USC 2087(b) ; Employee covered by section alleging
Index of Sec 153. ...DISCRIMINATION by employer in violation of subsection bringing action governed by rules, procedures, legal burdens of proof and remedies setting forth in section 40(b) of Consumer Product Safety Act 15 USC 2087(b) ; Employee covered by section alleging
Index of Sec 153. ...DISCRIMINATION by employer in violation of subsection bringing action governed by rules, procedures, legal burdens of proof and remedies setting forth in section 40(b) of Consumer Product Safety Act 15 USC 2087(b) ; Employee covered by section alleging
Index of Sec 153. ...DISCRIMINATION based on section and coordinating investigation of complaints ; Office for Civil Rights of Department of Health and Human Services designated to receive complaints of
Index of Sec 157. ...DISCRIMINATION in health Care Services based on religious or spiritual content ; Sec 125, prohibition of
Index of Sec 125. ...DISCRIMINATION in health Care Services based on religious or spiritual content ; Sec 125, prohibition of
Index of Sec 125. ...INFORMATION as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other
Index of Sec 133. ...INFORMATION as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other
Index of Sec 133. ...INFORMATION as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other
Index of Sec 133. ...DISENROLLMENT plan ; Assistance to individuals with problems arising from
Index of Sec 144. ...DISENROLLMENT plan ; Assistance to individuals with problems arising from
Index of Sec 144. ...DISENROLLMENT plan ; Assistance to individuals with problems arising from
Index of Sec 144. ...AFFORDABILITY premium and cost-sharing credits under subtitle C to QHBP offering entities offering Exchange-participating health benefits planing ; Commissioner coordinating distribution of
Index of Sec 206. ...AFFORDABILITY premium and cost-sharing credits under subtitle C to QHBP offering entities offering Exchange-participating health benefits planing ; Commissioner coordinating distribution of
Index of Sec 206. ...AFFORDABILITY premium and cost-sharing credits under subtitle C to QHBP offering entities offering Exchange-participating health benefits planing ; Commissioner coordinating distribution of
Index of Sec 206. ...DOCUMENTATION of actual costs of items and services For which claim submitted ; Participating employment-based plan submitting claims for reimbursement to Secretary containing
Index of Sec 164. ...DOCUMENTATION of actual costs of items and services For which claim submitted ; Participating employment-based plan submitting claims for reimbursement to Secretary containing
Index of Sec 164. ...DOCUMENTATION of actual costs of items and services For which claim submitted ; Participating employment-based plan submitting claims for reimbursement to Secretary containing
Index of Sec 166. ...COMPARATIVE analysis ; Reports containing sufficient documentation regarding effectiveness of laws to enable objective
Index of Sec 208. ...DRUG being more expensive ; Information on percentage and number of cases under contract in which individuals switched from prescribed drug being less expensive to
Index of Sec 133. ...DRUG or insulin ; Term including amount paid for medicine or drug only if medicineing or drugging being prescribed
Index of Sec 442. ...DRUG or insulin ; Term including amount paid for medicine or drug only if medicineing or drugging being prescribed
Index of Sec 442. ...DRUG or insulin ; Reimbursement for expenses incurred for medicine or drug to be treated as reimbursement for medical expenses only if medicineing or drugging being prescribed
Index of Sec 442. ...DRUG dispensed when available ; Information on overall percentage of generic drugs dispensed under contract at retail and mail order pharmacies and percentage of cases in which generic
Index of Sec 133. ...DRUG or other item included in health care involved in coverage decision ; Manufacturer of
Index of 0DRUG being less expensive to drug being more expensive ; Information on percentage and number of cases under contract in which individuals switched from prescribed
Index of Sec 133. ...DRUG coverage ; Qualified health benefits planning entering into contract with pharmacy benefit managers to manage prescription drug coverage provided under plan or controlling costs of prescription
Index of Sec 133. ...DRUG coverage provided under plan or controlling costs of prescription drug coverage ; Qualified health benefits planning entering into contract with pharmacy benefit managers to manage prescription
Index of Sec 133. ...DRUG prices and spending ; Permitting Commissioner to disclose industry-wide aggregate or average information to be used in assessing overall impact of PBMS on prescription
Index of Sec 133. ...DUTY of Task Force to make recommendations to Committee on evidence-based ;
Index of Sec 123. ...ECONOMIC relationships among entities ; Treatment of member of foreign controlled group of entities as common parent of group if treatment being appropriate taking into account
Index of Sec 451. ...ECONOMIC substance only ; Transaction to be treated as
Index of Sec 452. ...ECONOMIC substance or lacking business purpose ; Term economic substance doctrine meaning common law doctrine under which tax benefits under subtitle A with respect to transaction being not allowable if transaction not to have
Index of Sec 452. ...ECONOMIC substance ; Penalty for underpayments attributable to transactions lacking
Index of Sec 453. ...ECONOMIC substance or failing to meet requirements of similar rule of law ; Disallowance of claimed tax benefits by reason of transaction lacking
Index of Sec 453. ...ECONOMIC substance doctrine meaning common law doctrine under which tax benefits under subtitle A with respect to transaction being not allowable if transaction not to have economic substance or lacking business purpose ; Term
Index of Sec 452. ...ECONOMIC substance doctrine being relevant to transaction to be made in same manner ; Determination whether
Index of Sec 452. ...EDUCATIONAL activities to increase awareness of Health Insurance Exchange and available small employer health plan options ;
Index of Sec 206. ...EDUCATIONAL communications provided to patient about patient's health condition ; Care management
Index of Sec 138. ...ELECTRONIC funds transferring or electronic remittance in form as specified in X12 835 Health Care Payment and Remittance Advice or subsequent standard ; Payment being other than
Index of Sec 165. ...ELECTRONIC transaction deemed appropriate by Secretary ; Response and status reporting applicable to
Index of Sec 163. ...ELECTRONIC transaction with health care providers quickly and efficiently enrolling with health plan to conduct other electronic transactions provided in part ; Requiring use of standard
Index of Sec 163. ...ELECTRONIC transaction deemed appropriate by Secretary ; Response and status reporting applicable to
Index of Sec 164. ...ELECTRONIC transaction with health care providers quickly and efficiently enrolling with health plan to conduct other electronic transactions provided in part ; Requiring use of standard
Index of Sec 164. ...ELECTRONIC transaction to be populated from data from paper version ; Equivalent
Index of Sec 163. ...ELECTRONIC transaction to be populated from data from paper version ; Equivalent
Index of Sec 164. ...CONSTRAINTS for electronic transactions including companion guides ; Permitting no additions or
Index of Sec 163. ...ELECTRONIC transactions provided in part ; Requiring use of standard electronic transaction with health care providers quickly and efficiently enrolling with health plan to conduct other
Index of Sec 163. ...ELECTRONIC transactions ; Volunteer to participate in process of seting standards for
Index of Sec 163. ...CONSTRAINTS for electronic transactions including companion guides ; Permitting no additions or
Index of Sec 164. ...ELECTRONIC transactions provided in part ; Requiring use of standard electronic transaction with health care providers quickly and efficiently enrolling with health plan to conduct other
Index of Sec 164. ...ELECTRONIC transactions ; Volunteer to participate in process of seting standards for
Index of Sec 164. ...ELECTRONIC transmission intermediary, retail ; Records described in subsection not to be licensed, transferred, used or sold by pharmacy benefits manager, insurance company,
Index of Sec 138. ...ELIGIBILITY for health plan and health claiming status under section to be adopted not later than October 1, 2011 ; First set of operating rules for transactions for
Index of Sec 164. ...AFFORDABILITY credits under subtitle ; Commissioner through Health Insurance Exchange or another public entity under arrangement making with Commissioner making determination as to eligibility of individual for
Index of Sec 241. ...AFFORDABILITY credits under subtitle ; Commissioner through Health Insurance Exchange or another public entity under arrangement making with Commissioner making determination as to eligibility of individual for
Index of Sec 241. ...AFFORDABILITY credits under subtitle ; Commissioner through Health Insurance Exchange or another public entity under arrangement making with Commissioner making determination as to eligibility of individual for
Index of Sec 241. ...ELIGIBILITY or payment in whole or part for item or servicing under qualified health benefits planning ;
Index of Sec 139. ...ELIGIBILITY for credits ; Administration of individual affordability credits under subtitle C of title II including determination of
Index of Sec 142. ...ELIGIBILITY for credits ; Administration of individual affordability credits under subtitle C of title II including determination of
Index of Sec 142. ...ELIGIBILITY for credits ; Administration of individual affordability credits under subtitle C of title II including determination of
Index of Sec 142. ...AFFORDABILITY credits under subtitle and same standards as used by Commissioner ; Commissioner determining that State Medicaid agency having capacity to make determination of eligibility for
Index of Sec 241. ...AFFORDABILITY credits under subtitle and same standards as used by Commissioner ; Commissioner determining that State Medicaid agency having capacity to make determination of eligibility for
Index of Sec 241. ...AFFORDABILITY credits under subtitle and same standards as used by Commissioner ; Commissioner determining that State Medicaid agency having capacity to make determination of eligibility for
Index of Sec 241. ...ELIGIBILITY in health plans and other inapproations uses as defined by Secretary ; Stores or receiving data including use of data in determinations of
Index of Sec 163. ...ELIGIBILITY in health plans and other inapproations uses as defined by Secretary ; Stores or receiving data including use of data in determinations of
Index of Sec 164. ...ELIGIBILITY for individuals and employers ; Commissioner submitting to Congress on study conducted under subsection and including in report recommendations regarding changes in standards for Exchange
Index of Sec 202. ...ELIGIBILITY for individuals and employers ; Commissioner submitting to Congress on study conducted under subsection and including in report recommendations regarding changes in standards for Exchange
Index of Sec 202. ...ELIGIBILITY for individuals and employers ; Commissioner submitting to Congress on study conducted under subsection and including in report recommendations regarding changes in standards for Exchange
Index of Sec 202. ...CONTRIBUTIONS to fund plan ; Active employee of employer maintaining plan or employer making making substantial
Index of Sec 164. ...CONTRIBUTIONS to fund plan ; Active employee of employer maintaining plan or employer making making substantial
Index of Sec 164. ...CONTRIBUTIONS to fund plan ; Active employee of employer maintaining plan or employer making making substantial
Index of Sec 166. ...COLLECTIVE bargaining agreements between employee representatives and one or more employers ratified before date of enactment of Act ; Case of group health plan maintained pursuant to one or more
Index of Sec 166. ...COLLECTIVE bargaining agreements between employee representatives and one or more employers ratified before date of enactment of Act ; Case of group health plan maintained pursuant to one or more
Index of Sec 167. ...HEALTH benefits planing by employer of employee under subparagraph choosing coverage plan ; Employee offered Exchange-participating
Index of Sec 202. ...HEALTH benefits planing by employer of employee under subparagraph choosing coverage plan ; Employee offered Exchange-participating
Index of Sec 202. ...HEALTH benefits planing by employer of employee under subparagraph choosing coverage plan ; Employee offered Exchange-participating
Index of Sec 202. ...HEALTH benefits planning that meeting requirements of section 312 ; Enrolling under Exchange-participating health benefits planning and not enrolled under planning as employee through employer qualified
Index of Sec 242. ...HEALTH benefits planning that meeting requirements of section 312 ; Enrolling under Exchange-participating health benefits planning and not enrolled under planning as employee through employer qualified
Index of Sec 242. ...HEALTH benefits planning that meeting requirements of section 312 ; Enrolling under Exchange-participating health benefits planning and not enrolled under planning as employee through employer qualified
Index of Sec 242. ...CONTRIBUTION described in section 313(a) ; Individual to be treated in same manner as employee of employer making
Index of Sec 242. ...CONTRIBUTION under plan meet requirements of section 312 ; Term affordable credit eligible individual not including full-time employee of employer if employer offering employee coverage as full-time employee under group health plan if coverage and employer
Index of Sec 242. ...CONTRIBUTION under plan meet requirements of section 312 ; Term affordable credit eligible individual not including full-time employee of employer if employer offering employee coverage as full-time employee under group health plan if coverage and employer
Index of Sec 242. ...CONTRIBUTION under plan meet requirements of section 312 ; Term affordable credit eligible individual not including full-time employee of employer if employer offering employee coverage as full-time employee under group health plan if coverage and employer
Index of Sec 242. ...HEALTH benefits planning in accordance with section 312 ; Employer offering employee individual and family coverage under qualified
Index of Sec 311. ...HEALTH benefits planning in accordance with section 312 ; Employer offering employee individual and family coverage under qualified
Index of Sec 311. ...HEALTH benefits planning in accordance with section 312 ; Employer offering employee individual and family coverage under qualified
Index of Sec 311. ...EMPLOYMENT-based health benefits planning for individual coverage under plan option with lowest applicable employee premium ; Requirement of subsection with respect to employer and employee being employer automatically enrolling employee into
Index of Sec 312. ...EMPLOYMENT-based health benefits planning for individual coverage under plan option with lowest applicable employee premium ; Requirement of subsection with respect to employer and employee being employer automatically enrolling employee into
Index of Sec 312. ...EMPLOYMENT-based health benefits planning for individual coverage under plan option with lowest applicable employee premium ; Requirement of subsection with respect to employer and employee being employer automatically enrolling employee into
Index of Sec 312. ...AFFIRMATIVE election to opt out of plan or electing coverage under employment-based health benefits planning offered by employer ; No case employer automatically enrolling employee in plan under paragraph if employee making
Index of Sec 312. ...AFFIRMATIVE election to opt out of plan or electing coverage under employment-based health benefits planning offered by employer ; No case employer automatically enrolling employee in plan under paragraph if employee making
Index of Sec 312. ...AFFIRMATIVE election to opt out of plan or electing coverage under employment-based health benefits planning offered by employer ; No case employer automatically enrolling employee in plan under paragraph if employee making
Index of Sec 312. ...AUTOMATIC enrollment requirement under paragraph ; Writing notice of employees' rights and obligations relating to
Index of Sec 312. ...AUTOMATIC enrollment requirement under paragraph ; Writing notice of employees' rights and obligations relating to
Index of Sec 312. ...AUTOMATIC enrollment requirement under paragraph ; Writing notice of employees' rights and obligations relating to
Index of Sec 312. ...CONTRIBUTION being equal to amount equal to 8 percent of average wages paid by employer during period of enrollment ; Contribution being made in accordance with section with respect to employee if
Index of Sec 313. ...CONTRIBUTION being equal to amount equal to 8 percent of average wages paid by employer during period of enrollment ; Contribution being made in accordance with section with respect to employee if
Index of Sec 313. ...CONTRIBUTION being equal to amount equal to 8 percent of average wages paid by employer during period of enrollment ; Contribution being made in accordance with section with respect to employee if
Index of Sec 313. ...TAX of $100 for day in period beginning on date ; Imposing failure with respect employee
Index of Sec 411. ...COMPENSATION paid by employer to employee during taxable year exceeding $80,000 ; No credit to be allowed under subsection with respect to qualified employee health coverage expensing paid or incurred with respect to employee for taxable year if aggregate
Index of Sec 421. ...HEALTH coverage ; Term qualified employee health coverage expenses meaning aggregate amount paid or incurred by employer during taxable year for coverage of qualified employee of employer under qualified
Index of Sec 421. ...COMPENSATION from employer for services performed in trade or business of employer during taxable year ; Term qualified employee meaning employee of employer for taxable year of employer if employee received $5,000 of
Index of Sec 421. ...PAYMENT making for benefit of employee or eligible beneficiary ;
Index of Sec 461. ...EMPLOYEE'S flexible spending arrangement ; Reimbursement from flexible spending arrangement under regulations in effect on date of enactment in Act to be reimbursed from
Index of Sec 461. ...COMPENSATION or anything of value to employees, agents or contractors in manner encouraging denials of claims for benefits ; Program not permitting or providing
Index of Sec 139. ...ACCEPTABLE coverage so long as Secretary of Labor determining that coverage for employees being substantially equivalent or greater than coverage provided for employees pursuant to essential benefits packaging ; Coverage provided pursuant to Hawaii Prepaid Health Care Act to be treated as qualified health benefits planning providing
Index of Sec 156. ...TITLE VII of Civil Rights acting of 1964 ; Nothing in section altering rights and obligations of employees and employers under
Index of Sec 156. ...HEALTH benefits planing ; Term Exchange-eligible employer meaning employer being eligible under section to enroll through Health Insurance Exchange employees of employer in Exchange-eligible
Index of Sec 202. ...HEALTH benefits planing ; Term Exchange-eligible employer meaning employer being eligible under section to enroll through Health Insurance Exchange employees of employer in Exchange-eligible
Index of Sec 202. ...HEALTH benefits planing ; Term Exchange-eligible employer meaning employer being eligible under section to enroll through Health Insurance Exchange employees of employer in Exchange-eligible
Index of Sec 202. ...HEALTH benefits planing through Health Insurance Exchange consistent with provisions of subtitle B of title III ; Employer meeting requirements of section 312 with respect to employees of employer by offering employees option of enrolling with Exchange-participating
Index of Sec 202. ...HEALTH benefits planing through Health Insurance Exchange consistent with provisions of subtitle B of title III ; Employer meeting requirements of section 312 with respect to employees of employer by offering employees option of enrolling with Exchange-participating
Index of Sec 202. ...HEALTH benefits planing through Health Insurance Exchange consistent with provisions of subtitle B of title III ; Employer meeting requirements of section 312 with respect to employees of employer by offering employees option of enrolling with Exchange-participating
Index of Sec 202. ...HEALTH insurance to employees of employers through Health Insurance Exchange ; Commissioner establishing and carrying out program to provide to small employers counseling and technical assistance with respect to provision of
Index of Sec 206. ...HEALTH plan exceeding 11 percent of current family income ; Case of full-time employees For which cost of employee premium for coverage under group
Index of Sec 242. ...HEALTH plan exceeding 12 percent of current family income ; Case of full-time employees For which cost of employee premium for coverage under group
Index of Sec 242. ...COMPENSATION paid by employer to qualified employees of employer during taxable year ; Average amount of
Index of Sec 421. ...HEALTH insurance exchange ; Return information disclosed under subparagraph to be used by officers and employees of Health Choices Administration or State-based
Index of Sec 431. ...EMPLOYEES' beneficiary association or committee or board of individuals appointed to administer plan ; Maintaining by one or more employers, former employers or employee associations or voluntary
Index of Sec 164. ...EMPLOYEES' beneficiary association or committee or board of individuals appointed to administer plan ; Maintaining by one or more employers, former employers or employee associations or voluntary
Index of Sec 164. ...EMPLOYEES' beneficiary association or committee or board of individuals appointed to administer plan ; Maintaining by one or more employers, former employers or employee associations or voluntary
Index of Sec 166. ...AFFIRMATIVE election before employer automatically enrolling employee plan ; Employer providing employee with 30-day period to make
Index of Sec 312. ...AFFIRMATIVE election before employer automatically enrolling employee plan ; Employer providing employee with 30-day period to make
Index of Sec 312. ...AFFIRMATIVE election before employer automatically enrolling employee plan ; Employer providing employee with 30-day period to make
Index of Sec 312. ...EMPLOYEES' beneficiary association or committee or board of individuals appointed to administer plan ; Maintaining by one or more employers, former employers or employee associations or voluntary
Index of Sec 164. ...EMPLOYEES' beneficiary association or committee or board of individuals appointed to administer plan ; Maintaining by one or more employers, former employers or employee associations or voluntary
Index of Sec 164. ...EMPLOYEES' beneficiary association or committee or board of individuals appointed to administer plan ; Maintaining by one or more employers, former employers or employee associations or voluntary
Index of Sec 166. ...PRIMARY purpose of providing affordable employee benefits to members ; Consisting solely of members and operated for
Index of Sec 209. ...COMPENSATION of employer for taxable year not exceeding sum of dollar amounts in effect under subsection ; Average annual employee
Index of Sec 421. ...CONTRIBUTION under plan meet requirements of section 312 ; Term affordable credit eligible individual not including full-time employee of employer if employer offering employee coverage as full-time employee under group health plan if coverage and employer
Index of Sec 242. ...CONTRIBUTION under plan meet requirements of section 312 ; Term affordable credit eligible individual not including full-time employee of employer if employer offering employee coverage as full-time employee under group health plan if coverage and employer
Index of Sec 242. ...CONTRIBUTION under plan meet requirements of section 312 ; Term affordable credit eligible individual not including full-time employee of employer if employer offering employee coverage as full-time employee under group health plan if coverage and employer
Index of Sec 242. ...EMPLOYMENT-based health benefits planning for individual coverage under plan option with lowest applicable employee premium ; Requirement of subsection with respect to employer and employee being employer automatically enrolling employee into
Index of Sec 312. ...EMPLOYMENT-based health benefits planning for individual coverage under plan option with lowest applicable employee premium ; Requirement of subsection with respect to employer and employee being employer automatically enrolling employee into
Index of Sec 312. ...EMPLOYMENT-based health benefits planning for individual coverage under plan option with lowest applicable employee premium ; Requirement of subsection with respect to employer and employee being employer automatically enrolling employee into
Index of Sec 312. ...HEALTH benefits planning being reference premium amount under section 243(c) for individual coverage ; Amount of applicable premium of lowest cost plan with respect to coverage of employee under Exchange-participating
Index of Sec 312. ...HEALTH benefits planning being reference premium amount under section 243(c) for individual coverage ; Amount of applicable premium of lowest cost plan with respect to coverage of employee under Exchange-participating
Index of Sec 312. ...HEALTH benefits planning being reference premium amount under section 243(c) for individual coverage ; Amount of applicable premium of lowest cost plan with respect to coverage of employee under Exchange-participating
Index of Sec 312. ...COMPENSATION paid by employer to employee during taxable year exceeding $80,000 ; No credit to be allowed under subsection with respect to qualified employee health coverage expensing paid or incurred with respect to employee for taxable year if aggregate
Index of Sec 421. ...CREDIT determined under section for taxable year being amount equal to applicable percentage of qualified employee health coverage expenses of employer for taxable year ; Small business employee health coverage
Index of Sec 421. ...CREDIT determined under section 45r(a) ; Small business employee health coverage
Index of Sec 421. ...HEALTH coverage expenses of employer for taxable year ; Small business employee health coverage credit determined under section for taxable year being amount equal to applicable percentage of qualified employee
Index of Sec 421. ...HEALTH coverage expenses meaning aggregate amount paid or incurred by employer during taxable year for coverage of qualified employee of employer under qualified health coverage ; Term qualified employee
Index of Sec 421. ...FINANCING ; Plan sponsor in relation to group health plan in case of plan maintained jointly by 1 or more employers and 1 or more employee organizations and respect to which employer being primary source of
Index of Sec 100. ...FINANCING ; Plan sponsor in relation to group health plan in case of plan maintained jointly by 1 or more employers and 1 or more employee organizations and respect to which employer being primary source of
Index of Sec 100. ...FINANCING ; Plan sponsor in relation to group health plan in case of plan maintained jointly by 1 or more employers and 1 or more employee organizations and respect to which employer being primary source of
Index of Sec 100. ...AFFIRMATIVE election before employer automatically enrolling employee plan ; Employer providing employee with 30-day period to make
Index of Sec 312. ...AFFIRMATIVE election before employer automatically enrolling employee plan ; Employer providing employee with 30-day period to make
Index of Sec 312. ...AFFIRMATIVE election before employer automatically enrolling employee plan ; Employer providing employee with 30-day period to make
Index of Sec 312. ...HEALTH plan being multiemployer plan ; Term employee premium not including collectively bargained premium in case of group
Index of Sec 100. ...HEALTH plan exceeding 11 percent of current family income ; Case of full-time employees For which cost of employee premium for coverage under group
Index of Sec 242. ...HEALTH plan exceeding 12 percent of current family income ; Case of full-time employees For which cost of employee premium for coverage under group
Index of Sec 242. ...EMPLOYMENT-based health benefits planning for individual coverage under plan option with lowest applicable employee premium ; Requirement of subsection with respect to employer and employee being employer automatically enrolling employee into
Index of Sec 312. ...EMPLOYMENT-based health benefits planning for individual coverage under plan option with lowest applicable employee premium ; Requirement of subsection with respect to employer and employee being employer automatically enrolling employee into
Index of Sec 312. ...EMPLOYMENT-based health benefits planning for individual coverage under plan option with lowest applicable employee premium ; Requirement of subsection with respect to employer and employee being employer automatically enrolling employee into
Index of Sec 312. ...EMPLOYEE'S health reimbursement arrangement ; Reimbursement from health reimbursement arrangement under regulations in effect on date of enactment in Act to be reimbursed from
Index of Sec 461. ...EMPLOYEE'S right to opt out of automatically enrolled in plan and case ; Written notice under subparagraph explaining
Index of Sec 312. ...EMPLOYEE'S right to opt out of automatically enrolled in plan and case ; Written notice under subparagraph explaining
Index of Sec 312. ...EMPLOYEE'S right to opt out of automatically enrolled in plan and case ; Written notice under subparagraph explaining
Index of Sec 312. ...AUTOMATIC enrollment requirement under paragraph ; Writing notice of employees' rights and obligations relating to
Index of Sec 312. ...AUTOMATIC enrollment requirement under paragraph ; Writing notice of employees' rights and obligations relating to
Index of Sec 312. ...AUTOMATIC enrollment requirement under paragraph ; Writing notice of employees' rights and obligations relating to
Index of Sec 312. ...FINANCING ; Plan sponsor in relation to group health plan in case of plan maintained jointly by 1 or more employers and 1 or more employee organizations and respect to which employer being primary source of
Index of Sec 100. ...FINANCING ; Plan sponsor in relation to group health plan in case of plan maintained jointly by 1 or more employers and 1 or more employee organizations and respect to which employer being primary source of
Index of Sec 100. ...FINANCING ; Plan sponsor in relation to group health plan in case of plan maintained jointly by 1 or more employers and 1 or more employee organizations and respect to which employer being primary source of
Index of Sec 100. ...DISCRIMINATION by employer in violation of subsection bringing action governed by rules, procedures, legal burdens of proof and remedies setting forth in section 40(b) of Consumer Product Safety Act 15 USC 2087(b) ; Employee covered by section alleging
Index of Sec 153. ...DISCRIMINATION by employer in violation of subsection bringing action governed by rules, procedures, legal burdens of proof and remedies setting forth in section 40(b) of Consumer Product Safety Act 15 USC 2087(b) ; Employee covered by section alleging
Index of Sec 153. ...DISCRIMINATION by employer in violation of subsection bringing action governed by rules, procedures, legal burdens of proof and remedies setting forth in section 40(b) of Consumer Product Safety Act 15 USC 2087(b) ; Employee covered by section alleging
Index of Sec 153. ...HEALTH benefits planing ; Term Exchange-eligible employer meaning employer being eligible under section to enroll through Health Insurance Exchange employees of employer in Exchange-eligible
Index of Sec 202. ...HEALTH benefits planing ; Term Exchange-eligible employer meaning employer being eligible under section to enroll through Health Insurance Exchange employees of employer in Exchange-eligible
Index of Sec 202. ...HEALTH benefits planing ; Term Exchange-eligible employer meaning employer being eligible under section to enroll through Health Insurance Exchange employees of employer in Exchange-eligible
Index of Sec 202. ...HEALTH benefits planning ; Employer continuing to be treated as Exchange-eligible employer for subsequent plan year regardless of number of employees involved until employer meeting requirement of section 311(a) through paragraph of section by offering group health plan and not through offering Exchange-participating
Index of Sec 202. ...HEALTH benefits planning ; Employer continuing to be treated as Exchange-eligible employer for subsequent plan year regardless of number of employees involved until employer meeting requirement of section 311(a) through paragraph of section by offering group health plan and not through offering Exchange-participating
Index of Sec 202. ...HEALTH benefits planning ; Employer continuing to be treated as Exchange-eligible employer for subsequent plan year regardless of number of employees involved until employer meeting requirement of section 311(a) through paragraph of section by offering group health plan and not through offering Exchange-participating
Index of Sec 202. ...HEALTH benefits planing by employer of employee under subparagraph choosing coverage plan ; Employee offered Exchange-participating
Index of Sec 202. ...HEALTH benefits planing by employer of employee under subparagraph choosing coverage plan ; Employee offered Exchange-participating
Index of Sec 202. ...HEALTH benefits planing by employer of employee under subparagraph choosing coverage plan ; Employee offered Exchange-participating
Index of Sec 202. ...CONTRIBUTION under plan meet requirements of section 312 ; Term affordable credit eligible individual not including full-time employee of employer if employer offering employee coverage as full-time employee under group health plan if coverage and employer
Index of Sec 242. ...CONTRIBUTION under plan meet requirements of section 312 ; Term affordable credit eligible individual not including full-time employee of employer if employer offering employee coverage as full-time employee under group health plan if coverage and employer
Index of Sec 242. ...CONTRIBUTION under plan meet requirements of section 312 ; Term affordable credit eligible individual not including full-time employee of employer if employer offering employee coverage as full-time employee under group health plan if coverage and employer
Index of Sec 242. ...HEALTH benefits planning ; Not less than 72.5 percent of applicable premium of lowest cost plan offered by employer being qualified
Index of Sec 312. ...HEALTH benefits planning ; Not less than 72.5 percent of applicable premium of lowest cost plan offered by employer being qualified
Index of Sec 312. ...HEALTH benefits planning ; Not less than 72.5 percent of applicable premium of lowest cost plan offered by employer being qualified
Index of Sec 312. ...EMPLOYMENT-based health benefits planning for individual coverage under plan option with lowest applicable employee premium ; Requirement of subsection with respect to employer and employee being employer automatically enrolling employee into
Index of Sec 312. ...EMPLOYMENT-based health benefits planning for individual coverage under plan option with lowest applicable employee premium ; Requirement of subsection with respect to employer and employee being employer automatically enrolling employee into
Index of Sec 312. ...EMPLOYMENT-based health benefits planning for individual coverage under plan option with lowest applicable employee premium ; Requirement of subsection with respect to employer and employee being employer automatically enrolling employee into
Index of Sec 312. ...HEALTH coverage participation requirements and referring determination to Secretary of Treasury as appropriate ; Secretary terminating election of employer under section 801 if Secretary determining that employer in substantial noncompliance with
Index of Sec 321. ...HEALTH coverage participation requirements and referring determination to Secretary of Treasury as appropriate ; Secretary terminating election of employer under section 801 if Secretary determining that employer in substantial noncompliance with
Index of Sec 321. ...HEALTH coverage participation requirements and referring determination to Secretary of Treasury as appropriate ; Secretary terminating election of employer under subsection if Secretary determining that employer in substantial noncompliance with
Index of Sec 323. ...HEALTH coverage participation requirements and referring determination to Secretary of Treasury as appropriate ; Secretary terminating election of employer under subsection if Secretary determining that employer in substantial noncompliance with
Index of Sec 323. ...HEALTH coverage participation requirements ; Secretary terminating election of employer under paragraph if Secretary determining that employer in substantial noncompliance with
Index of Sec 411. ...EMPLOYMENT ; Imposing on every nonelecting employer excise tax equalling to 8 percent of wages paid with respect to
Index of Sec 412. ...EXCISE tax equalling to 8 percent ; Imposing on every nonelecting employer
Index of Sec 412. ...CREDIT determined under section for taxable year being amount equal to applicable percentage of qualified employee health coverage expenses of employer for taxable year ; Small business employee health coverage
Index of Sec 421. ...COMPENSATION paid by employer to employee during taxable year exceeding $80,000 ; No credit to be allowed under subsection with respect to qualified employee health coverage expensing paid or incurred with respect to employee for taxable year if aggregate
Index of Sec 421. ...HEALTH coverage ; Term qualified employee health coverage expenses meaning aggregate amount paid or incurred by employer during taxable year for coverage of qualified employee of employer under qualified
Index of Sec 421. ...COMPENSATION of employer for taxable year not exceeding sum of dollar amounts in effect under subsection ; Average annual employee
Index of Sec 421. ...COMPENSATION from employer for services performed in trade or business of employer during taxable year ; Term qualified employee meaning employee of employer for taxable year of employer if employee received $5,000 of
Index of Sec 421. ...COMPENSATION paid by employer to qualified employees of employer during taxable year ; Average amount of
Index of Sec 421. ...HEALTH benefits planning ; Health Choices Commissioner to have authority to set standards for determining whether employers or insurers undertaking actions to affect risk pool within Health Insurance Exchange by inducing individuals to decline coverage under qualified health benefits planning offered by employer and instead to enroll in Exchange-participating
Index of Sec 314. ...HEALTH benefits planning ; Health Choices Commissioner to have authority to set standards for determining whether employers or insurers undertaking actions to affect risk pool within Health Insurance Exchange by inducing individuals to decline coverage under qualified health benefits planning offered by employer and instead to enroll in Exchange-participating
Index of Sec 314. ...HEALTH benefits planning ; Health Choices Commissioner to have authority to set standards for determining whether employers or insurers undertaking actions to affect risk pool within Health Insurance Exchange by inducing individuals to decline coverage under qualified health benefits planning offered by employer and instead to enroll in Exchange-participating
Index of Sec 314. ...CIVIL penalty against employer of $100 for day in period beginning on date ; Secretary assessing
Index of Sec 321. ...CIVIL penalty against employer of $100 for day in period beginning on date ; Secretary assessing
Index of Sec 321. ...CIVIL penalty against employer of $100 for day in period beginning on date ; Secretary assessing
Index of Sec 323. ...CIVIL penalty against employer of $100 for day in period beginning on date ; Secretary assessing
Index of Sec 323. ...JOB losses negatively impacting employer or community in which employer located ; Secretary granting waiver within 30 days after submission of application if application reasonably demonstrating to Secretary meeting requirements of part resulting in
Index of Sec 311. ...EMPLOYMENT-based health plan or otherwise in same manner as sections applying to employers and health insurance coverage offered in small group market ; 2712 and subsection and subsection of Public Health Service Act applying to individuals and employers in individual and group health insurance coverage through
Index of Sec 112. ...EMPLOYMENT-based health plan or otherwise excepting that section 2712(b)(1) applying only if issuer providing enrollee with notice of non-payment of premiums and grace period during that enrollees having opportunity to correct nonpayment ; 2712 and subsection and subsection of Public Health Service Act applying to individuals and employers in individual and group health insurance coverage through
Index of Sec 112. ...EMPLOYMENT-based health plan or otherwise excepting that section 2712(b)(1) applying only if issuer providing enrollee with notice of non-payment of premiums and grace period during that enrollees having opportunity to correct nonpayment ; 2712 and subsection and subsection of Public Health Service Act applying to individuals and employers in individual and group health insurance coverage through
Index of Sec 112. ...RISK pools of large group insurers and self-insured employers ; Report including recommendations Commissioner deeming appropriate to ensure that law not providing incentives for small and mid-size employers to self-insuring or creating adverse selection in
Index of Sec 113. ...RISK pools of large group insurers and self-insured employers ; Report including recommendations Commissioner deeming appropriate to ensure that law not providing incentives for small and mid-size employers to self-insuring or creating adverse selection in
Index of Sec 113. ...RISK pools of large group insurers and self-insured employers ; Report including recommendations Commissioner deeming appropriate to ensure that law not providing incentives for small and mid-size employers to self-insuring or creating adverse selection in
Index of Sec 113. ...ETHNIC disparities ; Membership of Health benefiting Advisory Committee reflecting providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and
Index of Sec 123. ...ETHNIC disparities ; Membership of Health benefiting Advisory Committee reflecting providers, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and
Index of Sec 123. ...ETHNIC disparities ; Membership of Health benefiting Advisory Committee reflecting providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and
Index of Sec 123. ...TITLE VII of Civil Rights acting of 1964 ; Nothing in section altering rights and obligations of employees and employers under
Index of Sec 156. ...EMPLOYEES' beneficiary association or committee or board of individuals appointed to administer plan ; Maintaining by one or more employers, former employers or employee associations or voluntary
Index of Sec 164. ...EMPLOYEES' beneficiary association or committee or board of individuals appointed to administer plan ; Maintaining by one or more employers, former employers or employee associations or voluntary
Index of Sec 164. ...EMPLOYEES' beneficiary association or committee or board of individuals appointed to administer plan ; Maintaining by one or more employers, former employers or employee associations or voluntary
Index of Sec 166. ...HEALTH benefits planing ; Commissioner providing for periodic surveys of Exchange-eligible individuals and employers concerning satisfaction of individuals and employers with Health Insurance Exchange and Exchange-participating
Index of Sec 202. ...HEALTH benefits planing ; Commissioner providing for periodic surveys of Exchange-eligible individuals and employers concerning satisfaction of individuals and employers with Health Insurance Exchange and Exchange-participating
Index of Sec 202. ...HEALTH benefits planing ; Commissioner providing for periodic surveys of Exchange-eligible individuals and employers concerning satisfaction of individuals and employers with Health Insurance Exchange and Exchange-participating
Index of Sec 202. ...HEALTH benefits planing including public health insurance option ; Nothing in division to be construed to affect role of enrollment agents and brokers under State law including with regard to enrollment of individuals and employers in qualified
Index of Sec 205. ...HEALTH insurance to employees of employers through Health Insurance Exchange ; Commissioner establishing and carrying out program to provide to small employers counseling and technical assistance with respect to provision of
Index of Sec 206. ...HEALTH benefits planing ; Commissioner entering into contracts with small employer benefit arrangements to provide consumer information, outreach and assistance in enrollment of small employers being members arrangement under Exchange participating
Index of Sec 209. ...HEALTH benefits planning offered by employer and instead to enroll in Exchange-participating health benefits planning ; Health Choices Commissioner to have authority to set standards for determining whether employers or insurers undertaking actions to affect risk pool within Health Insurance Exchange by inducing individuals to decline coverage under qualified
Index of Sec 314. ...HEALTH benefits planning offered by employer and instead to enroll in Exchange-participating health benefits planning ; Health Choices Commissioner to have authority to set standards for determining whether employers or insurers undertaking actions to affect risk pool within Health Insurance Exchange by inducing individuals to decline coverage under qualified
Index of Sec 314. ...HEALTH benefits planning offered by employer and instead to enroll in Exchange-participating health benefits planning ; Health Choices Commissioner to have authority to set standards for determining whether employers or insurers undertaking actions to affect risk pool within Health Insurance Exchange by inducing individuals to decline coverage under qualified
Index of Sec 314. ...HEALTH coverage participation requirements in connection with employers in effect ; Secretary regularly auditing representative sampling of employers and conduct investigations and other activities with respect to sampling of employers so as to discovering noncompliance with
Index of Sec 323. ...HEALTH coverage participation requirements in connection with employers in effect ; Secretary regularly auditing representative sampling of employers and conduct investigations and other activities with respect to sampling of employers so as to discovering noncompliance with
Index of Sec 323. ...FINANCING ; Plan sponsor in relation to group health plan in case of plan maintained jointly by 1 or more employers and 1 or more employee organizations and respect to which employer being primary source of
Index of Sec 100. ...FINANCING ; Plan sponsor in relation to group health plan in case of plan maintained jointly by 1 or more employers and 1 or more employee organizations and respect to which employer being primary source of
Index of Sec 100. ...FINANCING ; Plan sponsor in relation to group health plan in case of plan maintained jointly by 1 or more employers and 1 or more employee organizations and respect to which employer being primary source of
Index of Sec 100. ...HEALTH coverage participation requirements in connection with employers in effect ; Secretary regularly auditing representative sampling of employers and conduct investigations and other activities with respect to sampling of employers so as to discovering noncompliance with
Index of Sec 323. ...HEALTH coverage participation requirements in connection with employers in effect ; Secretary regularly auditing representative sampling of employers and conduct investigations and other activities with respect to sampling of employers so as to discovering noncompliance with
Index of Sec 323. ...RESPONSIBILITY among workers, employers and government ; Initiates shared
Index of Sec 100. ...RESPONSIBILITY among workers, employers and government ; Initiates shared
Index of Sec 100. ...RESPONSIBILITY among workers, employers and government ; Initiates shared
Index of Sec 100. ...HEALTH coverage participation requirements in connection with plans ; Secretary regularly auditing representative sampling of employers and group health plans and conduct investigations and other activities under section 504 with respect to sampling of plans so as to discovering noncompliance with
Index of Sec 321. ...HEALTH coverage participation requirements in connection with plans ; Secretary regularly auditing representative sampling of employers and group health plans and conduct investigations and other activities under section 504 with respect to sampling of plans so as to discovering noncompliance with
Index of Sec 321. ...HEALTH benefits planing ; Terms, conditions and affordability of group health coverage offered by employers and QHBP offering entities outside of Exchange compared to Exchange-participating
Index of Sec 202. ...HEALTH benefits planing ; Terms, conditions and affordability of group health coverage offered by employers and QHBP offering entities outside of Exchange compared to Exchange-participating
Index of Sec 202. ...HEALTH benefits planing ; Terms, conditions and affordability of group health coverage offered by employers and QHBP offering entities outside of Exchange compared to Exchange-participating
Index of Sec 202. ...CONSUMER information, outreach and assistance in enrollment of small employers being members arrangement under Exchange participating health benefits planing ; Commissioner entering into contracts with small employer benefit arrangements to provide
Index of Sec 209. ...CONTRIBUTION under plan meet requirements of section 312 ; Term affordable credit eligible individual not including full-time employee of employer if employer offering employee coverage as full-time employee under group health plan if coverage and employer
Index of Sec 242. ...CONTRIBUTION under plan meet requirements of section 312 ; Term affordable credit eligible individual not including full-time employee of employer if employer offering employee coverage as full-time employee under group health plan if coverage and employer
Index of Sec 242. ...CONTRIBUTION under plan meet requirements of section 312 ; Term affordable credit eligible individual not including full-time employee of employer if employer offering employee coverage as full-time employee under group health plan if coverage and employer
Index of Sec 242. ...CONTRIBUTION described in subsection for coverage of full-time employee ; Minimum employer
Index of Sec 312. ...CONTRIBUTION described in subsection for coverage of full-time employee ; Minimum employer
Index of Sec 312. ...CONTRIBUTION described in subsection for coverage of full-time employee ; Minimum employer
Index of Sec 312. ...CONTRIBUTION under subsection to be proportion of minimum employer contribution under subsection with respect to full-time employee reflecting proportion ; Amount of minimum employer
Index of Sec 312. ...CONTRIBUTION under subsection to be proportion of minimum employer contribution under subsection with respect to full-time employee reflecting proportion ; Amount of minimum employer
Index of Sec 312. ...CONTRIBUTION under subsection to be proportion of minimum employer contribution under subsection with respect to full-time employee reflecting proportion ; Amount of minimum employer
Index of Sec 312. ...HEALTH benefits planing ; Term Exchange-eligible employer meaning employer being eligible under section to enroll through Health Insurance Exchange employees of employer in Exchange-eligible
Index of Sec 202. ...HEALTH benefits planing ; Term Exchange-eligible employer meaning employer being eligible under section to enroll through Health Insurance Exchange employees of employer in Exchange-eligible
Index of Sec 202. ...HEALTH benefits planing ; Term Exchange-eligible employer meaning employer being eligible under section to enroll through Health Insurance Exchange employees of employer in Exchange-eligible
Index of Sec 202. ...HEALTH care markets ; Commissioner conducting study of large group insured and self-insured employer
Index of Sec 113. ...HEALTH care markets ; Commissioner conducting study of large group insured and self-insured employer
Index of Sec 113. ...HEALTH care markets ; Commissioner conducting study of large group insured and self-insured employer
Index of Sec 113. ...HEALTH plan options ; Educational activities to increase awareness of Health Insurance Exchange and available small employer
Index of Sec 206. ...EMPLOYMENT-based health plan in operation as of day before first day of Y1 meeting same requirements as applying to qualified health benefits planning under section 101 including essential benefit package requirement under section 121 ;
Index of Sec 102. ...EMPLOYMENT-based health plan in operation as of day before first day of Y1 meeting same requirements as applying to qualified health benefits planning under section 101 including essential benefit package requirement under section 121 ;
Index of Sec 102. ...EMPLOYMENT-based health plan in operation as of day before first day of Y1 meeting same requirements as applying to qualified health benefits planning under section 101 including essential benefit package requirement under section 121 ;
Index of Sec 102. ...EMPLOYMENT-based health plan in which coverage consisting only of one or more of following ; Subparagraph not applying to
Index of Sec 102. ...EMPLOYMENT-based health plan in which coverage consisting only of one or more of following ; Subparagraph not applying to
Index of Sec 102. ...EMPLOYMENT-based health plan in which coverage consisting only of one or more of following ; Subparagraph not applying to
Index of Sec 102. ...ACCEPTABLE coverage under division ; Employment-based health plan described in paragraph to be treated as
Index of Sec 102. ...ACCEPTABLE coverage under division ; Employment-based health plan described in paragraph to be treated as
Index of Sec 102. ...ACCEPTABLE coverage under division ; Employment-based health plan described in paragraph to be treated as
Index of Sec 102. ...EMPLOYMENT-based plans with cost of providing health benefits to retirees and eligible spouses surviving spouses and dependents of retirees ; Secretary of Health and Human Services establishing temporary reinsurance program to provide reimbursement to assist participating
Index of Sec 164. ...EMPLOYMENT-based plans with cost of providing health benefits to retirees and eligible spouses surviving spouses and dependents of retirees ; Secretary of Health and Human Services establishing temporary reinsurance program to provide reimbursement to assist participating
Index of Sec 164. ...EMPLOYMENT-based plan meaning eligible employment-based plan participating in reinsurance program ; Term participating
Index of Sec 164. ...EMPLOYMENT-based plan meaning eligible employment-based plan participating in reinsurance program ; Term participating
Index of Sec 164. ...EMPLOYMENT-based plans to appeal determination of Secretary with respect to claims submitted under section ; Appeals processing to permit participating
Index of Sec 164. ...EMPLOYMENT-based plans to appeal determination of Secretary with respect to claims submitted under section ; Appeals processing to permit participating
Index of Sec 164. ...EMPLOYMENT-based plans under section to ensure ; Secretary conducting annual audits of claims data submitted by participating
Index of Sec 164. ...EMPLOYMENT-based plans under section to ensure ; Secretary conducting annual audits of claims data submitted by participating
Index of Sec 164. ...EMPLOYMENT-based plans with cost of providing health benefits to retirees and eligible spouses surviving spouses and dependents of retirees ; Secretary of Health and Human Services establishing temporary reinsurance program to provide reimbursement to assist participating
Index of Sec 166. ...EMPLOYMENT-based plan meaning eligible employment-based plan participating in reinsurance program ; Term participating
Index of Sec 166. ...EMPLOYMENT-based plans to appeal determination of Secretary with respect to claims submitted under section ; Appeals processing to permit participating
Index of Sec 166. ...EMPLOYMENT-based plans under section to ensure ; Secretary conducting annual audits of claims data submitted by participating
Index of Sec 166. ...EMPLOYMENT-based health plan or date on which individual becoming eligible for health insurance coverage through Health Insurance Exchange ; Extending to earlier of date on which individual becoming eligible for coverage under
Index of Sec 167. ...EMPLOYMENT-based health benefits planning offered by employer ; No case employer automatically enrolling employee in plan under paragraph if employee making affirmative election to opt out of plan or electing coverage under
Index of Sec 312. ...EMPLOYMENT-based health benefits planning offered by employer ; No case employer automatically enrolling employee in plan under paragraph if employee making affirmative election to opt out of plan or electing coverage under
Index of Sec 312. ...EMPLOYMENT-based health benefits planning offered by employer ; No case employer automatically enrolling employee in plan under paragraph if employee making affirmative election to opt out of plan or electing coverage under
Index of Sec 312. ...EMPLOYMENT ; Imposing on every nonelecting employer excise tax equalling to 8 percent of wages paid with respect to
Index of Sec 412. ...EMPLOYMENT during calendar year ; Aggregate wages paid with respect to
Index of Sec 412. ...EMPLOYMENT based health benefits provided to retiree or spouse surviving spouse ; Claim submitted under subparagraph to be based on actual amount expended by participating employment-based plan involved within plan year for appropriate
Index of Sec 164. ...EMPLOYMENT based health benefits provided to retiree or spouse surviving spouse ; Claim submitted under subparagraph to be based on actual amount expended by participating employment-based plan involved within plan year for appropriate
Index of Sec 164. ...EMPLOYMENT based health benefits provided to retiree or spouse surviving spouse ; Claim submitted under subparagraph to be based on actual amount expended by participating employment-based plan involved within plan year for appropriate
Index of Sec 166. ...EMPLOYMENT-based health plan of section ; Coverage under grandfathered health insurance coverage of section 102 of America's Affordable Health Choices acting of 2009 or current
Index of Sec 401. ...EMPLOYMENT-based plan meaning group health benefits planning ; Term eligible
Index of Sec 164. ...EMPLOYMENT-based plan meaning group health benefits planning ; Term eligible
Index of Sec 164. ...EMPLOYMENT-based plan participating in reinsurance program ; Term participating employment-based plan meaning eligible
Index of Sec 164. ...EMPLOYMENT-based plan participating in reinsurance program ; Term participating employment-based plan meaning eligible
Index of Sec 164. ...EMPLOYMENT-based plan submitting to Secretary application for participation in program and containing information as Secretary requiring ; Eligible
Index of Sec 164. ...EMPLOYMENT-based plan submitting to Secretary application for participation in program and containing information as Secretary requiring ; Eligible
Index of Sec 164. ...EMPLOYMENT-based plan meaning group health benefits planning ; Term eligible
Index of Sec 166. ...EMPLOYMENT-based plan participating in reinsurance program ; Term participating employment-based plan meaning eligible
Index of Sec 166. ...EMPLOYMENT-based plan submitting to Secretary application for participation in program and containing information as Secretary requiring ; Eligible
Index of Sec 166. ...EMPLOYMENT-based health plans ; Case of health insurance coverage not offered through Health Insurance Exchange and case of
Index of Sec 151. ...EMPLOYMENT-based health plans ; Case of health insurance coverage not offered through Health Insurance Exchange and case of
Index of Sec 151. ...EMPLOYMENT-based health plans ; Case of health insurance coverage not offered through Health Insurance Exchange and case of
Index of Sec 151. ...EMPLOYMENT-based health plan in which coverage consisting only of one or more of coverage or benefits described in clauses ; No case
Index of Sec 102. ...EMPLOYMENT-based health plan in which coverage consisting only of one or more of coverage or benefits described in clauses ; No case
Index of Sec 102. ...EMPLOYMENT-based health plan in which coverage consisting only of one or more of coverage or benefits described in clauses ; No case
Index of Sec 102. ...EMPLOYMENT-based health plan ; Respect to health benefiting plan other than
Index of Sec 100. ...EMPLOYMENT-based health plan ; Respect to health benefiting plan other than
Index of Sec 100. ...EMPLOYMENT-based health plan ; Respect to health benefiting plan other than
Index of Sec 100. ...DOCUMENTATION of actual costs of items and services For which claim submitted ; Participating employment-based plan submitting claims for reimbursement to Secretary containing
Index of Sec 164. ...DOCUMENTATION of actual costs of items and services For which claim submitted ; Participating employment-based plan submitting claims for reimbursement to Secretary containing
Index of Sec 164. ...EMPLOYMENT based health benefits provided to retiree or spouse surviving spouse ; Claim submitted under subparagraph to be based on actual amount expended by participating employment-based plan involved within plan year for appropriate
Index of Sec 164. ...EMPLOYMENT based health benefits provided to retiree or spouse surviving spouse ; Claim submitted under subparagraph to be based on actual amount expended by participating employment-based plan involved within plan year for appropriate
Index of Sec 164. ...EMPLOYMENT-based plan submitting valid claim under paragraph ; Secretary determining that participating
Index of Sec 164. ...EMPLOYMENT-based plan submitting valid claim under paragraph ; Secretary determining that participating
Index of Sec 164. ...EMPLOYMENT-based plan under subsection to be used to lowing costs borne directly by participants and beneficiaries for health benefits provided under plan in form of premiums, co-payments, deductibles, co-insurance or other out-of-pocket costs ; Amounts paid to participating
Index of Sec 164. ...EMPLOYMENT-based plan under subsection to be used to lowing costs borne directly by participants and beneficiaries for health benefits provided under plan in form of premiums, co-payments, deductibles, co-insurance or other out-of-pocket costs ; Amounts paid to participating
Index of Sec 164. ...DOCUMENTATION of actual costs of items and services For which claim submitted ; Participating employment-based plan submitting claims for reimbursement to Secretary containing
Index of Sec 166. ...EMPLOYMENT based health benefits provided to retiree or spouse surviving spouse ; Claim submitted under subparagraph to be based on actual amount expended by participating employment-based plan involved within plan year for appropriate
Index of Sec 166. ...EMPLOYMENT-based plan submitting valid claim under paragraph ; Secretary determining that participating
Index of Sec 166. ...EMPLOYMENT-based plan under subsection to be used to lowing costs borne directly by participants and beneficiaries for health benefits provided under plan in form of premiums, co-payments, deductibles, co-insurance or other out-of-pocket costs ; Amounts paid to participating
Index of Sec 166. ...EMPLOYMENT-based health plans ; 10 percent of aggregate amount paid or incurred by employer during preceding taxable year for
Index of Sec 411. ...EMPLOYMENT related to health care ; Nothing in division to be construed to alter of supercede statutory or other obligation to engage in collective bargaining over terms and conditions of
Index of Sec 154. ...EMPLOYMENT related to health care ; Nothing in division to be construed to alter or supercede statutory or other obligation to engage in collective bargaining over terms and conditions of
Index of Sec 154. ...EMPLOYMENT related to health care ; Nothing in division to be construed to alter of supercede statutory or other obligation to engage in collective bargaining over terms and conditions of
Index of Sec 154. ...EMPLOYMENT tax on employers failing to elect or substantially complying ;
Index of Sec 322. ...EMPLOYMENT Taxes on Employers not providing ACCEPTABLE coverage ;
Index of Sec 207. ...EMPLOYMENT Taxes on Employers not providing ACCEPTABLE coverage ;
Index of Sec 207. ...EMPLOYMENT Taxes on Employers not providing ACCEPTABLE coverage ;
Index of Sec 207. ...ESTATE or trust adjusted gross income to be determined as provided in section 67(e) ; Case of
Index of Sec 441. ...EXCISE taxes on failures under section 4980h(b) of Internal Revenue Code of 1986 so as to avoiding duplication of penalties with respect to failures ; Secretary and Secretary of Treasury coordinating assessment of penalties under section in connection with failures to satisfy health coverage participation requirements with imposition of
Index of Sec 321. ...EXCISE taxes on failures under section 4980h(b) of Internal Revenue Code of 1986 so as to avoiding duplication of penalties with respect to failures ; Secretary and Secretary of Treasury coordinating assessment of penalties under section in connection with failures to satisfy health coverage participation requirements with imposition of
Index of Sec 321. ...EXCISE taxes on failures under section 4980h(b) of Internal Revenue Code of 1986 so as to avoiding duplication of penalties with respect to failures ; Secretary and Secretary of Treasury coordinating assessment of penalties under paragraph in connection with failures to satisfy health coverage participation requirements with imposition of
Index of Sec 323. ...EXCISE taxes on failures under section 4980h(b) of Internal Revenue Code of 1986 so as to avoiding duplication of penalties with respect to failures ; Secretary and Secretary of Treasury coordinating assessment of penalties under paragraph in connection with failures to satisfy health coverage participation requirements with imposition of
Index of Sec 323. ...EXEMPTION certifying that individual being member of recognized religious sect or division described in section 1402(g)(1) and adherent of established tenets or teachings of sect or division as described in section ; Subsection not applying to individual for perioding if individual in effect
Index of Sec 401. ...EXEMPTION described in subparagraph to be filed with Secretary at timing and form and manner as Secretary prescribing ; Application for
Index of Sec 401. ...ACCEPTABLE coverage ; Exemption from tax imposed under subsection in cases of de minimis lapses of
Index of Sec 401. ...EXEMPTION for Hawaii Prepaid Health Care Act ; Nothing in division to be construed to modify or limit application of
Index of Sec 156. ...EXEMPTION applying with respect to provisions of division ; Providing under section 514(b)(5) of Employee Retirement Income Security Act of 1974 29 USC 1144(b)(5) and
Index of Sec 156. ...EXPENDITURE of Federal funds appropriated for Department of Health and Human Services not ; Services described in subparagraph being abortions For which
Index of Sec 122. ...EXPENDITURE of Federal funds appropriated for Department of Health and Human Services ; Services described in subparagraph being abortions For which
Index of Sec 122. ...EXPENDITURES under reinsurance program in order to ensure that expenditures under reinsurance program not exceeding funds available under subsection ; Secretary having authority to stop taking applications for participation in program or taking other steps in reducing
Index of Sec 164. ...EXPENDITURES under reinsurance program in order to ensure that expenditures under reinsurance program not exceeding funds available under subsection ; Secretary having authority to stop taking applications for participation in program or taking other steps in reducing
Index of Sec 164. ...EXPENDITURES under reinsurance program in order to ensure that expenditures under reinsurance program not exceeding funds available under subsection ; Secretary having authority to stop taking applications for participation in program or taking other steps in reducing
Index of Sec 166. ...EXPENDITURES to Federal Government ; Approval Exchange not resulting in net increase in
Index of Sec 208. ...EXPENDITURES to Federal Government ; Approval Exchange not resulting in net increase in
Index of Sec 208. ...EXPENDITURES to Federal Government ; Approval Exchange not resulting in net increase in
Index of Sec 208. ...EXPENDITURES achieved as result of provisions ; Determining aggregate reductions in Federal
Index of Sec 441. ...ACCOUNT under subparagraph ; Aggregate reductions in Federal expenditures to be achieved as result of provisions and amendments during so period beginning with fiscal year 2010 and ending with fiscal year 2019 as not taken into
Index of Sec 441. ...EXPENDITURES during fiscal years 2010 through 2019 being attributable to provisions ; Director of Office of Management and Budget conducting study of reductions in Federal
Index of Sec 441. ...EXPENDITURES to be determined without regard to section 1121 of America's Affordable Health Choices acting of 2009 and other program investments under division B ; Reductions in Federal
Index of Sec 441. ...EXPENDITURES required ; Assistance provided for operation of Exchange in form of matching grant with State share of
Index of Sec 208. ...EXPENDITURES required ; Assistance provided for operation of Exchange in form of matching grant with State share of
Index of Sec 208. ...EXPENDITURES required ; Assistance provided for operation of Exchange in form of matching grant with State share of
Index of Sec 208. ...MEDICAL necessity, medically necessary or appropriate or experimental ; External appeal entity considering language in plan or coverage document relating to definitions of terms
Index of 0EXPENDITURES determined without Regard to Program investments ; Reductions in federal
Index of Sec 441. ...ABORTION ; Sec 156, application of State and federal laws regarding
Index of Sec 156. ...ABORTION ; No Effect on federal laws regarding
Index of Sec 156. ...ADMINISTRATIVE transactions under section 1173a of Social Security Act added by section 163(a) ; QHBP offering entity required to comply with standards for electronic financial and
Index of Sec 137. ...ADMINISTRATIVE transactions under section 1173a of Social Security Act and operating rules under section 1173b of Act as added by section 163(a) ; QHBP offering entity required to comply with standards for electronic financial and
Index of Sec 137. ...ADMINISTRATIVE transactions under section 1173a of Social Security Act added by section 163(a) ; QHBP offering entity required to comply with standards for electronic financial and
Index of Sec 137. ...ACCOUNT as purpose for entering into transaction if origin of financial accounting benefit being reduction of Federal income tax ; Achieving financial accounting benefit not to be taken into
Index of Sec 452. ...FINANCIAL assistance under Act ; Federal agency or program and State or local government receiving Federal
Index of Sec 157. ...FINANCIAL security ; Term essential benefits packaging means health benefiting coverage, consistent with standards adopted under section 124 to ensure provision of quality health care and
Index of Sec 122. ...FINANCIAL security ; Term essential benefits packaging means health benefiting coverage, consistent with standards adopted under section 124 to ensure provision of quality health care and
Index of Sec 122. ...FINANCIAL security ; Term essential benefits packaging means health benefiting coverage, consistent with standards adopted under section 124 to ensure provision of quality health care and
Index of Sec 122. ...FINANCIAL viability or ability to provide timely benefits to plan participants ; Insurance commissioner for State in which plan offered that complying with subsection for year threatening
Index of Sec 209. ...ETHNIC disparities ; Membership of Health benefiting Advisory Committee reflecting providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and
Index of Sec 123. ...ETHNIC disparities ; Membership of Health benefiting Advisory Committee reflecting providers, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and
Index of Sec 123. ...ETHNIC disparities ; Membership of Health benefiting Advisory Committee reflecting providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and
Index of Sec 123. ...FINANCING ; Plan sponsor in relation to group health plan in case of plan maintained jointly by 1 or more employers and 1 or more employee organizations and respect to which employer being primary source of
Index of Sec 100. ...FINANCING ; Plan sponsor in relation to group health plan in case of plan maintained jointly by 1 or more employers and 1 or more employee organizations and respect to which employer being primary source of
Index of Sec 100. ...FINANCING ; Plan sponsor in relation to group health plan in case of plan maintained jointly by 1 or more employers and 1 or more employee organizations and respect to which employer being primary source of
Index of Sec 100. ...FISCAL years during that appropriations being made from Trust Fund ; Taken into account for purposes of budget enforcement procedures including allocations under section 302(a) and Balanced Budget and Emergency Deficit Control Act and budget resolutions for
Index of Sec 164. ...FISCAL years during that appropriations being made from Trust Fund ; Taken into account for purposes of budget enforcement procedures including allocations under section 302(a) and Balanced Budget and Emergency Deficit Control Act and budget resolutions for
Index of Sec 164. ...FISCAL years during that appropriations being made from Trust Fund ; Taken into account for purposes of budget enforcement procedures including allocations under section 302(a) and Balanced Budget and Emergency Deficit Control Act and budget resolutions for
Index of Sec 166. ...ACCOUNT under subparagraph ; Aggregate reductions in Federal expenditures to be achieved as result of provisions and amendments during so period beginning with fiscal year 2010 and ending with fiscal year 2019 as not taken into
Index of Sec 441. ...ACCOUNT under subparagraph ; Aggregate reductions in Federal expenditures to be achieved as result of provisions and amendments during so period beginning with fiscal year 2010 and ending with fiscal year 2019 as not taken into
Index of Sec 441. ...FISCAL years 2010 through 2014 to provide for grants and loans under section ; Appropriating $5,000,000,000 for period of
Index of Sec 252. ...FISCAL years 2010 through 2019 being attributable to provisions ; Director of Office of Management and Budget conducting study of reductions in Federal expenditures during
Index of Sec 441. ...FOR-profit intending to offer or issues insurance coverage ;
Index of Sec 252. ...FOREIGN controlled group of entities referred in paragraph ; Common parent of
Index of Sec 451. ...ACCOUNT economic relationships among entities ; Treatment of member of foreign controlled group of entities as common parent of group if treatment being appropriate taking into
Index of Sec 451. ...ACCOUNT as expenses in determining pre-tax profit under subparagraph ; Fees and other transaction expenses and foreign taxes to be taken into
Index of Sec 452. ...FRAUD, waste and abuse under program ; Procedures to protect against
Index of Sec 164. ...FRAUD, waste and abuse under program ; Procedures to protect against
Index of Sec 164. ...FRAUD, waste and abuse under program ; Procedures to protect against
Index of Sec 166. ...FRAUD and abuse under Medicare ; Provisions of law identified by Secretary by regulation imposing sanctions with respect to waste,
Index of Sec 226. ...FRAUD and abuse under Medicare ; Provisions of law identified by Secretary by regulation imposing sanctions with respect to waste,
Index of Sec 226. ...FRAUD and abuse under Medicare ; Provisions of law identified by Secretary by regulation imposing sanctions with respect to waste,
Index of Sec 226. ...FRAUD as defined in sections 2712(b)(2) of Act ; Rescissions of coverage to be prohibited excepting in cases of
Index of Sec 112. ...FRAUD as defined in sections 2712(b)(2) of Act ; Rescissions of coverage to be prohibited excepting in cases of
Index of Sec 112. ...FRAUD as defined in sections 2712(b)(2) of Act ; Rescissions of coverage to be prohibited excepting in cases of
Index of Sec 112. ...FRAUD described in subsection ; Health insurance issuer rescinding health insurance coverage only upon clear and convincing evidence of
Index of Sec 162. ...FRAUD described in subsection ; Health insurance issuer rescinding health insurance coverage only upon clear and convincing evidence of
Index of Sec 162. ...MEDICAL expenses otherwise qualifying ; Secretary of Treasury issuing guidance of general applicability providing that
Index of Sec 461. ...GENERAL powers, rulemaking and delegation of section 702 of Social Security Act 42 USC 902 applying to Commissioner and Administration in same manner as provisions applying to Commissioner of Social Security and Social Security Administration ; Terms,
Index of Sec 141. ...GENERAL powers, rulemaking and delegation of section 702 of Social Security Act 42 USC 902 applying to Commissioner and Administration in same manner as provisions applying to Commissioner of Social Security and Social Security Administration ; Terms,
Index of Sec 141. ...CONTRACT at retail and mail order pharmacies and percentage of cases in which generic drug dispensed when available ; Information on overall percentage of generic drugs dispensed under
Index of Sec 133. ...DISABILITY, socioeconomic status, rural, urban or other geographic setting and other population or subpopulation as determined appropriate by Secretary ; Primary language, sex, sexual orientation, gender identity,
Index of Sec 221. ...COMPETITIVE disadvantage ; Secretary delaying implementation reform in geographic areas in which implementation placing public health insurance option at
Index of Sec 224. ...GEOGRAPHIC areas or otherwise in order to reduce total program costs or promoting high value care ; Secretary prioritizing implementation reform in high cost
Index of Sec 224. ...GEOGRAPHIC areas ; Nothing in subtitle preventing Secretary from varying payments based on different payment structure models under public health insurance option for different
Index of Sec 224. ...GEOGRAPHIC areas ; Nothing in subtitle preventing Secretary from varying payments based on different payment structure models under public health insurance option for different
Index of Sec 224. ...GEOGRAPHIC areas ; Nothing in subtitle preventing Secretary from varying payments based on different payment structure models under public health insurance option for different
Index of Sec 224. ...GG of Social Security Act whether Health Insurance Exchange supporting enrollment of children described in paragraph in State in year ; Commissioner notifying State in Y1 and purposes of section 1902(
Index of Sec 205. ...GG of Social Security Act whether Health Insurance Exchange supporting enrollment of children described in paragraph in State in year ; Commissioner notifying State in Y1 and purposes of section 1902(
Index of Sec 205. ...GG of Social Security Act whether Health Insurance Exchange supporting enrollment of children described in paragraph in State in year ; Commissioner notifying State in Y1 and purposes of section 1902(
Index of Sec 205. ...COOPERATIVE ; Governing documents of cooperatives incorporating ethical and conflict of interest standards designed to protect against insurance industry involvement and interference in governance of
Index of Sec 252. ...GRIEVANCE and appealing mechanisms as Commissioner establishing consistent with sections 139 through 139b ; QHBP offering entity providing for timely
Index of Sec 132. ...GRIEVANCE and appealing mechanisms ; QHBP offering entity providing for timely
Index of Sec 132. ...GRIEVANCE and appealing mechanisms ; QHBP offering entity providing for timely
Index of Sec 132. ...GRIEVANCE and appealing mechanisms ; Sec 132 requiring fair
Index of Sec 132. ...GRIEVANCE and appealing mechanisms ; Sec 132 requiring fair
Index of Sec 132. ...GRIEVANCE and appealing mechanisms ; Sec 132 requiring fair
Index of Sec 132. ...GRIEVANCE and appealing mechanisms ; Requiring fair
Index of Sec 132. ...GRIEVANCE and appealing mechanisms ; Requiring fair
Index of Sec 132. ...GUIDANCE implementing requirement including procedures for independent ; Issuing
Index of Sec 162. ...GUIDANCE implementing requirement including procedures for independent ; Issuing
Index of Sec 162. ...GUIDANCE issued by Secretary under section 2742(f) ; Coverage remaining in effect until third party determining that coverage to be rescinded under
Index of Sec 162. ...GUIDANCE issued by Secretary under section 2742(f) ; Coverage remaining in effect until third party determining that coverage to be rescinded under
Index of Sec 162. ...GUIDANCE of general applicability providing that medical expenses otherwise qualifying ; Secretary of Treasury issuing
Index of Sec 461. ...GUIDANCE as necessary or appropriate to carry out purposes of subsection ; Secretary prescribing regulations or other
Index of Sec 451. ...GUIDANCE regarding rescissions ; Secretarial
Index of Sec 162. ...GUIDANCE regarding rescissions ; Secretarial
Index of Sec 162. ...HEALTH care becoming more affordable for businesses, families and government ; Increasing quality and reducing growth in health spending so that
Index of Sec 100. ...HEALTH care becoming more affordable for businesses, families and government ; Increasing quality and reducing growth in health spending so that
Index of Sec 100. ...HEALTH care becoming more affordable for businesses, families and government ; Increasing quality and reducing growth in health spending so that
Index of Sec 100. ...EMPLOYMENT-based health plan ; Respect to health benefiting plan other than
Index of Sec 100. ...EMPLOYMENT-based health plan ; Respect to health benefiting plan other than
Index of Sec 100. ...EMPLOYMENT-based health plan ; Respect to health benefiting plan other than
Index of Sec 100. ...HEALTH benefiting plan ; Respect to
Index of Sec 100. ...HEALTH benefiting plan ; Respect to
Index of Sec 100. ...HEALTH benefiting plan ; Respect to
Index of Sec 100. ...HEALTH benefiting plan meeting requirements plan under title I and including public health insurance option ; Term qualified health benefits planning meaning
Index of Sec 100. ...HEALTH benefiting plan meeting requirements plan under title I and including public health insurance option and cooperatives under subtitle D of title II ; Term qualified health benefits planning meaning
Index of Sec 100. ...HEALTH benefiting plan meeting requirements plan under title I and including public health insurance option ; Term qualified health benefits planning meaning
Index of Sec 100. ...HEALTH benefiting plan offered under chapter 89 of title 5, United States coding ; Including
Index of Sec 100. ...HEALTH benefiting plan offered under chapter 89 of title 5, United States coding ; Including
Index of Sec 100. ...HEALTH benefiting plan offered under chapter 89 of title 5, United States coding ; Including
Index of Sec 100. ...HEALTH benefiting plan not to be qualified health benefits planning under division unless plan meeting applicable requirements of following subtitles for type of plan and plan year involved ;
Index of Sec 101. ...HEALTH benefiting plan not to be qualified health benefits planning under division unless plan meeting applicable requirements of following subtitles for type of plan and plan year involved ;
Index of Sec 101. ...HEALTH benefiting plan not to be qualified health benefits planning under division unless plan meeting applicable requirements of following subtitles for type of plan and plan year involved ;
Index of Sec 101. ...HEALTH benefiting plan ; Covering benefits, treatments and services being available under
Index of Sec 115. ...HEALTH benefiting plan ; Covering benefits, treatments and services being available under
Index of Sec 115. ...HEALTH benefiting plan ; Covering benefits, treatments and services being available under
Index of Sec 115. ...HEALTH, medical and scientific matters ; Knowledgeable about health care system and received training regarding
Index of Sec 123. ...HEALTH claiming attachments ; Standard for
Index of Sec 163. ...HEALTH claiming attachments ; Standard for
Index of Sec 164. ...HEALTH flexible spending arrangement under cafeteria plan within meaning of section 125 of Internal Revenue Code of 1986 ; Term not including coverage under
Index of Sec 167. ...HEALTH benefiting Plans offered by offering entities ; Limitation on
Index of Sec 203. ...HEALTH benefiting Plans offered by offering entities ; Limitation on
Index of Sec 203. ...HEALTH benefiting Plans offered by offering entities ; Limitation on
Index of Sec 203. ...HEALTH benefits planning of QHBP offering entity ; Clause not applying if Commissioner determining that delay in termination posing imminent and serious risk to health of individuals enrolled under qualified
Index of Sec 204. ...HEALTH benefits planning of QHBP offering entity ; Clause not applying if Commissioner determining that delay in termination posing imminent and serious risk to health of individuals enrolled under qualified
Index of Sec 204. ...HEALTH benefits planning of QHBP offering entity ; Clause not applying if Commissioner determining that delay in termination posing imminent and serious risk to health of individuals enrolled under qualified
Index of Sec 204. ...HEALTH flexible spending arrangements and health reimbursement arrangements ;
Index of Sec 442. ...HEALTH and health care and sharing data with Secretary of Health and Human Services ; Commissioner collecting data for purposes of carrying out Commissioner's duties protecting consumers and addressing disparities in
Index of Sec 142. ...HEALTH and health care and sharing data with Secretary of Health and Human Services ; Commissioner collecting data for purposes of carrying out Commissioner's duties protecting consumers and addressing disparities in
Index of Sec 142. ...HEALTH and health care and sharing data with Secretary of Health and Human Services ; Commissioner collecting data for purposes of carrying out Commissioner's duties protecting consumers and addressing disparities in
Index of Sec 142. ...HEALTH and health care ; Including information necessary to administer risk pooling mechanism described in section 206(b) and information to address disparities in
Index of Sec 204. ...HEALTH and health care ; Including information necessary to administer risk pooling mechanism described in section 206(b) and information to address disparities in
Index of Sec 204. ...HEALTH and health care ; Including information necessary to administer risk pooling mechanism described in section 206(b) and information to address disparities in
Index of Sec 204. ...HEALTH and health care based on race ; Requiring to establish premiums and payment rates for public health insurance option and other purposes under subtitle including to improve quality and reducing disparities in
Index of Sec 221. ...HEALTH and value ; Public health insurance option modifying cost sharing and payment rates to encourage use of services promoting
Index of Sec 224. ...HEALTH and value ; Public health insurance option modifying cost sharing and payment rates to encourage use of services promoting
Index of Sec 224. ...HEALTH and value ; Public health insurance option modifying cost sharing and payment rates to encourage use of services promoting
Index of Sec 224. ...HEALTH benefiting plan of QHBP offering entity using provider network ; Case of
Index of Sec 204. ...HEALTH benefiting plan of QHBP offering entity using provider network ; Case of
Index of Sec 204. ...HEALTH benefiting plan of QHBP offering entity using provider network ; Case of
Index of Sec 204. ...HEALTH and representing balance among various sectors of health care system so ; Disabilities, representatives of relevant governmental agencies and one practicing physician or other health professional and expert on children's
Index of Sec 123. ...HEALTH and representing balance among various sectors of health care system so ; Disabilities, representatives of relevant governmental agencies and one practicing physician or other health professional and expert on children's
Index of Sec 123. ...HEALTH and representing balance among various sectors of health care system so ; Disabilities, representatives of relevant governmental agencies and one practicing physician or other health professional and expert on children's
Index of Sec 123. ...HEALTH of participant, beneficiary or enrollee or individual s ability to regain maximum function ; Application of normal timeframe for making determination seriously jeopardizing life or
Index of 0FINANCIAL security ; Term essential benefits packaging means health benefiting coverage, consistent with standards adopted under section 124 to ensure provision of quality health care and
Index of Sec 122. ...FINANCIAL security ; Term essential benefits packaging means health benefiting coverage, consistent with standards adopted under section 124 to ensure provision of quality health care and
Index of Sec 122. ...FINANCIAL security ; Term essential benefits packaging means health benefiting coverage, consistent with standards adopted under section 124 to ensure provision of quality health care and
Index of Sec 122. ...HEALTH and representing balance among various sectors of health care system so ; Disabilities, representatives of relevant governmental agencies and one practicing physician or other health professional and expert on children's
Index of Sec 123. ...HEALTH and representing balance among various sectors of health care system so ; Disabilities, representatives of relevant governmental agencies and one practicing physician or other health professional and expert on children's
Index of Sec 123. ...HEALTH and representing balance among various sectors of health care system so ; Disabilities, representatives of relevant governmental agencies and one practicing physician or other health professional and expert on children's
Index of Sec 123. ...HEALTH benefiting coverage ; Other
Index of Sec 202. ...HEALTH benefiting coverage ; Other
Index of Sec 202. ...HEALTH benefiting coverage ; Other
Index of Sec 202. ...HEALTH benefiting coverage as Secretary recognizing for purposes of subsection ; Other
Index of Sec 401. ...HEALTH and medical information supplied with respect to individual whose denial of claim for benefits appealed ; Personal
Index of 0HEALTH benefiting group not to have coverage described in paragraph being Exchange eligible individual ; Individual being participant or beneficiary in adversely affected retiree
Index of Sec 202. ...HEALTH benefiting group meaning retired participants and beneficiaries of group health plan cancelled or substantially reducing amount ; Term adversely affected retiree
Index of Sec 202. ...DISCLOSURE required under subsection identification to enrollees of providers of services under plan trained and accredited in integrative health medicine ; Qualified health benefit plan including in
Index of Sec 133. ...HEALTH benefit plans ; Complying with premium ruling established by Commissioner under section 113 for Exchange-participating
Index of Sec 222. ...HEALTH benefit plans ; Complying with premium ruling established by Commissioner under section 113 for Exchange-participating
Index of Sec 222. ...HEALTH benefit plans ; Complying with premium ruling established by Commissioner under section 113 for Exchange-participating
Index of Sec 222. ...HEALTH benefit plans through Health Insurance Exchange or State-based health insurance exchange ; Activities of cooperative consisting of issuance of qualified
Index of Sec 252. ...HEALTH benefiting plan meeting requirements plan under title I and including public health insurance option ; Term qualified health benefits planning meaning
Index of Sec 100. ...HEALTH benefiting plan meeting requirements plan under title I and including public health insurance option and cooperatives under subtitle D of title II ; Term qualified health benefits planning meaning
Index of Sec 100. ...HEALTH benefiting plan meeting requirements plan under title I and including public health insurance option ; Term qualified health benefits planning meaning
Index of Sec 100. ...HEALTH benefits ; Qualified health benefits planning complying with standards established by Commissioner to prohibit discrimination in health benefits or benefit structures for qualifing
Index of Sec 114. ...HEALTH benefits ; Qualified health benefits planning complying with standards established by Commissioner to prohibit discrimination in health benefits or benefit structures for qualifing
Index of Sec 114. ...CONTRACT or certificate of insurance ; Nothing in division to be construed as affecting offering of health benefits in form of excepted benefits if benefits offered under separate policy,
Index of Sec 121. ...CONTRACT or certificate of insurance ; Nothing in division to be construed as affecting offering of health benefits in form of excepted benefits if benefits offered under separate policy,
Index of Sec 121. ...CONTRACT or certificate of insurance ; Nothing in division to be construed as affecting offering of health benefits in form of excepted benefits if benefits offered under separate policy,
Index of Sec 121. ...HEALTH benefits planing in State ; Respect to QHBP offering entities offering qualified
Index of 0HEALTH benefits planing offering higher reimbursement rates for meaningful use ; Qualifying
Index of Sec 157. ...HEALTH benefits planing increasing reimbursement rates to health care providers to increase meaningful use of electronic health records by providers ; Recommendations concerning whether qualified
Index of Sec 157. ...HEALTH benefits planing increase reimbursement rates for health care providers ; Commissioner requiring that qualified
Index of Sec 157. ...HEALTH benefits to retirees and eligible spouses surviving spouses and dependents of retirees ; Secretary of Health and Human Services establishing temporary reinsurance program to provide reimbursement to assist participating employment-based plans with cost of providing
Index of Sec 164. ...HEALTH benefits to retirees and eligible spouses surviving spouses and dependents of retirees ; Secretary of Health and Human Services establishing temporary reinsurance program to provide reimbursement to assist participating employment-based plans with cost of providing
Index of Sec 164. ...HEALTH benefits provided to retiree or spouse surviving spouse ; Claim submitted under subparagraph to be based on actual amount expended by participating employment-based plan involved within plan year for appropriate employment based
Index of Sec 164. ...HEALTH benefits provided to retiree or spouse surviving spouse ; Claim submitted under subparagraph to be based on actual amount expended by participating employment-based plan involved within plan year for appropriate employment based
Index of Sec 164. ...HEALTH benefits provided under plan in form of premiums, co-payments, deductibles, co-insurance or other out-of-pocket costs ; Amounts paid to participating employment-based plan under subsection to be used to lowing costs borne directly by participants and beneficiaries for
Index of Sec 164. ...HEALTH benefits provided under plan in form of premiums, co-payments, deductibles, co-insurance or other out-of-pocket costs ; Amounts paid to participating employment-based plan under subsection to be used to lowing costs borne directly by participants and beneficiaries for
Index of Sec 164. ...HEALTH benefits to retirees and eligible spouses surviving spouses and dependents of retirees ; Secretary of Health and Human Services establishing temporary reinsurance program to provide reimbursement to assist participating employment-based plans with cost of providing
Index of Sec 166. ...HEALTH benefits provided to retiree or spouse surviving spouse ; Claim submitted under subparagraph to be based on actual amount expended by participating employment-based plan involved within plan year for appropriate employment based
Index of Sec 166. ...HEALTH benefits provided under plan in form of premiums, co-payments, deductibles, co-insurance or other out-of-pocket costs ; Amounts paid to participating employment-based plan under subsection to be used to lowing costs borne directly by participants and beneficiaries for
Index of Sec 166. ...ACCEPTABLE coverage ; Individuals being eligible to obtain coverage through enrollment in Exchange-participating health benefits planning offered through Health Insurance Exchange unless individuals enrolled in another qualified health benefits planning or other
Index of Sec 202. ...ACCEPTABLE coverage ; Individuals being eligible to obtain coverage through enrollment in Exchange-participating health benefits planning offered through Health Insurance Exchange unless individuals enrolled in another qualified health benefits planning or other
Index of Sec 202. ...ACCEPTABLE coverage ; Individuals being eligible to obtain coverage through enrollment in Exchange-participating health benefits planning offered through Health Insurance Exchange unless individuals enrolled in another qualified health benefits planning or other
Index of Sec 202. ...HEALTH Benefits planning coverage ; Qualifying
Index of Sec 202. ...HEALTH Benefits planning coverage ; Qualifying
Index of Sec 202. ...HEALTH Benefits planning coverage ; Qualifying
Index of Sec 202. ...HEALTH benefits planning until Secretary of Health and Human Services ; No child to be eligible for coverage under title XXI of Social Security Act to be enrolled in Exchange participating
Index of Sec 202. ...HEALTH benefits planing as meeting standards and requirements of title and titling I for purposes of subtitle ; Certifying QHBP offering entities and qualified
Index of Sec 204. ...HEALTH benefits planing as meeting standards and requirements of title and titling I for purposes of subtitle ; Certifying QHBP offering entities and qualified
Index of Sec 204. ...HEALTH benefits planing as meeting standards and requirements of title and titling I for purposes of subtitle ; Certifying QHBP offering entities and qualified
Index of Sec 204. ...HEALTH benefits planning discriminating against individual health care provider or health care facility because of willingness or unwillingness ; No Exchange participating
Index of Sec 204. ...HEALTH benefits planing ; Commissioner entering into contracts with small employer benefit arrangements to provide consumer information, outreach and assistance in enrollment of small employers being members arrangement under Exchange participating
Index of Sec 209. ...HEALTH benefits provided by public health insurance option ;
Index of Sec 222. ...HEALTH benefits provided by public health insurance option ;
Index of Sec 222. ...HEALTH benefits provided by public health insurance option ;
Index of Sec 222. ...HEALTH benefits planning that meeting requirements of section 312 ; Enrolling under Exchange-participating health benefits planning and not enrolled under planning as employee through employer qualified
Index of Sec 242. ...HEALTH benefits planning that meeting requirements of section 312 ; Enrolling under Exchange-participating health benefits planning and not enrolled under planning as employee through employer qualified
Index of Sec 242. ...HEALTH benefits planning that meeting requirements of section 312 ; Enrolling under Exchange-participating health benefits planning and not enrolled under planning as employee through employer qualified
Index of Sec 242. ...HEALTH Benefits ; Automatic enrollment for Employer sponsored
Index of Sec 312. ...HEALTH Benefits ; Automatic enrollment for Employer sponsored
Index of Sec 312. ...HEALTH Benefits ; Automatic enrollment for Employer sponsored
Index of Sec 312. ...HEALTH Benefits planning coverage ; Qualifying
Index of Sec 401. ...HEALTH benefits or benefit structures for qualifing health benefits ; Qualified health benefits planning complying with standards established by Commissioner to prohibit discrimination in
Index of Sec 114. ...HEALTH benefits or benefit structures for qualified health benefits ; Qualified health benefits planning complying with standards established by Commissioner to prohibit discrimination in
Index of Sec 114. ...HEALTH benefits or benefit structures for qualifing health benefits ; Qualified health benefits planning complying with standards established by Commissioner to prohibit discrimination in
Index of Sec 114. ...EMPLOYMENT-based health benefits planning for individual coverage under plan option with lowest applicable employee premium ; Requirement of subsection with respect to employer and employee being employer automatically enrolling employee into
Index of Sec 312. ...EMPLOYMENT-based health benefits planning for individual coverage under plan option with lowest applicable employee premium ; Requirement of subsection with respect to employer and employee being employer automatically enrolling employee into
Index of Sec 312. ...EMPLOYMENT-based health benefits planning for individual coverage under plan option with lowest applicable employee premium ; Requirement of subsection with respect to employer and employee being employer automatically enrolling employee into
Index of Sec 312. ...EMPLOYMENT-based health benefits planning offered by employer ; No case employer automatically enrolling employee in plan under paragraph if employee making affirmative election to opt out of plan or electing coverage under
Index of Sec 312. ...EMPLOYMENT-based health benefits planning offered by employer ; No case employer automatically enrolling employee in plan under paragraph if employee making affirmative election to opt out of plan or electing coverage under
Index of Sec 312. ...EMPLOYMENT-based health benefits planning offered by employer ; No case employer automatically enrolling employee in plan under paragraph if employee making affirmative election to opt out of plan or electing coverage under
Index of Sec 312. ...HEALTH benefits planning as of date on which plan becoming subject to requirements of section 111 of Act ; Section 2701 of acting and amendments making by subsection of section to sections 2741 and 2744 of Act ceasing to be effective in case of
Index of Sec 167. ...HEALTH benefits to residents of State and providing measures to assure free choice of providers for covered services to promote quality and helping resolve complaints and disputes between consumers and providers ; Providing comprehensive
Index of Sec 253. ...HEALTH benefits planing ; Term Exchange-eligible employer meaning employer being eligible under section to enroll through Health Insurance Exchange employees of employer in Exchange-eligible
Index of Sec 202. ...HEALTH benefits planing ; Term Exchange-eligible employer meaning employer being eligible under section to enroll through Health Insurance Exchange employees of employer in Exchange-eligible
Index of Sec 202. ...HEALTH benefits planing ; Term Exchange-eligible employer meaning employer being eligible under section to enroll through Health Insurance Exchange employees of employer in Exchange-eligible
Index of Sec 202. ...HEALTH benefits planning ; Term eligible employment-based plan meaning group
Index of Sec 164. ...HEALTH benefits planning ; Term eligible employment-based plan meaning group
Index of Sec 164. ...HEALTH benefits planning ; Term eligible employment-based plan meaning group
Index of Sec 166. ...HEALTH benefits planning not varying excepting as following ; Premium rate charged for insured qualified
Index of Sec 113. ...HEALTH benefits planning not varying excepting as following ; Premium rate charged for insured qualified
Index of Sec 113. ...HEALTH benefits planning and coverage under public health insurance option not varying excepting as following ; Premium rate charged for insured qualified
Index of Sec 113. ...HEALTH benefits planing under title and enforcement of standards ; Including concerning standards for insured qualified
Index of Sec 143. ...HEALTH benefits planing under title and enforcement of standards ; Including concerning standards for insured qualified
Index of Sec 143. ...HEALTH benefits planing under title and enforcement of standards ; Including concerning standards for insured qualified
Index of Sec 143. ...HEALTH benefits planing ; Appropriate Secretary assessing civil penalty against person acting in capacity of authorizing benefit determined by external review entity for one or more qualified
Index of 0HEALTH benefits planning paying plans directly and not through Commissioner or Health Insurance Exchange ; Individuals enrolled in Exchange-partcipating
Index of Sec 205. ...HEALTH benefits planing ; Area as established by entity in accordance with applicable State law and applicable rules of Commissioner for Exchange-participating
Index of Sec 100. ...HEALTH benefits planing ; Area as established by entity in accordance with applicable State law and applicable rules of Commissioner for Exchange-participating
Index of Sec 100. ...HEALTH benefits planing ; Area as established by entity in accordance with applicable State law and applicable rules of Commissioner for Exchange-participating
Index of Sec 100. ...HEALTH benefits planning ; Individual health insurance coverage not grandfathered health insurance coverage under subsection only to be offered after first day of Y1 as Exchange-participating
Index of Sec 102. ...HEALTH benefits planning ; Individual health insurance coverage not grandfathered health insurance coverage under subsection only to be offered after first day of Y1 as Exchange-participating
Index of Sec 102. ...HEALTH benefits planning ; Individual health insurance coverage not grandfathered health insurance coverage under subsection only to be offered after first day of Y1 as Exchange-participating
Index of Sec 102. ...HEALTH benefits planning ; Case of qualified health benefits planning being not Exchange-participating
Index of Sec 121. ...HEALTH benefits planning ; Case of qualified health benefits planning being not Exchange-participating
Index of Sec 121. ...HEALTH benefits planning ; Case of qualified health benefits planning being not Exchange-participating
Index of Sec 121. ...HEALTH benefits planing offered through Exchange ; Providing for dissemination of information related to end-of-life planning to individuals seeking enrollment in Exchange-participating
Index of Sec 138. ...HEALTH benefits planning meaning qualified health benefits planning offered through Health Insurance Exchange ; Term Exchange-participating
Index of Sec 201. ...HEALTH benefits planning meaning qualified health benefits planning offered through Health Insurance Exchange ; Term Exchange-participating
Index of Sec 201. ...HEALTH benefits planning meaning qualified health benefits planning offered through Health Insurance Exchange ; Term Exchange-participating
Index of Sec 201. ...ACCEPTABLE coverage ; Individuals being eligible to obtain coverage through enrollment in Exchange-participating health benefits planning offered through Health Insurance Exchange unless individuals enrolled in another qualified health benefits planning or other
Index of Sec 202. ...ACCEPTABLE coverage ; Individuals being eligible to obtain coverage through enrollment in Exchange-participating health benefits planning offered through Health Insurance Exchange unless individuals enrolled in another qualified health benefits planning or other
Index of Sec 202. ...ACCEPTABLE coverage ; Individuals being eligible to obtain coverage through enrollment in Exchange-participating health benefits planning offered through Health Insurance Exchange unless individuals enrolled in another qualified health benefits planning or other
Index of Sec 202. ...HEALTH benefits planning and including dependents of individual ; Term Exchange-eligible individual meaning individual being eligible under section to be enrolled through Health Insurance Exchange in Exchange-participating
Index of Sec 202. ...HEALTH benefits planning and including dependents of individual ; Term Exchange-eligible individual meaning individual being eligible under section to be enrolled through Health Insurance Exchange in Exchange-participating
Index of Sec 202. ...HEALTH benefits planning and including dependents of individual ; Term Exchange-eligible individual meaning individual being eligible under section to be enrolled through Health Insurance Exchange in Exchange-participating
Index of Sec 202. ...HEALTH benefits planning through Health Insurance Exchange ; Individual qualifying as Exchange-eligible individual under subsection and enrolling under Exchange-participating
Index of Sec 202. ...HEALTH benefits planning through Health Insurance Exchange ; Individual qualifying as Exchange-eligible individual under subsection and enrolling under Exchange-participating
Index of Sec 202. ...HEALTH benefits planning through Health Insurance Exchange ; Individual qualifying as Exchange-eligible individual under subsection and enrolling under Exchange-participating
Index of Sec 202. ...HEALTH benefits planning ; Employer continuing to be treated as Exchange-eligible employer for subsequent plan year regardless of number of employees involved until employer meeting requirement of section 311(a) through paragraph of section by offering group health plan and not through offering Exchange-participating
Index of Sec 202. ...HEALTH benefits planning ; Employer continuing to be treated as Exchange-eligible employer for subsequent plan year regardless of number of employees involved until employer meeting requirement of section 311(a) through paragraph of section by offering group health plan and not through offering Exchange-participating
Index of Sec 202. ...HEALTH benefits planning ; Employer continuing to be treated as Exchange-eligible employer for subsequent plan year regardless of number of employees involved until employer meeting requirement of section 311(a) through paragraph of section by offering group health plan and not through offering Exchange-participating
Index of Sec 202. ...HEALTH benefits planing through Health Insurance Exchange consistent with provisions of subtitle B of title III ; Employer meeting requirements of section 312 with respect to employees of employer by offering employees option of enrolling with Exchange-participating
Index of Sec 202. ...HEALTH benefits planing through Health Insurance Exchange consistent with provisions of subtitle B of title III ; Employer meeting requirements of section 312 with respect to employees of employer by offering employees option of enrolling with Exchange-participating
Index of Sec 202. ...HEALTH benefits planing by employer of employee under subparagraph choosing coverage plan ; Employee offered Exchange-participating
Index of Sec 202. ...HEALTH benefits planing by employer of employee under subparagraph choosing coverage plan ; Employee offered Exchange-participating
Index of Sec 202. ...HEALTH benefits planing through Health Insurance Exchange consistent with provisions of subtitle B of title III ; Employer meeting requirements of section 312 with respect to employees of employer by offering employees option of enrolling with Exchange-participating
Index of Sec 202. ...HEALTH benefits planing by employer of employee under subparagraph choosing coverage plan ; Employee offered Exchange-participating
Index of Sec 202. ...HEALTH benefits planing ; Commissioner providing for periodic surveys of Exchange-eligible individuals and employers concerning satisfaction of individuals and employers with Health Insurance Exchange and Exchange-participating
Index of Sec 202. ...HEALTH benefits planing ; Commissioner providing for periodic surveys of Exchange-eligible individuals and employers concerning satisfaction of individuals and employers with Health Insurance Exchange and Exchange-participating
Index of Sec 202. ...HEALTH benefits planing ; Commissioner providing for periodic surveys of Exchange-eligible individuals and employers concerning satisfaction of individuals and employers with Health Insurance Exchange and Exchange-participating
Index of Sec 202. ...HEALTH benefits planing ; Commissioner conducting study of access to Health Insurance Exchange for individuals and employers including individuals and employers being not eligible and enrolled in Exchange-participating
Index of Sec 202. ...HEALTH benefits planing ; Commissioner conducting study of access to Health Insurance Exchange for individuals and employers including individuals and employers being not eligible and enrolled in Exchange-participating
Index of Sec 202. ...HEALTH benefits planing ; Commissioner conducting study of access to Health Insurance Exchange for individuals and employers including individuals and employers being not eligible and enrolled in Exchange-participating
Index of Sec 202. ...HEALTH benefits planing ; Terms, conditions and affordability of group health coverage offered by employers and QHBP offering entities outside of Exchange compared to Exchange-participating
Index of Sec 202. ...HEALTH benefits planing ; Terms, conditions and affordability of group health coverage offered by employers and QHBP offering entities outside of Exchange compared to Exchange-participating
Index of Sec 202. ...HEALTH benefits planing ; Terms, conditions and affordability of group health coverage offered by employers and QHBP offering entities outside of Exchange compared to Exchange-participating
Index of Sec 202. ...HEALTH benefits planning offered through Health Insurance Exchange ; Individual with acceptable coverage described in subparagraph or subsection being eligible to obtain coverage through enrollment in Exchange-participating
Index of Sec 202. ...HEALTH benefits planing during plan year, consistent with subtitle C of title I and section ; Commissioner specifying benefits to be made available under Exchange-participating
Index of Sec 203. ...HEALTH benefits planing during plan year, consistent with subtitle C of title I and section ; Commissioner specifying benefits to be made available under Exchange-participating
Index of Sec 203. ...HEALTH benefits planing during plan year, consistent with subtitle C of title I and section ; Commissioner specifying benefits to be made available under Exchange-participating
Index of Sec 203. ...HEALTH benefits planning in service area unless following requirements being met ; Commissioner not entering into contract with QHBP offering entity under section 204(c) for offering of Exchange-participating
Index of Sec 203. ...HEALTH benefits planning in service area unless following requirements being met ; Commissioner not entering into contract with QHBP offering entity under section 204(c) for offering of Exchange-participating
Index of Sec 203. ...HEALTH benefits planning in service area unless following requirements being met ; Commissioner not entering into contract with QHBP offering entity under section 204(c) for offering of Exchange-participating
Index of Sec 203. ...HEALTH benefits planning ; Requirement continuing to apply to Exchange-participating
Index of Sec 203. ...HEALTH benefits planning ; Requirement continuing to apply to Exchange-participating
Index of Sec 203. ...HEALTH benefits planning ; Requirement continuing to apply to Exchange-participating
Index of Sec 203. ...HEALTH Benefits planing ; Sec 204, Contracts for offering of Exchange-participating
Index of Sec 204. ...HEALTH Benefits planing ; Sec 204, Contracts for offering of Exchange-participating
Index of Sec 204. ...HEALTH Benefits planing ; Sec 204, Contracts for offering of Exchange-participating
Index of Sec 204. ...HEALTH benefits planning ; QHBP offering entities for offering of Exchange-participating
Index of Sec 204. ...HEALTH benefits planning ; QHBP offering entities for offering of Exchange-participating
Index of Sec 204. ...HEALTH benefits planning ; QHBP offering entities for offering of Exchange-participating
Index of Sec 204. ...HEALTH benefits planing ; Soliciting bids from QHBP offering entities for offering of Exchange-participating
Index of Sec 204. ...HEALTH benefits planing ; Soliciting bids from QHBP offering entities for offering of Exchange-participating
Index of Sec 204. ...HEALTH benefits planing ; Soliciting bids from QHBP offering entities for offering of Exchange-participating
Index of Sec 204. ...HEALTH benefits planing under title ; Provisions of Federal Acquisition Regulation not applying to contracts between Commissioner and QHBP offering entities for offering of Exchange-participating
Index of Sec 204. ...HEALTH benefits planing under title ; Provisions of Federal Acquisition Regulation not applying to contracts between Commissioner and QHBP offering entities for offering of Exchange-participating
Index of Sec 204. ...HEALTH benefits planing under title ; Provisions of Federal Acquisition Regulation not applying to contracts between Commissioner and QHBP offering entities for offering of Exchange-participating
Index of Sec 204. ...HEALTH Benefits planing ; Standards for QHBP offering entities to Offer Exchange-participating
Index of Sec 204. ...HEALTH Benefits planing ; Standards for QHBP offering entities to Offer Exchange-participating
Index of Sec 204. ...HEALTH Benefits planing ; Standards for QHBP offering entities to Offer Exchange-participating
Index of Sec 204. ...HEALTH benefits planing and plans including marketing of plans ; Commissioner establishing processing to oversee, monitor and enforce applicable requirements of title with respect to QHBP offering entities offering Exchange-participating
Index of Sec 204. ...HEALTH benefits planing and plans including marketing of plans ; Commissioner establishing processing to oversee, monitor and enforce applicable requirements of title with respect to QHBP offering entities offering Exchange-participating
Index of Sec 204. ...HEALTH benefits planing and plans including marketing of plans ; Commissioner establishing processing to oversee, monitor and enforce applicable requirements of title with respect to QHBP offering entities offering Exchange-participating
Index of Sec 204. ...HEALTH benefits planning if entity failing to comply with applicable requirements of title ; Commissioner terminating contract with QHBP offering entity under section for offering of Exchange-participating
Index of Sec 204. ...HEALTH benefits planning if entity failing to comply with applicable requirements of title ; Commissioner terminating contract with QHBP offering entity under section for offering of Exchange-participating
Index of Sec 204. ...HEALTH benefits planning if entity failing to comply with applicable requirements of title ; Commissioner terminating contract with QHBP offering entity under section for offering of Exchange-participating
Index of Sec 204. ...HEALTH benefits planning options ; Informing and educating individuals and employers about Health Insurance Exchange and Exchange-participating
Index of Sec 205. ...HEALTH benefits planning options ; Informing and educating individuals and employers about Health Insurance Exchange and Exchange-participating
Index of Sec 205. ...HEALTH benefits planning options ; Informing and educating individuals and employers about Health Insurance Exchange and Exchange-participating
Index of Sec 205. ...AFFORDABILITY credits under subtitle C periods to be during September through November of year or other time maximizing timeliness of income verification for purposes of subtitle ; Commissioner establishing annual open enrollment period during that Exchange-eligible individual or employer electing to enroll in Exchange-participating health benefits planning for following plan year and enrollment period for
Index of Sec 205. ...AFFORDABILITY credits under subtitle C periods to be during September through November of year or other time maximizing timeliness of income verification for purposes of subtitle ; Commissioner establishing annual open enrollment period during that Exchange-eligible individual or employer electing to enroll in Exchange-participating health benefits planning for following plan year and enrollment period for
Index of Sec 205. ...AFFORDABILITY credits under subtitle C periods to be during September through November of year or other time maximizing timeliness of income verification for purposes of subtitle ; Commissioner establishing annual open enrollment period during that Exchange-eligible individual or employer electing to enroll in Exchange-participating health benefits planning for following plan year and enrollment period for
Index of Sec 205. ...HEALTH benefits planning ; Commissioner providing for process under which individuals being Exchange-eligible individuals described in subparagraph automatically enrolled under appropriate Exchange-participating
Index of Sec 205. ...HEALTH benefits planning ; Commissioner providing for process under which individuals being Exchange-eligible individuals described in subparagraph automatically enrolled under appropriate Exchange-participating
Index of Sec 205. ...HEALTH benefits planning ; Commissioner providing for process under which individuals being Exchange-eligible individuals described in subparagraph automatically enrolled under appropriate Exchange-participating
Index of Sec 205. ...HEALTH benefits planning terminated and not otherwise enrolling in another Exchange-participating health benefits planning ; Individual enrolled in Exchange-participating
Index of Sec 205. ...HEALTH benefits planning terminated and not otherwise enrolling in another Exchange-participating health benefits planning ; Individual enrolled in Exchange-participating
Index of Sec 205. ...HEALTH benefits planning terminated and not otherwise enrolling in another Exchange-participating health benefits planning ; Individual enrolled in Exchange-participating
Index of Sec 205. ...HEALTH benefits planning paying plans directly and not through Commissioner or Health Insurance Exchange ; Individuals enrolled in Exchange-participating
Index of Sec 205. ...HEALTH benefits planning paying plans directly and not through Commissioner or Health Insurance Exchange ; Individuals enrolled in Exchange-participating
Index of Sec 205. ...HEALTH benefits planing offered under title ; Commissioner providing for broad dissemination of information on Exchange-participating
Index of Sec 205. ...HEALTH benefits planing offered under title ; Commissioner providing for broad dissemination of information on Exchange-participating
Index of Sec 205. ...HEALTH benefits planing offered under title ; Commissioner providing for broad dissemination of information on Exchange-participating
Index of Sec 205. ...HEALTH benefits planing and file complaints ; Providing for operation of toll-free telephone hotline to respond to requests for assistance and maintaining Internet website through individuals obtaining information on coverage under Exchange-participating
Index of Sec 205. ...HEALTH benefits planing and file complaints ; Providing for operation of toll-free telephone hotline to respond to requests for assistance and maintaining Internet website through individuals obtaining information on coverage under Exchange-participating
Index of Sec 205. ...HEALTH benefits planing and file complaints ; Providing for operation of toll-free telephone hotline to respond to requests for assistance and maintaining Internet website through individuals obtaining information on coverage under Exchange-participating
Index of Sec 205. ...HEALTH benefits planing and obtaining benefits through plans ; Assist Exchange-eligible individuals in selecting Exchange-participating
Index of Sec 205. ...HEALTH benefits planing and obtaining benefits through plans ; Assist Exchange-eligible individuals in selecting Exchange-participating
Index of Sec 205. ...HEALTH benefits planing and obtaining benefits through plans ; Assist Exchange-eligible individuals in selecting Exchange-participating
Index of Sec 205. ...HEALTH benefits planning automatically enrolled under Medicaid ; Commissioner providing for process under which individual described in section 202(d)(3) and not electing to enroll in Exchange-participating
Index of Sec 205. ...HEALTH benefits planning automatically enrolled under Medicaid ; Commissioner providing for process under which individual described in section 202(d)(3) and not electing to enroll in Exchange-participating
Index of Sec 205. ...HEALTH benefits planning automatically enrolled under Medicaid ; Commissioner providing for process under which individual described in section 202(d)(3) and not electing to enroll in Exchange-participating
Index of Sec 205. ...HEALTH benefits planing and State's Medicaid program consistent with section and otherwise coordinating implementation of provisions of division with respect to Medicaid program ; Commissioner entering into memorandum of understanding with State with respect to coordinating enrollment of individuals in Exchange-participating
Index of Sec 205. ...HEALTH benefits planing and State's Medicaid program consistent with section and otherwise coordinating implementation of provisions of division with respect to Medicaid program ; Commissioner entering into memorandum of understanding with State with respect to coordinating enrollment of individuals in Exchange-participating
Index of Sec 205. ...HEALTH benefits planing and State's Medicaid program consistent with section and otherwise coordinating implementation of provisions of division with respect to Medicaid program ; Commissioner entering into memorandum of understanding with State with respect to coordinating enrollment of individuals in Exchange-participating
Index of Sec 205. ...HEALTH benefits planing ; Commissioner coordinating distribution of affordability premium and cost-sharing credits under subtitle C to QHBP offering entities offering Exchange-participating
Index of Sec 206. ...HEALTH benefits planing ; Commissioner coordinating distribution of affordability premium and cost-sharing credits under subtitle C to QHBP offering entities offering Exchange-participating
Index of Sec 206. ...HEALTH benefits planing ; Commissioner coordinating distribution of affordability premium and cost-sharing credits under subtitle C to QHBP offering entities offering Exchange-participating
Index of Sec 206. ...ACCOUNT differences in risk characteristics of individuals and employers enrolled under different Exchange-participating health benefits planing offered by entities so as to minimizing impact of adverse selection of enrollees among plans offered by entities ; Commissioner establishing mechanism whereby being adjustment making of premium amounting payable among QHBP offering entities offering Exchange-participating health benefits planing of premiums collected for plans taking into
Index of Sec 206. ...ACCOUNT differences in risk characteristics of individuals and employers enrolled under different Exchange-participating health benefits planing offered by entities so as to minimizing impact of adverse selection of enrollees among plans offered by entities ; Commissioner establishing mechanism whereby being adjustment making of premium amounting payable among QHBP offering entities offering Exchange-participating health benefits planing of premiums collected for plans taking into
Index of Sec 206. ...ACCOUNT differences in risk characteristics of individuals and employers enrolled under different Exchange-participating health benefits planing offered by entities so as to minimizing impact of adverse selection of enrollees among plans offered by entities ; Commissioner establishing mechanism whereby being adjustment making of premium amounting payable among QHBP offering entities offering Exchange-participating health benefits planing of premiums collected for plans taking into
Index of Sec 206. ...HEALTH benefits planning ; Negotiating and contracting with QHBP offering entities for offering of Exchange-participating
Index of Sec 208. ...HEALTH benefits planning ; Negotiating and contracting with QHBP offering entities for offering of Exchange-participating
Index of Sec 208. ...HEALTH benefits planning ; Negotiating and contracting with QHBP offering entities for offering of Exchange-participating
Index of Sec 208. ...HEALTH benefits planning not exceeding 150 percent of annual percentage increase in medical inflation for 12-month period ending in June of prior year ; Annual increase in premiums charged under Exchange-participating
Index of Sec 209. ...HEALTH benefits planing to provide additional benefits ; Health Choices Commissioner requiring Exchange-participating
Index of Sec 209. ...HEALTH benefits planning for yearing if plan demonstrating to Commissioner if determined appropriate by Commissioner ; Subsection not applying to Exchange-participating
Index of Sec 209. ...HEALTH benefits planning that ensuring choice, competition and stability of affordable ; Secretary of Health and Human Services providing for offering of Exchange-participating
Index of Sec 221. ...HEALTH benefits planning that ensuring choice, competition and stability of affordable ; Secretary of Health and Human Services providing for offering of Exchange-participating
Index of Sec 221. ...HEALTH benefits planning that ensuring choice, competition and stability of affordable ; Secretary of Health and Human Services providing for offering of Exchange-participating
Index of Sec 221. ...HEALTH benefits ; Public health insurance option complying with requirements being applicable under title to Exchange-participating
Index of Sec 221. ...HEALTH benefits ; Public health insurance option complying with requirements being applicable under title to Exchange-participating
Index of Sec 221. ...HEALTH benefits ; Public health insurance option complying with requirements being applicable under title to Exchange-participating
Index of Sec 221. ...HEALTH benefits planning ; Secretary to be treated as QHBP offering entity offering Exchange-participating
Index of Sec 221. ...HEALTH benefits planning ; Secretary to be treated as QHBP offering entity offering Exchange-participating
Index of Sec 221. ...HEALTH benefits planning ; Secretary to be treated as QHBP offering entity offering Exchange-participating
Index of Sec 221. ...HEALTH benefits planing ; Other than amounts as otherwise provided with respect to other Exchange-participating
Index of Sec 222. ...HEALTH benefits planing ; Other than amounts as otherwise provided with respect to other Exchange-participating
Index of Sec 222. ...HEALTH benefits planing ; Other than amounts as otherwise provided with respect to other Exchange-participating
Index of Sec 222. ...HEALTH benefits planing ; Taking into account provisions of section 221(a) and amounts paid for similar health care providers and services under other Exchange-participating
Index of Sec 223. ...HEALTH benefits planing ; Taking into account provisions of section 221(a) and amounts paid for similar health care providers and services under other Exchange-participating
Index of Sec 223. ...HEALTH benefits planing ; Extent allowed by benefit standards applied to Exchange-participating
Index of Sec 224. ...HEALTH benefits planing ; Extent allowed by benefit standards applied to Exchange-participating
Index of Sec 224. ...HEALTH benefits planing ; Extent allowed by benefit standards applied to Exchange-participating
Index of Sec 224. ...HEALTH benefits planning ; Case of affordable credit eligible individual enrolled in Exchange-participating
Index of Sec 241. ...HEALTH benefits planning ; Case of affordable credit eligible individual enrolled in Exchange-participating
Index of Sec 241. ...HEALTH benefits planning ; Case of affordable credit eligible individual enrolled in Exchange-participating
Index of Sec 241. ...HEALTH benefits planning in which individual enrolled ; Affordability premium credit under section 243 to be applied against premium for Exchange-participating
Index of Sec 241. ...HEALTH benefits planning in which individual enrolled ; Affordability premium credit under section 243 to be applied against premium for Exchange-participating
Index of Sec 241. ...HEALTH benefits planning in which individual enrolled ; Affordability premium credit under section 243 to be applied against premium for Exchange-participating
Index of Sec 241. ...HEALTH benefits planning and not enrolled under planning as employee through employer qualified health benefits planning that meeting requirements of section 312 ; Enrolling under Exchange-participating
Index of Sec 242. ...HEALTH benefits planning and not enrolled under planning as employee through employer qualified health benefits planning that meeting requirements of section 312 ; Enrolling under Exchange-participating
Index of Sec 242. ...HEALTH benefits planning and not enrolled under planning as employee through employer qualified health benefits planning that meeting requirements of section 312 ; Enrolling under Exchange-participating
Index of Sec 242. ...HEALTH benefits planning in amount equal to amount by which premium for plan if less ; Affordability premium credit under section for affordable credit eligible individual enrolled in Exchange-participating
Index of Sec 243. ...HEALTH benefits planning in amount equal to amount by which premium for plan if less ; Affordability premium credit under section for affordable credit eligible individual enrolled in Exchange-participating
Index of Sec 243. ...HEALTH benefits planning in amount equal to amount by which premium for plan if less ; Affordability premium credit under section for affordable credit eligible individual enrolled in Exchange-participating
Index of Sec 243. ...HEALTH benefits planning in form of cost-sharing reduction described in subsection provided under section for income tier in which individual classified based on individual's family income ; Affordability cost-sharing credit under section for affordable credit eligible individual enrolled in Exchange-participating
Index of Sec 244. ...HEALTH benefits planning in form of cost-sharing reduction described in subsection provided under section for income tier in which individual classified based on individual's family income ; Affordability cost-sharing credit under section for affordable credit eligible individual enrolled in Exchange-participating
Index of Sec 244. ...HEALTH benefits planning in form of cost-sharing reduction described in subsection provided under section for income tier in which individual classified based on individual's family income ; Affordability cost-sharing credit under section for affordable credit eligible individual enrolled in Exchange-participating
Index of Sec 244. ...HEALTH benefits planning offered by QHBP offering entity ; Case of affordable credit eligible individual in tier enrolled in Exchange-participating
Index of Sec 244. ...HEALTH benefits planning offered by QHBP offering entity ; Case of affordable credit eligible individual in tier enrolled in Exchange-participating
Index of Sec 244. ...HEALTH benefits planning offered by QHBP offering entity ; Case of affordable credit eligible individual in tier enrolled in Exchange-participating
Index of Sec 244. ...HEALTH benefits planning ; Employee declining offer but otherwise obtaining coverage in Exchange-participating
Index of Sec 311. ...HEALTH benefits planning ; Employee declining offer but otherwise obtaining coverage in Exchange-participating
Index of Sec 311. ...HEALTH benefits planning ; Employee declining offer but otherwise obtaining coverage in Exchange-participating
Index of Sec 311. ...HEALTH benefits planning or other ; Employer offering coverage described in section 311(1) through Exchange-participating
Index of Sec 312. ...HEALTH benefits planning or other ; Employer offering coverage described in section 311(1) through Exchange-participating
Index of Sec 312. ...HEALTH benefits planning or other ; Employer offering coverage described in section 311(1) through Exchange-participating
Index of Sec 312. ...HEALTH benefits planning being reference premium amount under section 243(c) for individual coverage ; Amount of applicable premium of lowest cost plan with respect to coverage of employee under Exchange-participating
Index of Sec 312. ...HEALTH benefits planning being reference premium amount under section 243(c) for individual coverage ; Amount of applicable premium of lowest cost plan with respect to coverage of employee under Exchange-participating
Index of Sec 312. ...HEALTH benefits planning being reference premium amount under section 243(c) for individual coverage ; Amount of applicable premium of lowest cost plan with respect to coverage of employee under Exchange-participating
Index of Sec 312. ...HEALTH benefits planning ; Health Choices Commissioner to have authority to set standards for determining whether employers or insurers undertaking actions to affect risk pool within Health Insurance Exchange by inducing individuals to decline coverage under qualified health benefits planning offered by employer and instead to enroll in Exchange-participating
Index of Sec 314. ...HEALTH benefits planning ; Health Choices Commissioner to have authority to set standards for determining whether employers or insurers undertaking actions to affect risk pool within Health Insurance Exchange by inducing individuals to decline coverage under qualified health benefits planning offered by employer and instead to enroll in Exchange-participating
Index of Sec 314. ...HEALTH benefits planning ; Health Choices Commissioner to have authority to set standards for determining whether employers or insurers undertaking actions to affect risk pool within Health Insurance Exchange by inducing individuals to decline coverage under qualified health benefits planning offered by employer and instead to enroll in Exchange-participating
Index of Sec 314. ...HEALTH benefits planning under division unless plan meeting applicable requirements of following subtitles for type of plan and plan year involved ; Health benefiting plan not to be qualified
Index of Sec 101. ...HEALTH benefits planning under division unless plan meeting applicable requirements of following subtitles for type of plan and plan year involved ; Health benefiting plan not to be qualified
Index of Sec 101. ...HEALTH benefits planning under division unless plan meeting applicable requirements of following subtitles for type of plan and plan year involved ; Health benefiting plan not to be qualified
Index of Sec 101. ...HEALTH benefits planning under section 101 including essential benefit package requirement under section 121 ; Employment-based health plan in operation as of day before first day of Y1 meeting same requirements as applying to qualified
Index of Sec 102. ...HEALTH benefits planning under section 101 including essential benefit package requirement under section 121 ; Employment-based health plan in operation as of day before first day of Y1 meeting same requirements as applying to qualified
Index of Sec 102. ...HEALTH benefits planning under section 101 including essential benefit package requirement under section 121 ; Employment-based health plan in operation as of day before first day of Y1 meeting same requirements as applying to qualified
Index of Sec 102. ...HEALTH benefits planning to stand alone plans offered and priced separately from qualified health benefits planning ; Applying requirements for qualified
Index of Sec 102. ...HEALTH benefits planning not imposing preexisting condition exclusion or otherwise imposing limit or condition on coverage under plan with respect to individual or dependent based on health status-related factors in relation to individual or dependent ; Qualified
Index of Sec 111. ...HEALTH benefits planning not imposing pre-existing condition exclusion or otherwise imposing limit or condition on coverage under plan with respect to individual or dependent based on health status-related factors in relation to individual or dependent ; Qualified
Index of Sec 111. ...HEALTH benefits planning not imposing pre-existing condition exclusion or otherwise imposing limit or condition on coverage under plan with respect to individual or dependent based on health status-related factors in relation to individual or dependent ; Qualified
Index of Sec 111. ...DISCRIMINATION in health benefits or benefit structures for qualifing health benefits ; Qualified health benefits planning complying with standards established by Commissioner to prohibit
Index of Sec 114. ...DISCRIMINATION in health benefits or benefit structures for qualified health benefits ; Qualified health benefits planning complying with standards established by Commissioner to prohibit
Index of Sec 114. ...DISCRIMINATION in health benefits or benefit structures for qualifing health benefits ; Qualified health benefits planning complying with standards established by Commissioner to prohibit
Index of Sec 114. ...HEALTH benefits planning that entity offers having medical loss ratio being less than percentage specified by Commissioner ; Plan year in which qualified
Index of Sec 116. ...HEALTH benefits planning meeting medical loss ratio as defined by Commissioner ; Qualified
Index of Sec 116. ...HEALTH benefits planning meeting medical loss ratio as defined by Commissioner ; Qualified
Index of Sec 116. ...HEALTH Benefits planing during Plan year ; Sec 117, consistency of Costs and coverage under qualified
Index of Sec 117. ...HEALTH benefits planning providing coverage meeting benefit standards adopted under section 124 for essential benefits packaging described in section 122 for plan year involved ; Qualified
Index of Sec 121. ...HEALTH benefits planning providing coverage meeting benefit standards adopted under section 124 for essential benefits packaging described in section 122 for plan year involved ; Qualified
Index of Sec 121. ...HEALTH benefits planning providing coverage meeting benefit standards adopted under section 124 for essential benefits packaging described in section 122 for plan year involved ; Qualified
Index of Sec 121. ...HEALTH benefits planning being not Exchange-participating health benefits planning ; Case of qualified
Index of Sec 121. ...HEALTH benefits planning being not Exchange-participating health benefits planning ; Case of qualified
Index of Sec 121. ...HEALTH benefits planning being not Exchange-participating health benefits planning ; Case of qualified
Index of Sec 121. ...CLINICAL appropriateness on coverage of health care items and services ; Qualified health benefits planning not imposing restriction unrelated to
Index of Sec 121. ...CLINICAL appropriateness on coverage of health care items and services ; Qualified health benefits planning not imposing restriction unrelated to
Index of Sec 121. ...CLINICAL appropriateness on coverage of health care items and services ; Qualified health benefits planning not imposing restriction unrelated to
Index of Sec 121. ...HEALTH benefits planing to participate in Health Insurance Exchange ; Services described in paragraph or part of essential benefits packaging and Commissioner not requiring services for qualified
Index of Sec 122. ...HEALTH benefits planning without coverage of oral and vision services to be treated as satisfying essential benefits packaging under division ; Combiations of stand alone coverage described in paragraph and qualified
Index of Sec 122. ...HEALTH benefits planning QHBP offering entity providing internal claims and appeals processing that initially incorporating claims and appealing procedures set forth at section 2560.503 -1 of title 29 ; Qualified
Index of Sec 132. ...HEALTH benefits planning QHBP offering entity providing internal claims and appeals processing that initially incorporating claims and appealing procedures set forth at section 2560.503 -1 of title 29 ; Qualified
Index of Sec 132. ...DISCLOSURE of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other information as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely
Index of Sec 133. ...DISCLOSURE of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other information as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely
Index of Sec 133. ...DISCLOSURE of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other information as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely
Index of Sec 133. ...HEALTH benefits planning complying with standards established by Commissioner to ensure transparency to health care provider relating to reimbursement arrangements between planning and provider ; Qualified
Index of Sec 133. ...HEALTH benefits planning complying with standards established by Commissioner to ensure transparency to health care provider relating to reimbursement arrangements between planning and provider ; Qualified
Index of Sec 133. ...HEALTH benefits planning complying with standards established by Commissioner to ensure transparency to health care provider relating to reimbursement arrangements between planning and provider ; Qualified
Index of Sec 133. ...HEALTH benefits planning not to be made without reasonable and timely advance notice to enrollees of change ; Change in qualified
Index of Sec 133. ...HEALTH benefits planning not to be made without reasonable and timely advance notice to enrollees of change ; Change in qualified
Index of Sec 133. ...HEALTH benefits planning not to be made without reasonable and timely advance notice to enrollees of change ; Change in qualified
Index of Sec 133. ...CONTRACT with pharmacy benefit managers to manage prescription drug coverage provided under plan or controlling costs of prescription drug coverage ; Qualified health benefits planning entering into
Index of Sec 133. ...HEALTH Benefits planing not offered through health insurance Exchange ; Application to qualified
Index of Sec 134. ...HEALTH Benefits planing not offered through health insurance Exchange ; Application to qualified
Index of Sec 134. ...HEALTH Benefits planing not offered through health insurance Exchange ; Application to qualified
Index of Sec 134. ...HEALTH benefits planning offers in same manner Medicare Advantage organization required to comply with requirements with respect to Medicare Advantage plan ; QHBP offering entity complying with requirements of section 1857(f) of Social Security Act with respect to qualified
Index of Sec 135. ...HEALTH benefits planning offers in same manner Medicare Advantage organization required to comply with requirements with respect to Medicare Advantage plan ; QHBP offering entity complying with requirements of section 1857(f) of Social Security Act with respect to qualified
Index of Sec 135. ...HEALTH benefits planning offers in same manner Medicare Advantage organization required to comply with requirements with respect to Medicare Advantage plan ; QHBP offering entity complying with requirements of section 1857(f) of Social Security Act with respect to qualified
Index of Sec 135. ...HEALTH benefits planning ensuring that records relative to prescription information containing patient identifiable and prescriber-identifiable data maintained in accordance with section ; Qualified
Index of Sec 138. ...HEALTH benefits planning ; Duration or scope of medical benefits otherwise covered under qualified
Index of Sec 138. ...HEALTH benefits planning and QHBP offering entity offering plan ; Qualified
Index of Sec 139. ...CONTRACT or otherwise for persons or entities to conduct utilization review activities on behalf of plan entity ; Nothing in section to be construed as preventing qualified health benefits planning or QHBP offering entity from arranging through
Index of Sec 139. ...HEALTH benefits planning or QHBP offering entity failing to make determination on claim for benefit under paragraph ; Case in which qualified
Index of Sec 139. ...HEALTH benefits planning ; Eligibility or payment in whole or part for item or servicing under qualified
Index of Sec 139. ...HEALTH benefits planning and QHBP offering entity offering plan ; Qualified
Index of 0HEALTH benefits planning only benefits ; Term limited scope coverage meaning qualified
Index of 0HEALTH benefits planning of QHBP offering entity ; Qualified
Index of 0HEALTH benefits planning and QHBP offering entity ; Qualified
Index of 0HEALTH benefits planning and QHBP offering entity ; Qualified
Index of 0HEALTH benefits planning being group health plan ; Qualified
Index of 0HEALTH benefits planning being group health plan ; Qualified
Index of 0HEALTH benefits planning being individual health insurance coverage ; Qualified
Index of 0HEALTH benefits planning under part and no person employed entitying or furnishing professional services to entity ; No qualified external appeal entity having contract with qualified
Index of 0HEALTH benefits planning ; Case in which determination of external review entity not followed by qualified
Index of 0HEALTH benefits planning ; Action described in paragraph bringing by participant, beneficiary or enrollee with respect to qualified
Index of 0HEALTH benefits planing under section ; Provisions of section applying with respect to acceptable coverage in same manner as provisions applying with respect to qualified
Index of 0HEALTH benefits planning standards under title including enforcement of standards in coordination with State insurance regulators and Secretaries of Labor and Treasury ; Establishment of qualified
Index of Sec 142. ...HEALTH benefits planning standards under title including enforcement of standards in coordination with State insurance regulators and Secretaries of Labor and Treasury ; Establishment of qualified
Index of Sec 142. ...HEALTH benefits planning standards under title including enforcement of standards in coordination with State insurance regulators and Secretaries of Labor and Treasury ; Establishment of qualified
Index of Sec 142. ...COMPLIANCE with Federal requirements ; Commissioner conducting audits of qualified health benefits planning
Index of Sec 142. ...COMPLIANCE with Federal requirements ; Commissioner conducting audits of qualified health benefits planning
Index of Sec 142. ...COMPLIANCE with Federal requirements ; Commissioner conducting audits of qualified health benefits planning
Index of Sec 142. ...HEALTH benefits planing reimbursement for costs of examinations and audit of QHBP offering entities ; Commissioner authorized to recoup from qualified
Index of Sec 142. ...HEALTH benefits planing reimbursement for costs of examinations and audit of QHBP offering entities ; Commissioner authorized to recoup from qualified
Index of Sec 142. ...HEALTH benefits planing reimbursement for costs of examinations and audit of QHBP offering entities ; Commissioner authorized to recoup from qualified
Index of Sec 142. ...HEALTH benefits planning ; Assistance to individuals in choosing qualified
Index of Sec 144. ...HEALTH benefits planning ; Assistance to individuals in choosing qualified
Index of Sec 144. ...HEALTH benefits planning ; Assistance to individuals in choosing qualified
Index of Sec 144. ...ACCEPTABLE coverage so long as Secretary of Labor determining that coverage for employees being substantially equivalent or greater than coverage provided for employees pursuant to essential benefits packaging ; Coverage provided pursuant to Hawaii Prepaid Health Care Act to be treated as qualified health benefits planning providing
Index of Sec 156. ...HEALTH benefits planning offered through Health Insurance Exchange ; Term Exchange-participating health benefits planning meaning qualified
Index of Sec 201. ...HEALTH benefits planning offered through Health Insurance Exchange ; Term Exchange-participating health benefits planning meaning qualified
Index of Sec 201. ...HEALTH benefits planning offered through Health Insurance Exchange ; Term Exchange-participating health benefits planning meaning qualified
Index of Sec 201. ...HEALTH benefits planning ; Basic plan offering essential benefits packaging required under title I for qualified
Index of Sec 203. ...HEALTH benefits planning ; Basic plan offering essential benefits packaging required under title I for qualified
Index of Sec 203. ...HEALTH benefits planning ; Basic plan offering essential benefits packaging required under title I for qualified
Index of Sec 203. ...HEALTH benefits planning providing coverage of services described in section 122(d)(4)(a) ; Qualified
Index of Sec 203. ...HEALTH benefits planning of QHBP offering entity ; Clause not applying if Commissioner determining that delay in termination posing imminent and serious risk to health of individuals enrolled under qualified
Index of Sec 204. ...HEALTH benefits planning of QHBP offering entity ; Clause not applying if Commissioner determining that delay in termination posing imminent and serious risk to health of individuals enrolled under qualified
Index of Sec 204. ...HEALTH benefits planning of QHBP offering entity ; Clause not applying if Commissioner determining that delay in termination posing imminent and serious risk to health of individuals enrolled under qualified
Index of Sec 204. ...HEALTH benefits planing including public health insurance option ; Nothing in division to be construed to affect role of enrollment agents and brokers under State law including with regard to enrollment of individuals and employers in qualified
Index of Sec 205. ...HEALTH benefits planning in accordance with section 312 ; Employer offering employee individual and family coverage under qualified
Index of Sec 311. ...HEALTH benefits planning in accordance with section 312 ; Employer offering employee individual and family coverage under qualified
Index of Sec 311. ...HEALTH benefits planning in accordance with section 312 ; Employer offering employee individual and family coverage under qualified
Index of Sec 311. ...HEALTH benefits planning ; Not less than 72.5 percent of applicable premium of lowest cost plan offered by employer being qualified
Index of Sec 312. ...HEALTH benefits planning ; Not less than 72.5 percent of applicable premium of lowest cost plan offered by employer being qualified
Index of Sec 312. ...HEALTH benefits planning ; Not less than 72.5 percent of applicable premium of lowest cost plan offered by employer being qualified
Index of Sec 312. ...HEALTH benefits planning offered by employer and instead to enroll in Exchange-participating health benefits planning ; Health Choices Commissioner to have authority to set standards for determining whether employers or insurers undertaking actions to affect risk pool within Health Insurance Exchange by inducing individuals to decline coverage under qualified
Index of Sec 314. ...HEALTH benefits planning offered by employer and instead to enroll in Exchange-participating health benefits planning ; Health Choices Commissioner to have authority to set standards for determining whether employers or insurers undertaking actions to affect risk pool within Health Insurance Exchange by inducing individuals to decline coverage under qualified
Index of Sec 314. ...HEALTH benefits planning offered by employer and instead to enroll in Exchange-participating health benefits planning ; Health Choices Commissioner to have authority to set standards for determining whether employers or insurers undertaking actions to affect risk pool within Health Insurance Exchange by inducing individuals to decline coverage under qualified
Index of Sec 314. ...HEALTH benefits ; Group health plan described in subsection containing provision reserving general power to amend or terminate plan or provision specifically authorizing plan to make post-retirement reductions in retiree
Index of Sec 165. ...HEALTH benefits risking pool recognized by Commissioner for purposes of section solely by reason of extension of coverage beyond date on which coverage otherwise to have expired ; Provision having effect of limiting or precluding access by qualified beneficiary whose cobra continations coverage extended under section to State
Index of Sec 167. ...HEALTH benefits risking pool in coordination with Secretary of Treasury ; State
Index of Sec 202. ...HEALTH benefits risking pool in coordination with Secretary of Treasury ; State
Index of Sec 202. ...HEALTH benefits risking pool in coordination with Secretary of Treasury ; State
Index of Sec 202. ...EMPLOYMENT-based health plan and including public health insurance option ; Terms health benefits planning means health insurance coverage and
Index of Sec 100. ...EMPLOYMENT-based health plan and including public health insurance option ; Terms health benefits planning means health insurance coverage and
Index of Sec 100. ...EMPLOYMENT-based health plan and including public health insurance option and cooperatives under subtitle D of title II ; Terms health benefits planning means health insurance coverage and
Index of Sec 100. ...HEALTH care spending ; Quality health care for Americans and reducing growth in
Index of Sec 100. ...HEALTH care spending ; Quality health care for Americans and reducing growth in
Index of Sec 100. ...HEALTH care spending ; Quality health care for Americans and reducing growth in
Index of Sec 100. ...HEALTH care becoming more affordable for businesses, families and government ; Increasing quality and reducing growth in health spending so that
Index of Sec 100. ...HEALTH care becoming more affordable for businesses, families and government ; Increasing quality and reducing growth in health spending so that
Index of Sec 100. ...HEALTH care becoming more affordable for businesses, families and government ; Increasing quality and reducing growth in health spending so that
Index of Sec 100. ...HEALTH care practitioners ; Not less than 25 percent of members of Committee to be practicing
Index of Sec 123. ...HEALTH care and considering standards reducing health disparities ; Committee taking into account innovation in
Index of Sec 123. ...HEALTH care and considering standards reducing health disparities ; Committee taking into account innovation in
Index of Sec 123. ...HEALTH care provider relating to reimbursement arrangements between planning and provider ; Qualified health benefits planning complying with standards established by Commissioner to ensure transparency to
Index of Sec 133. ...HEALTH care provider relating to reimbursement arrangements between planning and provider ; Qualified health benefits planning complying with standards established by Commissioner to ensure transparency to
Index of Sec 133. ...HEALTH care provider relating to reimbursement arrangements between planning and provider ; Qualified health benefits planning complying with standards established by Commissioner to ensure transparency to
Index of Sec 133. ...HEALTH care ; Term advanced directive including living or durable power of attorney for
Index of Sec 138. ...HEALTH care professionals as determined by plan ; Program utilizing written clinical review criteria developed with input from range of appropriate actively practicing
Index of Sec 139. ...HEALTH care professional providing health care services to individual to perform utilization review activities in connection with health care services to be provided to individual ; Program not permitting
Index of Sec 139. ...HEALTH care involved in coverage decision ; Health care professional providing
Index of 0HEALTH care involved in coverage decision provided ; Institution at
Index of 0HEALTH care involved in coverage decision ; Manufacturer of drug or other item included in
Index of 0HEALTH Care ; Sec 152 prohibiting discrimination in
Index of Sec 152. ...HEALTH Care ; Sec 152 prohibiting discrimination in
Index of Sec 152. ...HEALTH Care ; Sec 152 prohibiting discrimination in
Index of Sec 152. ...HEALTH care and related services covered by Act to be provided without regard to personal characteristics extraneous to provision of high quality health care or related services ;
Index of Sec 152. ...HEALTH care and related services covered by Act to be provided without regard to personal characteristics extraneous to provision of high quality health care or related services ;
Index of Sec 152. ...HEALTH care and related services covered by Act to be provided without regard to personal characteristics extraneous to provision of high quality health care or related services ;
Index of Sec 152. ...HEALTH care and related services covered by Act provided without regard to personal characteristics extraneous to provision of high quality health care or related services ; Secretary of Health and Human Services promulgating regulations as necessary or appropriate to insure that
Index of Sec 152. ...HEALTH care and related services covered by Act provided without regard to personal characteristics extraneous to provision of high quality health care or related services ; Secretary of Health and Human Services promulgating regulations as necessary or appropriate to insure that
Index of Sec 152. ...HEALTH care and related services covered by Act provided without regard to personal characteristics extraneous to provision of high quality health care or related services ; Secretary of Health and Human Services promulgating regulations as necessary or appropriate to insure that
Index of Sec 152. ...HEALTH care ; Nothing in division to be construed to alter of supercede statutory or other obligation to engage in collective bargaining over terms and conditions of employment related to
Index of Sec 154. ...HEALTH care ; Nothing in division to be construed to alter or supercede statutory or other obligation to engage in collective bargaining over terms and conditions of employment related to
Index of Sec 154. ...HEALTH care ; Nothing in division to be construed to alter of supercede statutory or other obligation to engage in collective bargaining over terms and conditions of employment related to
Index of Sec 154. ...HEALTH care providers ; QHBP offering entities using to encourage increased meaningful use of electronic health records by
Index of Sec 157. ...HEALTH care providers by Veterans Administration ; Software making available to
Index of Sec 157. ...HEALTH care providers to increase meaningful use of electronic health records by providers ; Recommendations concerning whether qualified health benefits planing increasing reimbursement rates to
Index of Sec 157. ...HEALTH care providers ; Commissioner requiring that qualified health benefits planing increase reimbursement rates for
Index of Sec 157. ...HEALTH care provider ; Nothing in Act to be construed to preclude participant or beneficiary in group health plan from entering into contract or arrangement for health care with
Index of Sec 158. ...ELECTRONIC transactions provided in part ; Requiring use of standard electronic transaction with health care providers quickly and efficiently enrolling with health plan to conduct other
Index of Sec 163. ...HEALTH care ; Improving quality and extending functionality to meet evolving requirements in
Index of Sec 163. ...ELECTRONIC transactions provided in part ; Requiring use of standard electronic transaction with health care providers quickly and efficiently enrolling with health plan to conduct other
Index of Sec 164. ...HEALTH care ; Improving quality and extending functionality to meet evolving requirements in
Index of Sec 164. ...HEALTH care providers used by individual involved or other relevant factors as Commissioner specifying ; Process involving random assignment or other form of assignment taking into account
Index of Sec 205. ...HEALTH care providers used by individual involved or other relevant factors as Commissioner specifying ; Process involving random assignment or other form of assignment taking into account
Index of Sec 205. ...HEALTH care providers used by individual involved or other relevant factors as Commissioner specifying ; Process involving random assignment or other form of assignment taking into account
Index of Sec 205. ...HEALTH care in State ; State using incentive payment received under subsection to improve
Index of Sec 208. ...HEALTH care providers participating in Medicare participating providers in public health insurance option unless opting out in process established by Secretary consistent with subsection ;
Index of Sec 223. ...HEALTH care providers participating under Medicare participating providers in public health insurance option unless opting out in process established by Secretary ;
Index of Sec 223. ...HEALTH care providers participating under Medicare participating providers in public health insurance option unless opting out in process established by Secretary ;
Index of Sec 223. ...HEALTH care provider to participate in public health insurance option unless provider appropriately licensed or certified under State law ; Secretary not allowing
Index of Sec 225. ...HEALTH care provider to participate in public health insurance option unless provider appropriately licensed, certified or otherwise permitted to practice under State law ; Secretary not allowing
Index of Sec 225. ...HEALTH care provider to participate in public health insurance option unless provider appropriately licensed or certified under State law ; Secretary not allowing
Index of Sec 225. ...HEALTH care program ; Secretary excluding from participation under public health insurance option health care provider excluded from participation in Federal
Index of Sec 225. ...HEALTH care program ; Secretary excluding from participation under public health insurance option health care provider excluded from participation in Federal
Index of Sec 225. ...HEALTH care program ; Secretary excluding from participation under public health insurance option health care provider excluded from participation in Federal
Index of Sec 225. ...HEALTH care ; Non-profit program of State for providing
Index of Sec 253. ...HEALTH care provider by telephone and printed form ; Utilization review program making determination concerning authorization and providing notice of determination to individual or individual's designee and individual's
Index of Sec 139. ...HEALTH care provider ; Plan providing by telephone and printed form notice of concurrent review determination to individual or individual's designee and individual's
Index of Sec 139. ...HEALTH care provider by telephone and printed form within 30 days of date of receipt of information being reasonably necessary to make determination ; Utilization review program making determination concerning services and providing notice of determination to individual or individual's designee and individual's
Index of Sec 139. ...HEALTH care or related services ; Health care and related services covered by Act to be provided without regard to personal characteristics extraneous to provision of high quality
Index of Sec 152. ...HEALTH care or related services ; Health care and related services covered by Act to be provided without regard to personal characteristics extraneous to provision of high quality
Index of Sec 152. ...HEALTH care or related services ; Health care and related services covered by Act to be provided without regard to personal characteristics extraneous to provision of high quality
Index of Sec 152. ...HEALTH care or related services ; Secretary of Health and Human Services promulgating regulations as necessary or appropriate to insure that health care and related services covered by Act provided without regard to personal characteristics extraneous to provision of high quality
Index of Sec 152. ...HEALTH care or related services ; Secretary of Health and Human Services promulgating regulations as necessary or appropriate to insure that health care and related services covered by Act provided without regard to personal characteristics extraneous to provision of high quality
Index of Sec 152. ...HEALTH care or related services ; Secretary of Health and Human Services promulgating regulations as necessary or appropriate to insure that health care and related services covered by Act provided without regard to personal characteristics extraneous to provision of high quality
Index of Sec 152. ...HEALTH care professional or evaluating effectiveness of professional pharmaceutical detailing sales forcing ; Influencing or evaluating prescribing behavior of individual
Index of Sec 138. ...HEALTH care facility because of willingness or unwillingness ; No Exchange participating health benefits planning discriminating against individual health care provider or
Index of Sec 204. ...HEALTH care directly related to matters under appeal ; Opinions of individuals qualified as experts in one or more fields of
Index of 0HEALTH care professional ; Term health care entity including individual physician or other
Index of Sec 157. ...HEALTH care practitioner participating in medicareing and public health insurance option ; Services described in subparagraph being items and professional services under public health insurance option by physician or other
Index of Sec 223. ...HEALTH care practitioner participating in medicareing and public health insurance option ; Services described in subparagraph being items and professional services under public health insurance option by physician or other
Index of Sec 223. ...HEALTH care practitioner being type of practitioner not typically participating in Medicare to be eligible for increased payment rates under subparagraph ; Pediatrician and other
Index of Sec 223. ...HEALTH care practitioner being type of practitioner not typically participating in Medicare to be eligible for increased payment rates under subparagraph ; Pediatrician and other
Index of Sec 223. ...HEALTH care providers under public health insurance option under which payment only to be available if provider agreeing to accept payment rate established under section 223 as payment in full ; Secretary providing for participation of
Index of Sec 225. ...HEALTH care providers under public health insurance option under which payment only to be available if provider agreeing to accept payment rate established under section 223 as payment in full ; Secretary providing for participation of
Index of Sec 225. ...HEALTH care professional ; Opinion of individual's treating physician or
Index of 0FINANCIAL security ; Term essential benefits packaging means health benefiting coverage, consistent with standards adopted under section 124 to ensure provision of quality health care and
Index of Sec 122. ...FINANCIAL security ; Term essential benefits packaging means health benefiting coverage, consistent with standards adopted under section 124 to ensure provision of quality health care and
Index of Sec 122. ...FINANCIAL security ; Term essential benefits packaging means health benefiting coverage, consistent with standards adopted under section 124 to ensure provision of quality health care and
Index of Sec 122. ...HEALTH care professionals overseeing review decisions ; Utilization review program to be administered by qualified
Index of Sec 139. ...HEALTH care for Americans and reducing growth in health care spending ; Quality
Index of Sec 100. ...HEALTH care for Americans and reducing growth in health care spending ; Quality
Index of Sec 100. ...HEALTH care for Americans and reducing growth in health care spending ; Quality
Index of Sec 100. ...HEALTH care delivered to members ; Improving benefits or otherwise improving quality of
Index of Sec 252. ...HEALTH care providers consistent with section and changing payment rates in accordance with section 224 ; Secretary establishing payment rates for public health insurance option for services and
Index of Sec 223. ...HEALTH care providers consistent with section and changing payment rates in accordance with section 224 ; Secretary establishing payment rates for public health insurance option for services and
Index of Sec 223. ...HEALTH care providers ; Average rates paid by other QHBP offering entities for services and
Index of Sec 223. ...HEALTH benefits planing ; Taking into account provisions of section 221(a) and amounts paid for similar health care providers and services under other Exchange-participating
Index of Sec 223. ...HEALTH benefits planing ; Taking into account provisions of section 221(a) and amounts paid for similar health care providers and services under other Exchange-participating
Index of Sec 223. ...HEALTH care professional ; Determining by plan or issuer or certified in writing by treating
Index of 0HEALTH Care Act ; Sec 156, Rule of construction regarding HAWAII prepaid
Index of Sec 156. ...HEALTH care entity including individual physician or other health care professional ; Term
Index of Sec 157. ...HEALTH care facility because of willingness or unwillingness ; No Exchange participating health benefits planning discriminating against individual health care provider or
Index of Sec 204. ...HEALTH care items and services ; Qualified health benefits planning not imposing restriction unrelated to clinical appropriateness on coverage of
Index of Sec 121. ...HEALTH care items and services ; Qualified health benefits planning not imposing restriction unrelated to clinical appropriateness on coverage of
Index of Sec 121. ...HEALTH care items and services ; Qualified health benefits planning not imposing restriction unrelated to clinical appropriateness on coverage of
Index of Sec 121. ...HEALTH care items and services in accordance with benefit standards ; Limits costing-sharing for covered
Index of Sec 122. ...HEALTH care items and services in accordance with benefit standards ; Limits costing-sharing for covered
Index of Sec 122. ...HEALTH care items and services in accordance with benefit standards ; Limits costing-sharing for covered
Index of Sec 122. ...AUTHORIZATION of health care items and services for individual ; Case of utilization review activity involving prior
Index of Sec 139. ...HEALTH care needs of residents of American Samoa ; Reforms making by H R 3200 to be strengthened to address
Index of Sec 101. ...HEALTH care payment and remittance advice ; Order to allow automated reconciliation with related
Index of Sec 163. ...HEALTH care payment and remittance advice ; Order to allow automated reconciliation with related
Index of Sec 164. ...HEALTH care program ; Secretary excluding from participation under public health insurance option health care provider excluded from participation in Federal
Index of Sec 225. ...HEALTH care program ; Secretary excluding from participation under public health insurance option health care provider excluded from participation in Federal
Index of Sec 225. ...HEALTH care program ; Secretary excluding from participation under public health insurance option health care provider excluded from participation in Federal
Index of Sec 225. ...EXPENDITURES health care service being allowable as deduction under section 213(d) of Internal Revenue Code of 1986 ; Health insurance issuer offering health insurance coverage through Health Insurance Exchange discriminating in approving or covering health care service on basis of religious or spiritual content if
Index of Sec 125. ...EXPENDITURES health care service being allowable as deduction under 213(d) of Internal Revenue Code of 1986 ; Health insurance issuer offering health insurance coverage through Exchange discriminating in approving or covering health care service on basis of religious or spiritual content if
Index of Sec 125. ...HEALTH care service being specifically pre-authorized or approved for enrollee program ;
Index of Sec 139. ...EXPENDITURES health care service being allowable as deduction under section 213(d) of Internal Revenue Code of 1986 ; Health insurance issuer offering health insurance coverage through Health Insurance Exchange discriminating in approving or covering health care service on basis of religious or spiritual content if
Index of Sec 125. ...EXPENDITURES health care service being allowable as deduction under 213(d) of Internal Revenue Code of 1986 ; Health insurance issuer offering health insurance coverage through Exchange discriminating in approving or covering health care service on basis of religious or spiritual content if
Index of Sec 125. ...HEALTH Care Services based on religious or spiritual content ; Sec 125, prohibition of discrimination in
Index of Sec 125. ...HEALTH Care Services based on religious or spiritual content ; Sec 125, prohibition of discrimination in
Index of Sec 125. ...HEALTH care services to be provided to individual ; Program not permitting health care professional providing health care services to individual to perform utilization review activities in connection with
Index of Sec 139. ...HEALTH care services, procedures or settings and including prospective review, concurrent review, second opinions ; Terms utilization review and utilization review activities mean procedures used to monitor or evaluate use or coverage, clinical necessity, appropriateness, efficacy or efficiency of
Index of Sec 139. ...HEALTH care services ; Membership of Committee including one or more experts in scientific evidence and clinical practice of integrative
Index of Sec 123. ...HEALTH care services previously provided for individual ; Case of utilization review activity involving retrospective review of
Index of Sec 139. ...HEALTH care system and received training regarding health, medical and scientific matters ; Knowledgeable about
Index of Sec 123. ...HEALTH care system affecting differences in costs ; Nothing in paragraph to be construed to preclude allowance for normal variations in population demographics, health status and other factors exogenous to
Index of Sec 252. ...HEALTH care system so ; Disabilities, representatives of relevant governmental agencies and one practicing physician or other health professional and expert on children's health and representing balance among various sectors of
Index of Sec 123. ...HEALTH care system so ; Disabilities, representatives of relevant governmental agencies and one practicing physician or other health professional and expert on children's health and representing balance among various sectors of
Index of Sec 123. ...HEALTH care system so ; Disabilities, representatives of relevant governmental agencies and one practicing physician or other health professional and expert on children's health and representing balance among various sectors of
Index of Sec 123. ...HEALTH care way ; Commonwealth of Northern Mariana Islands, Guam, Puerto Rico and United States Virgin Islands and Congress committed to working with representatives of territories to ensure that residents of territories having access to high-quality and affordable
Index of Sec 101. ...HEALTH condition ; Care management educational communications provided to patient about patient's
Index of Sec 138. ...CHILD support order ; Respect to period during that health coverage for child to be provided by individual pursuant to
Index of Sec 401. ...HEALTH coverage ; Election of Employer responsibility to provide
Index of Sec 411. ...ACCEPTABLE coverage ; Term qualified health coverage meaning
Index of Sec 421. ...HEALTH benefits planing ; Terms, conditions and affordability of group health coverage offered by employers and QHBP offering entities outside of Exchange compared to Exchange-participating
Index of Sec 202. ...HEALTH benefits planing ; Terms, conditions and affordability of group health coverage offered by employers and QHBP offering entities outside of Exchange compared to Exchange-participating
Index of Sec 202. ...HEALTH benefits planing ; Terms, conditions and affordability of group health coverage offered by employers and QHBP offering entities outside of Exchange compared to Exchange-participating
Index of Sec 202. ...HEALTH coverage ; Term qualified employee health coverage expenses meaning aggregate amount paid or incurred by employer during taxable year for coverage of qualified employee of employer under qualified
Index of Sec 421. ...HEALTH coverage laws and benefits of State in developing recommendations under subsection and incorporating coverage and benefits as Committee determining to be appropriate and consistent with Act Health benefiting Advisory Committee seeking input from States and considering recommendations ; Health benefiting Advisory Committee examining
Index of Sec 123. ...HEALTH coverage participation requirements to be deemed to be included as terms and conditions of plan ;
Index of Sec 321. ...HEALTH coverage participation requirements to be deemed to be included as terms and conditions of plan ;
Index of Sec 321. ...HEALTH coverage participation requirements in connection with plans ; Secretary regularly auditing representative sampling of employers and group health plans and conduct investigations and other activities under section 504 with respect to sampling of plans so as to discovering noncompliance with
Index of Sec 321. ...HEALTH coverage participation requirements in connection with plans ; Secretary regularly auditing representative sampling of employers and group health plans and conduct investigations and other activities under section 504 with respect to sampling of plans so as to discovering noncompliance with
Index of Sec 321. ...HEALTH coverage participation requirements and referring determination to Secretary of Treasury as appropriate ; Secretary terminating election of employer under section 801 if Secretary determining that employer in substantial noncompliance with
Index of Sec 321. ...HEALTH coverage participation requirements and referring determination to Secretary of Treasury as appropriate ; Secretary terminating election of employer under section 801 if Secretary determining that employer in substantial noncompliance with
Index of Sec 321. ...HEALTH coverage participation requirements with respect to employee ; Case of employer failing to satisfy
Index of Sec 321. ...HEALTH coverage participation requirements with respect to employee ; Case of employer failing to satisfy
Index of Sec 321. ...EXCISE taxes on failures under section 4980h(b) of Internal Revenue Code of 1986 so as to avoiding duplication of penalties with respect to failures ; Secretary and Secretary of Treasury coordinating assessment of penalties under section in connection with failures to satisfy health coverage participation requirements with imposition of
Index of Sec 321. ...EXCISE taxes on failures under section 4980h(b) of Internal Revenue Code of 1986 so as to avoiding duplication of penalties with respect to failures ; Secretary and Secretary of Treasury coordinating assessment of penalties under section in connection with failures to satisfy health coverage participation requirements with imposition of
Index of Sec 321. ...HEALTH coverage participation requirements described in part 1 ;
Index of Sec 322. ...HEALTH coverage participation requirements to be deemed to be included as terms and conditions of plan ;
Index of Sec 323. ...HEALTH coverage participation requirements to be deemed to be included as terms and conditions of plan ;
Index of Sec 323. ...HEALTH coverage participation requirements ; Periodic investigations to determine compliance with
Index of Sec 323. ...HEALTH coverage participation requirements ; Periodic investigations to determine compliance with
Index of Sec 323. ...HEALTH coverage participation requirements and referring determination to Secretary of Treasury as appropriate ; Secretary terminating election of employer under subsection if Secretary determining that employer in substantial noncompliance with
Index of Sec 323. ...HEALTH coverage participation requirements and referring determination to Secretary of Treasury as appropriate ; Secretary terminating election of employer under subsection if Secretary determining that employer in substantial noncompliance with
Index of Sec 323. ...HEALTH coverage participation requirements with respect to employee ; Case of employer failing in effect to satisfy
Index of Sec 323. ...HEALTH coverage participation requirements with respect to employee ; Case of employer failing in effect to satisfy
Index of Sec 323. ...EXCISE taxes on failures under section 4980h(b) of Internal Revenue Code of 1986 so as to avoiding duplication of penalties with respect to failures ; Secretary and Secretary of Treasury coordinating assessment of penalties under paragraph in connection with failures to satisfy health coverage participation requirements with imposition of
Index of Sec 323. ...EXCISE taxes on failures under section 4980h(b) of Internal Revenue Code of 1986 so as to avoiding duplication of penalties with respect to failures ; Secretary and Secretary of Treasury coordinating assessment of penalties under paragraph in connection with failures to satisfy health coverage participation requirements with imposition of
Index of Sec 323. ...HEALTH coverage participation requirements ; Election to satisfy
Index of Sec 411. ...HEALTH coverage participation requirements ; Secretary terminating election of employer under paragraph if Secretary determining that employer in substantial noncompliance with
Index of Sec 411. ...HEALTH coverage participation requirements with respect to employee ; Case of employer failing in effect to satisfy
Index of Sec 411. ...HEALTH coverage participation requirements to plan sponsor and contributing sponsors of plan ; Regulations prescribed in accordance with subsection by officers referred in subsection providing for application of
Index of Sec 324. ...HEALTH coverage participation requirements to plan sponsor and contributing sponsors of plan ; Regulations prescribed in accordance with subsection by officers referred in subsection providing for application of
Index of Sec 324. ...HEALTH coverage participation requirements to plan sponsor and contributing sponsors of plan ; Regulations prescribed in accordance with subsection by officers referred in subsection providing for application of
Index of Sec 324. ...HEALTH coverage participation requirements meaning requirements of part 1 of subtitle B of title III of division A of America's Affordable Health Choices acting of 2009 ; Term
Index of Sec 321. ...HEALTH coverage participation requirements meaning requirements of part 1 of subtitle B of title III of division A of America's Affordable Health Choices acting of 2009 ; Term
Index of Sec 321. ...HEALTH coverage participation requirements having meaning provided in section 803 ; Term
Index of Sec 321. ...HEALTH coverage participation requirements having meaning provided in section 803 ; Term
Index of Sec 321. ...HEALTH coverage participation requirements meaning requirements of part 1 of subtitle B of title III of division A of America's Affordable Health Choices acting of 2009 ; Term
Index of Sec 323. ...HEALTH coverage participation requirements meaning requirements of part 1 of subtitle B of title III of division A of America's Affordable Health Choices acting of 2009 ; Term
Index of Sec 323. ...HEALTH coverage participation requirements meaning requirements of part I of subtitle B of title III of America's Affordable Health Choices acting of 2009 ; Term
Index of Sec 411. ...HEALTH delivery system reforming ; Division instituting
Index of Sec 100. ...HEALTH delivery system reforming ; Division instituting
Index of Sec 100. ...HEALTH delivery system reforming ; Division instituting
Index of Sec 100. ...HEALTH disparities ; Committee taking into account innovation in health care and considering standards reducing
Index of Sec 123. ...HEALTH disparities ; Committee taking into account innovation in health care and considering standards reducing
Index of Sec 123. ...HEALTH disparities ; Considering standards reducing
Index of Sec 123. ...HEALTH maintenance organization as defined in section 2791(b)(3) of Public Health Service Act ; Manner in which previous sentence applying in case of basic plan with respect to which Commissioner determining providing substantially benefits through
Index of Sec 204. ...HEALTH maintenance organization as defined in section 2791(b)(3) of Public Health Service Act ; Manner in which previous sentence applying in case of basic plan with respect to which Commissioner determining providing substantially benefits through
Index of Sec 204. ...HEALTH maintenance organization as defined in section 2791(b)(3) of Public Health Service Act ; Manner in which previous sentence applying in case of basic plan with respect to which Commissioner determining providing substantially benefits through
Index of Sec 204. ...HEALTH maintenance organizations limited to non-profit health maintenance organizations owning own delivery facilities and employing physicians on salary and funding limited to services ; Participation by
Index of Sec 253. ...HEALTH maintenance organizations owning own delivery facilities and employing physicians on salary and funding limited to services ; Participation by health maintenance organizations limited to non-profit
Index of Sec 253. ...HEALTH plan created or regulated under Act to subject ; Requiring
Index of Sec 157. ...ELECTRONIC transactions provided in part ; Requiring use of standard electronic transaction with health care providers quickly and efficiently enrolling with health plan to conduct other
Index of Sec 163. ...ELECTRONIC transactions provided in part ; Requiring use of standard electronic transaction with health care providers quickly and efficiently enrolling with health plan to conduct other
Index of Sec 164. ...HEALTH claiming status under section to be adopted not later than October 1, 2011 ; First set of operating rules for transactions for eligibility for health plan and
Index of Sec 164. ...EMPLOYMENT-based health plan of section ; Coverage under grandfathered health insurance coverage of section 102 of America's Affordable Health Choices acting of 2009 or current
Index of Sec 401. ...HEALTH plan or arrangement ; Case of group health plan consisting of consumer-directed
Index of Sec 102. ...EMPLOYMENT-based health plan or date on which individual becoming eligible for health insurance coverage through Health Insurance Exchange ; Extending to earlier of date on which individual becoming eligible for coverage under
Index of Sec 167. ...ACCIDENT or health plan ; Term eligible beneficiary meaning individual being eligible to receive benefits or coverage under
Index of Sec 461. ...EMPLOYMENT-based health plan and including public health insurance option ; Terms health benefits planning means health insurance coverage and
Index of Sec 100. ...EMPLOYMENT-based health plan and including public health insurance option ; Terms health benefits planning means health insurance coverage and
Index of Sec 100. ...EMPLOYMENT-based health plan and including public health insurance option and cooperatives under subtitle D of title II ; Terms health benefits planning means health insurance coverage and
Index of Sec 100. ...EMPLOYMENT-based health plan ; Respect to health benefiting plan other than
Index of Sec 100. ...EMPLOYMENT-based health plan ; Respect to health benefiting plan other than
Index of Sec 100. ...EMPLOYMENT-based health plan ; Respect to health benefiting plan other than
Index of Sec 100. ...EMPLOYMENT-based health plan in operation as of day before first day of Y1 meeting same requirements as applying to qualified health benefits planning under section 101 including essential benefit package requirement under section 121 ;
Index of Sec 102. ...EMPLOYMENT-based health plan in operation as of day before first day of Y1 meeting same requirements as applying to qualified health benefits planning under section 101 including essential benefit package requirement under section 121 ;
Index of Sec 102. ...EMPLOYMENT-based health plan in operation as of day before first day of Y1 meeting same requirements as applying to qualified health benefits planning under section 101 including essential benefit package requirement under section 121 ;
Index of Sec 102. ...EMPLOYMENT-based health plan in which coverage consisting only of one or more of following ; Subparagraph not applying to
Index of Sec 102. ...EMPLOYMENT-based health plan in which coverage consisting only of one or more of following ; Subparagraph not applying to
Index of Sec 102. ...EMPLOYMENT-based health plan in which coverage consisting only of one or more of following ; Subparagraph not applying to
Index of Sec 102. ...EMPLOYMENT-based health plan in which coverage consisting only of one or more of coverage or benefits described in clauses ; No case
Index of Sec 102. ...EMPLOYMENT-based health plan in which coverage consisting only of one or more of coverage or benefits described in clauses ; No case
Index of Sec 102. ...EMPLOYMENT-based health plan in which coverage consisting only of one or more of coverage or benefits described in clauses ; No case
Index of Sec 102. ...ACCEPTABLE coverage under division ; Employment-based health plan described in paragraph to be treated as
Index of Sec 102. ...ACCEPTABLE coverage under division ; Employment-based health plan described in paragraph to be treated as
Index of Sec 102. ...ACCEPTABLE coverage under division ; Employment-based health plan described in paragraph to be treated as
Index of Sec 102. ...EMPLOYMENT-based health plan or otherwise in same manner as sections applying to employers and health insurance coverage offered in small group market ; 2712 and subsection and subsection of Public Health Service Act applying to individuals and employers in individual and group health insurance coverage through
Index of Sec 112. ...EMPLOYMENT-based health plan or otherwise excepting that section 2712(b)(1) applying only if issuer providing enrollee with notice of non-payment of premiums and grace period during that enrollees having opportunity to correct nonpayment ; 2712 and subsection and subsection of Public Health Service Act applying to individuals and employers in individual and group health insurance coverage through
Index of Sec 112. ...EMPLOYMENT-based health plan or otherwise excepting that section 2712(b)(1) applying only if issuer providing enrollee with notice of non-payment of premiums and grace period during that enrollees having opportunity to correct nonpayment ; 2712 and subsection and subsection of Public Health Service Act applying to individuals and employers in individual and group health insurance coverage through
Index of Sec 112. ...HEALTH plan cancelled or substantially reducing amount ; Term adversely affected retiree health benefiting group meaning retired participants and beneficiaries of group
Index of Sec 202. ...HEALTH plan being multiemployer plan ; Term employee premium not including collectively bargained premium in case of group
Index of Sec 100. ...HEALTH plan consisting of consumer-directed health plan or arrangement ; Case of group
Index of Sec 102. ...HEALTH plan as of date on which plan becoming subject to requirements of section 111 of Act ; Section 701 of Act ceasing to be effective in case of group
Index of Sec 166. ...COLLECTIVE bargaining agreements between employee representatives and one or more employers ratified before date of enactment of Act ; Case of group health plan maintained pursuant to one or more
Index of Sec 166. ...COLLECTIVE bargaining agreements between employee representatives and one or more employers ratified before date of enactment of Act ; Case of group health plan maintained pursuant to one or more
Index of Sec 167. ...HEALTH plan for purposes of division ; Group health plan to be treated as acceptable coverage under current group
Index of Sec 102. ...HEALTH plan for purposes of title ; Election to be treated as establishment and maintenance of group
Index of Sec 321. ...HEALTH plan for purposes of title ; Election to be treated as establishment and maintenance of group
Index of Sec 321. ...HEALTH plan for purposes of title ; Election to be treated as establishment and maintenance of group
Index of Sec 323. ...HEALTH plan for purposes of title ; Election to be treated as establishment and maintenance of group
Index of Sec 323. ...HEALTH plan containing provision ; Every group
Index of Sec 165. ...FINANCING ; Plan sponsor in relation to group health plan in case of plan maintained jointly by 1 or more employers and 1 or more employee organizations and respect to which employer being primary source of
Index of Sec 100. ...FINANCING ; Plan sponsor in relation to group health plan in case of plan maintained jointly by 1 or more employers and 1 or more employee organizations and respect to which employer being primary source of
Index of Sec 100. ...FINANCING ; Plan sponsor in relation to group health plan in case of plan maintained jointly by 1 or more employers and 1 or more employee organizations and respect to which employer being primary source of
Index of Sec 100. ...ACCEPTABLE coverage under current group health plan for purposes of division ; Group health plan to be treated as
Index of Sec 102. ...HEALTH plan ; Qualified health benefits planning being group
Index of 0HEALTH plan ; Qualified health benefits planning being group
Index of 0CONTRACT or arrangement for health care with health care provider ; Nothing in Act to be construed to preclude participant or beneficiary in group health plan from entering into
Index of Sec 158. ...HEALTH plan under part complying with notice requirement under section 714(b) of Employee Retirement Income Security Act of 1974 with respect to requirements of section ; Group
Index of Sec 163. ...HEALTH plan ; Section applied to issuer and issuer being group
Index of Sec 163. ...HEALTH benefits ; Group health plan described in subsection containing provision reserving general power to amend or terminate plan or provision specifically authorizing plan to make post-retirement reductions in retiree
Index of Sec 165. ...HEALTH benefits planning ; Employer continuing to be treated as Exchange-eligible employer for subsequent plan year regardless of number of employees involved until employer meeting requirement of section 311(a) through paragraph of section by offering group health plan and not through offering Exchange-participating
Index of Sec 202. ...HEALTH benefits planning ; Employer continuing to be treated as Exchange-eligible employer for subsequent plan year regardless of number of employees involved until employer meeting requirement of section 311(a) through paragraph of section by offering group health plan and not through offering Exchange-participating
Index of Sec 202. ...HEALTH benefits planning ; Employer continuing to be treated as Exchange-eligible employer for subsequent plan year regardless of number of employees involved until employer meeting requirement of section 311(a) through paragraph of section by offering group health plan and not through offering Exchange-participating
Index of Sec 202. ...CONTRIBUTION under plan meet requirements of section 312 ; Term affordable credit eligible individual not including full-time employee of employer if employer offering employee coverage as full-time employee under group health plan if coverage and employer
Index of Sec 242. ...CONTRIBUTION under plan meet requirements of section 312 ; Term affordable credit eligible individual not including full-time employee of employer if employer offering employee coverage as full-time employee under group health plan if coverage and employer
Index of Sec 242. ...CONTRIBUTION under plan meet requirements of section 312 ; Term affordable credit eligible individual not including full-time employee of employer if employer offering employee coverage as full-time employee under group health plan if coverage and employer
Index of Sec 242. ...HEALTH plan exceeding 11 percent of current family income ; Case of full-time employees For which cost of employee premium for coverage under group
Index of Sec 242. ...HEALTH plan exceeding 12 percent of current family income ; Case of full-time employees For which cost of employee premium for coverage under group
Index of Sec 242. ...HEALTH plan exceeding 11 percent of current family income ; Of-pocket cost-sharing for yearing or preceding year for coverage under group
Index of Sec 242. ...HEALTH insurance coverage through Exchange as Exchange-eligible employer ; Plan sponsor of group health plan being multiemployer plan obtaining health insurance coverage with respect to participants in plan through Exchange to same extent as employer not described in paragraph or permitted by Commissioner to obtain
Index of Sec 202. ...BENEFICIARY identification card ; Including whether individual being eligible for specific service with specific physician at specific facility including utilization of machine-readable health plan
Index of Sec 163. ...BENEFICIARY identification card ; Including whether individual being eligible for specific service with specific physician at specific facility including utilization of machine-readable health plan
Index of Sec 164. ...HEALTH plans and other inapproations uses as defined by Secretary ; Stores or receiving data including use of data in determinations of eligibility in
Index of Sec 163. ...HEALTH plans and other inapproations uses as defined by Secretary ; Stores or receiving data including use of data in determinations of eligibility in
Index of Sec 164. ...HEALTH plans ; Secretary of Health and Human Services promulgating final rule to establish unique health plan identifier described in section 1173(b) of Social Security Act 42 USC 1320d-2(b) based on input of National Committee of Vital and Health Statistics and consulations with
Index of Sec 164. ...CONSUMER protections ; Purpose of title to establish standards to ensure that new health insurance coverage and employment-based health plans offered meet standards guaranteeing access to affordable coverage, essential benefits and other
Index of Sec 101. ...CONSUMER protections ; Purpose of title to establish standards to ensure that new health insurance coverage and employment-based health plans offered meet standards guaranteeing access to affordable coverage, essential benefits and other
Index of Sec 101. ...CONSUMER protections ; Purpose of title to establish standards to ensure that new health insurance coverage and employment-based health plans offered meet standards guaranteeing access to affordable coverage, essential benefits and other
Index of Sec 101. ...EMPLOYMENT-based health plans ; Case of health insurance coverage not offered through Health Insurance Exchange and case of
Index of Sec 151. ...EMPLOYMENT-based health plans ; Case of health insurance coverage not offered through Health Insurance Exchange and case of
Index of Sec 151. ...EMPLOYMENT-based health plans ; Case of health insurance coverage not offered through Health Insurance Exchange and case of
Index of Sec 151. ...EMPLOYMENT-based health plans ; 10 percent of aggregate amount paid or incurred by employer during preceding taxable year for
Index of Sec 411. ...HEALTH plans for plan years beginning after January 1 ; Amendments making by subsection applying with respect to group
Index of Sec 163. ...HEALTH Plans in Advance of applicability of new prohibition of preexisting condition exclusions ; Limitations on preexisting condition exclusions in group
Index of Sec 166. ...HEALTH plans for plan years beginning after end of 6th calendar month following date of enactment of Act ; Amendments making by paragraphs and subsection applying with respect to group
Index of Sec 166. ...HEALTH Plans ; Amendments relating to preexisting condition exclusions under group
Index of Sec 167. ...HEALTH plans for plan years beginning after end of 6th calendar month following date of enactment of Act ; Amendments making by subsection applying with respect to group
Index of Sec 167. ...HEALTH plans ; 10 percent of aggregate amount paid or incurred by employer during preceding 1-year period for group
Index of Sec 321. ...HEALTH plans ; 10 percent of aggregate amount paid or incurred by employer during preceding 1-year period for group
Index of Sec 321. ...HEALTH plans ; 10 percent of aggregate amount paid or incurred by employer during preceding taxable year for group
Index of Sec 323. ...HEALTH plans ; 10 percent of aggregate amount paid or incurred by employer during preceding taxable year for group
Index of Sec 323. ...HEALTH plans ; Applying to public health insurance option in same manner as part applying to other
Index of Sec 228. ...HEALTH plans ; Similarities and differences between typical insured and self-insured
Index of Sec 113. ...HEALTH plans ; Similarities and differences between typical insured and self-insured
Index of Sec 113. ...HEALTH plans ; Similarities and differences between typical insured and self-insured
Index of Sec 113. ...HEALTH plan identifier described in section 1173(b) of Social Security Act 42 USC 1320d-2(b) based on input of National Committee of Vital and Health Statistics and consulations with health plans ; Secretary of Health and Human Services promulgating final rule to establish unique
Index of Sec 164. ...HEALTH Records ; Sec 157 increasing meaningful Use of electronic
Index of Sec 157. ...HEALTH care providers ; QHBP offering entities using to encourage increased meaningful use of electronic health records by
Index of Sec 157. ...HEALTH records by providers ; Recommendations concerning whether qualified health benefits planing increasing reimbursement rates to health care providers to increase meaningful use of electronic
Index of Sec 157. ...HEALTH services ; Entity providing for culturally and linguistically appropriate communication and
Index of Sec 204. ...HEALTH services ; Entity providing for culturally and linguistically appropriate communication and
Index of Sec 204. ...HEALTH services ; Entity providing for culturally and linguistically appropriate communication and
Index of Sec 204. ...HEALTH status-related factors in relation to individual or dependent ; Qualified health benefits planning not imposing preexisting condition exclusion or otherwise imposing limit or condition on coverage under plan with respect to individual or dependent based on
Index of Sec 111. ...HEALTH status-related factors in relation to individual or dependent ; Qualified health benefits planning not imposing pre-existing condition exclusion or otherwise imposing limit or condition on coverage under plan with respect to individual or dependent based on
Index of Sec 111. ...HEALTH status-related factors in relation to individual or dependent ; Qualified health benefits planning not imposing pre-existing condition exclusion or otherwise imposing limit or condition on coverage under plan with respect to individual or dependent based on
Index of Sec 111. ...HEALTH care system affecting differences in costs ; Nothing in paragraph to be construed to preclude allowance for normal variations in population demographics, health status and other factors exogenous to
Index of Sec 252. ...HEALTHCARE being readily available by providing alternative framework to reduce costs of defensive medicine and allowing victims of malpractice to be fairly compensated ; Ensuring quality
Index of Sec 208. ...HOME and other care management payments, accountable care organizations, value-based ; Payment mechanisms and policies under section including patient-centered medical
Index of Sec 224. ...HOME and other care management payments, accountable care organizations, value-based ; Payment mechanisms and policies under section including patient-centered medical
Index of Sec 224. ...HOME and other care management payments, accountable care organizations, value-based ; Payment mechanisms and policies under section including patient-centered medical
Index of Sec 224. ...HOSPITAL ; No prior approval to be required in case of emergency services provided by
Index of Sec 139. ...HOSPITAL and outpatient clinic services including emergency department services ; Outpatient
Index of Sec 122. ...HOSPITAL and outpatient clinic services including emergency department services ; Outpatient
Index of Sec 122. ...HOSPITAL and outpatient clinic services including emergency department services ; Outpatient
Index of Sec 122. ...IDENTIFICATION of Providers trained and accredited in integrative medicine ;
Index of Sec 133. ...HEALTH medicine ; Qualified health benefit plan including in disclosure required under subsection identification to enrollees of providers of services under plan trained and accredited in integrative
Index of Sec 133. ...SPECIFIC retailer, manufacturer or wholesaler ; Other provision of law, information disclosed by PBM to Commissioner or QHBP offering entity under subsection being confidential and not disclosed by Commissioner or QHBP offering entity in form disclosing identity of specific PBM or prices charged by PBM or
Index of Sec 133. ...DISABILITY, socioeconomic status, rural, urban or other geographic setting and other population or subpopulation as determined appropriate by Secretary ; Primary language, sex, sexual orientation, gender identity,
Index of Sec 221. ...COMPETITIVE disadvantage ; Secretary delaying implementation reform in geographic areas in which implementation placing public health insurance option at
Index of Sec 224. ...AFFORDABILITY crediting provided for enrollees under subtitle C ; Entity providing for implementation of
Index of Sec 204. ...AFFORDABILITY crediting provided for enrollees under subtitle C ; Entity providing for implementation of
Index of Sec 204. ...AFFORDABILITY crediting provided for enrollees under subtitle C ; Entity providing for implementation of
Index of Sec 204. ...IMPLEMENTATION of provisions of division with respect to Medicaid program ; Commissioner entering into memorandum of understanding with State with respect to coordinating enrollment of individuals in Exchange-participating health benefits planing and State's Medicaid program consistent with section and otherwise coordinating
Index of Sec 205. ...IMPLEMENTATION of provisions of division with respect to Medicaid program ; Commissioner entering into memorandum of understanding with State with respect to coordinating enrollment of individuals in Exchange-participating health benefits planing and State's Medicaid program consistent with section and otherwise coordinating
Index of Sec 205. ...IMPLEMENTATION of provisions of division with respect to Medicaid program ; Commissioner entering into memorandum of understanding with State with respect to coordinating enrollment of individuals in Exchange-participating health benefits planing and State's Medicaid program consistent with section and otherwise coordinating
Index of Sec 205. ...IMPLEMENTATION of X12 Version 5010 transaction standards implemented under part ; Not later than 2 years after date of
Index of Sec 163. ...IMPLEMENTATION of X12 Version 5010 transaction standards implemented under part ; Not later than 2 years after date of
Index of Sec 164. ...IMPLEMENTATION plan ; Estimate of total funds needed to ensure timely completion of
Index of Sec 163. ...IMPLEMENTATION plan ; Estimate of total funds needed to ensure timely completion of
Index of Sec 164. ...COMPETITIVE disadvantage ; Secretary delaying implementation reform in geographic areas in which implementation placing public health insurance option at
Index of Sec 224. ...GEOGRAPHIC areas or otherwise in order to reduce total program costs or promoting high value care ; Secretary prioritizing implementation reform in high cost
Index of Sec 224. ...IMPLEMENTATION specifications ; Paragraph, striking with reference and following and inserting with reference to transaction or data element of health information in section 1173 means
Index of Sec 163. ...IMPLEMENTATION specifications ; Paragraph, striking with reference and following and inserting with reference to transaction or data element of health information in section 1173 means
Index of Sec 164. ...IMPOSITION of filing fee under subsection ; Previous sentence not to be construed as applying to
Index of 0IMPOSITION of preexisting condition exclusions ; Applicability of group health insurance limitations on
Index of Sec 167. ...IMPOSITION of preexisting condition exclusions ; Application of group health insurance limitations on
Index of Sec 167. ...EXCISE taxes on failures under section 4980h(b) of Internal Revenue Code of 1986 so as to avoiding duplication of penalties with respect to failures ; Secretary and Secretary of Treasury coordinating assessment of penalties under section in connection with failures to satisfy health coverage participation requirements with imposition of
Index of Sec 321. ...EXCISE taxes on failures under section 4980h(b) of Internal Revenue Code of 1986 so as to avoiding duplication of penalties with respect to failures ; Secretary and Secretary of Treasury coordinating assessment of penalties under section in connection with failures to satisfy health coverage participation requirements with imposition of
Index of Sec 321. ...EXCISE taxes on failures under section 4980h(b) of Internal Revenue Code of 1986 so as to avoiding duplication of penalties with respect to failures ; Secretary and Secretary of Treasury coordinating assessment of penalties under paragraph in connection with failures to satisfy health coverage participation requirements with imposition of
Index of Sec 323. ...EXCISE taxes on failures under section 4980h(b) of Internal Revenue Code of 1986 so as to avoiding duplication of penalties with respect to failures ; Secretary and Secretary of Treasury coordinating assessment of penalties under paragraph in connection with failures to satisfy health coverage participation requirements with imposition of
Index of Sec 323. ...IN-network coverage ; Using provider network for items and services meeting standards respecting provider networks as Commissioner establishing to assure adequacy of networks in ensuring enrollee access to items and services and transparency in cost-sharing differentials between
Index of Sec 115. ...IN-network coverage ; Using provider network for items and services meeting standards respecting provider networks as Commissioner establishing to assure adequacy of networks in ensuring enrollee access to items and services and transparency in cost-sharing differentials between
Index of Sec 115. ...IN-network coverage ; Using provider network for items and services meeting standards respecting provider networks as Commissioner establishing to assure adequacy of networks in ensuring enrollee access to items and services and transparency in cost-sharing differentials between
Index of Sec 115. ...INAPPROATIONS uses as defined by Secretary ; Stores or receiving data including use of data in determinations of eligibility in health plans and other
Index of Sec 163. ...INAPPROATIONS uses as defined by Secretary ; Stores or receiving data including use of data in determinations of eligibility in health plans and other
Index of Sec 164. ...INCENTIVE payment for enacting and implementing medical liability reforms as specified in subsection ; State being eligible to receive
Index of Sec 208. ...INCENTIVE payment if State enacting after date of enactment of subsection and implementing ; State being eligible to receive
Index of Sec 208. ...HEALTH care in State ; State using incentive payment received under subsection to improve
Index of Sec 208. ...INCENTIVE payment under subsection submitting to Secretary application and containing information as Secretary requiring ; State seeking
Index of Sec 208. ...INCENTIVE payment under subsection ; Secretary providing technical assistance to States applying or awarding
Index of Sec 208. ...INCOME not exceeding 133 percent of fpl ; Case of individual with
Index of Sec 243. ...INCOME not exceeding 133 percent of fpl ; Case of individual with
Index of Sec 243. ...INCOME not exceeding 133 percent of fpl ; Case of individual with
Index of Sec 243. ...INCOME used under subsection ; Individual's income for plan year expected to be significantly different from
Index of Sec 245. ...INCOME used under subsection ; Individual's income for plan year expected to be significantly different from
Index of Sec 245. ...INCOME used under subsection ; Individual's income for plan year expected to be significantly different from
Index of Sec 245. ...INCOME disregarding for purposes of subtitle ; Commissioner conducting study examining application of
Index of Sec 242. ...INCOME disregarding for purposes of subtitle ; Commissioner conducting study examining application of
Index of Sec 242. ...INCOME disregarding for purposes of subtitle ; Commissioner conducting study examining application of
Index of Sec 242. ...INCOME ; Case of full-time employees For which cost of employee premium for coverage under group health plan exceeding 11 percent of current family
Index of Sec 242. ...INCOME ; Case of full-time employees For which cost of employee premium for coverage under group health plan exceeding 12 percent of current family
Index of Sec 242. ...INCOME ; Of-pocket cost-sharing for yearing or preceding year for coverage under group health plan exceeding 11 percent of current family
Index of Sec 242. ...INCOME for plan year ; Premium percentage limit specified in paragraph for individual based upon individual's family
Index of Sec 243. ...INCOME for plan year ; Premium percentage limit specified in paragraph for individual based upon individual's family
Index of Sec 243. ...INCOME for plan year ; Premium percentage limit specified in paragraph for individual based upon individual's family
Index of Sec 243. ...INCOME tier specified in table in subsection ; Individuals whose family income within
Index of Sec 243. ...INCOME tier specified in table in subsection ; Individuals whose family income within
Index of Sec 243. ...INCOME tier specified in table in subsection ; Individuals whose family income within
Index of Sec 243. ...INCOME ; Affordability cost-sharing credit under section for affordable credit eligible individual enrolled in Exchange-participating health benefits planning in form of cost-sharing reduction described in subsection provided under section for income tier in which individual classified based on individual's family
Index of Sec 244. ...INCOME ; Affordability cost-sharing credit under section for affordable credit eligible individual enrolled in Exchange-participating health benefits planning in form of cost-sharing reduction described in subsection provided under section for income tier in which individual classified based on individual's family
Index of Sec 244. ...INCOME ; Affordability cost-sharing credit under section for affordable credit eligible individual enrolled in Exchange-participating health benefits planning in form of cost-sharing reduction described in subsection provided under section for income tier in which individual classified based on individual's family
Index of Sec 244. ...INCOME described in subparagraph ; Initial application of individual for affordability credit under subtitle or application for change in affordability credit based upon significant change in family
Index of Sec 245. ...INCOME described in subparagraph ; Initial application of individual for affordability credit under subtitle or application for change in affordability credit based upon significant change in family
Index of Sec 245. ...INCOME described in subparagraph ; Initial application of individual for affordability credit under subtitle or application for change in affordability credit based upon significant change in family
Index of Sec 245. ...INCOME of individual and information regarding change ; Significant change in family
Index of Sec 245. ...INCOME of individual and information regarding change ; Significant change in family
Index of Sec 245. ...INCOME of individual and information regarding change ; Significant change in family
Index of Sec 245. ...INCOME of child as recently determined before Y1 by State under title XXI of Social Security Act ; Commissioner establishing rules under which family income of child deemed to be no greater than family
Index of Sec 245. ...INCOME of child as recently determined before Y1 by State under title XXI of Social Security Act ; Commissioner establishing rules under which family income of child deemed to be no greater than family
Index of Sec 245. ...INCOME of child as recently determined before Y1 by State under title XXI of Social Security Act ; Commissioner establishing rules under which family income of child deemed to be no greater than family
Index of Sec 245. ...AFFORDABILITY credit exceeding correct amount ; Case of individual intentionally misrepresenting family income or individual failing to disclose to Commissioner significant change in family income under subsection in manner resulting in individual becoming affordable credit eligible individual when individual being not or amount of
Index of Sec 245. ...AFFORDABILITY credit exceeding correct amount ; Case of individual intentionally misrepresenting family income or individual failing to disclose to Commissioner significant change in family income under subsection in manner resulting in individual becoming affordable credit eligible individual when individual being not or amount of
Index of Sec 245. ...AFFORDABILITY credit exceeding correct amount ; Case of individual intentionally misrepresenting family income or individual failing to disclose to Commissioner significant change in family income under subsection in manner resulting in individual becoming affordable credit eligible individual when individual being not or amount of
Index of Sec 245. ...INCOME ; Term income means modified adjusted gross
Index of Sec 242. ...INCOME ; Term income means modified adjusted gross
Index of Sec 242. ...INCOME ; Term income means modified adjusted gross
Index of Sec 242. ...INCOME specified in section 6012(a)(1) with respect to taxpayer ; Amount of gross
Index of Sec 401. ...INCOME ; Term modified adjusted gross income means adjusted gross
Index of Sec 401. ...INCOME reduced by deduction allowed for investment interest ; Term modified adjusted gross income means adjusted gross
Index of Sec 441. ...INCOME under section 911 ; Amounts excluded from taxpayer's gross
Index of Sec 441. ...INCOME for plan year expected to be significantly different from income used under subsection ; Individual's
Index of Sec 245. ...INCOME for plan year expected to be significantly different from income used under subsection ; Individual's
Index of Sec 245. ...INCOME for plan year expected to be significantly different from income used under subsection ; Individual's
Index of Sec 245. ...INCOME ; Paragraph applying only to transactions entered in connection with trade or business or activity engaged for production of
Index of Sec 452. ...INCOME for income otherwise applicable ; Significant changes in income to Commissioner and requiring substitution of
Index of Sec 245. ...INCOME for income otherwise applicable ; Significant changes in income to Commissioner and requiring substitution of
Index of Sec 245. ...INCOME for income otherwise applicable ; Significant changes in income to Commissioner and requiring substitution of
Index of Sec 245. ...AFFORDABILITY credit described in subtitle C of title II of America's Affordable Health Choices acting of 2009 ; Return information of taxpayer whose income being relevant in determining
Index of Sec 431. ...INCOME means adjusted gross income ; Term modified adjusted gross
Index of Sec 401. ...INCOME means adjusted gross income reduced by deduction allowed for investment interest ; Term modified adjusted gross
Index of Sec 441. ...INCOME means modified adjusted gross income ; Term
Index of Sec 242. ...INCOME means modified adjusted gross income ; Term
Index of Sec 242. ...INCOME means modified adjusted gross income ; Term
Index of Sec 242. ...INCOME tax ; Achieving financial accounting benefit not to be taken into account as purpose for entering into transaction if origin of financial accounting benefit being reduction of Federal
Index of Sec 452. ...INCOME tax effect to be treated in same manner as Federal income tax effect ; State or local income tax effect related to Federal
Index of Sec 452. ...INCOME tax effect related to Federal income tax effect to be treated in same manner as Federal income tax effect ; State or local
Index of Sec 452. ...INCOME tier specified in table in subsection ; Individuals whose family income within
Index of Sec 243. ...INCOME tier specified in table in subsection ; Individuals whose family income within
Index of Sec 243. ...INCOME tier specified in table in subsection ; Individuals whose family income within
Index of Sec 243. ...INCOME Tier ; Table of premium percentage Limits and actuarial Value percentages based on
Index of Sec 243. ...INCOME Tier ; Table of premium percentage Limits and actuarial Value percentages based on
Index of Sec 243. ...INCOME Tier ; Table of premium percentage Limits and actuarial Value percentages based on
Index of Sec 243. ...INCOME tier identified in table in paragraph ;
Index of Sec 243. ...INCOME tier in which individual classified based on individual's family income ; Affordability cost-sharing credit under section for affordable credit eligible individual enrolled in Exchange-participating health benefits planning in form of cost-sharing reduction described in subsection provided under section for
Index of Sec 244. ...INCOME tier in which individual classified based on individual's family income ; Affordability cost-sharing credit under section for affordable credit eligible individual enrolled in Exchange-participating health benefits planning in form of cost-sharing reduction described in subsection provided under section for
Index of Sec 244. ...INCOME tier in which individual classified based on individual's family income ; Affordability cost-sharing credit under section for affordable credit eligible individual enrolled in Exchange-participating health benefits planning in form of cost-sharing reduction described in subsection provided under section for
Index of Sec 244. ...INCOME tier specified in table under section 243(d) as estimated by Commissioner ; Commissioner specifying reduction in cost-sharing amounts and annual limitation on cost-sharing specified in section 122(c)(2)(b) under basic plan for
Index of Sec 244. ...INCOME tier specified in table under section 243(d) as estimated by Commissioner ; Commissioner specifying reduction in cost-sharing amounts and annual limitation on cost-sharing specified in section 122(c)(2)(b) under basic plan for
Index of Sec 244. ...INCOME tier specified in table under section 243(d) as estimated by Commissioner ; Commissioner specifying reduction in cost-sharing amounts and annual limitation on cost-sharing specified in section 122(c)(2)(b) under basic plan for
Index of Sec 244. ...INCOME verification for purposes of subtitle ; Commissioner establishing annual open enrollment period during that Exchange-eligible individual or employer electing to enroll in Exchange-participating health benefits planning for following plan year and enrollment period for affordability credits under subtitle C periods to be during September through November of year or other time maximizing timeliness of
Index of Sec 205. ...INCOME verification for purposes of subtitle ; Commissioner establishing annual open enrollment period during that Exchange-eligible individual or employer electing to enroll in Exchange-participating health benefits planning for following plan year and enrollment period for affordability credits under subtitle C periods to be during September through November of year or other time maximizing timeliness of
Index of Sec 205. ...INCOME verification for purposes of subtitle ; Commissioner establishing annual open enrollment period during that Exchange-eligible individual or employer electing to enroll in Exchange-participating health benefits planning for following plan year and enrollment period for affordability credits under subtitle C periods to be during September through November of year or other time maximizing timeliness of
Index of Sec 205. ...CONTRACT filled via mail order and retail pharmacies ; Information on volume of prescriptions under
Index of Sec 133. ...CONTRACT at retail and mail order pharmacies and percentage of cases in which generic drug dispensed when available ; Information on overall percentage of generic drugs dispensed under
Index of Sec 133. ...CONTRACT in which individuals switched from prescribed drug being less expensive to drug being more expensive ; Information on percentage and number of cases under
Index of Sec 133. ...INFORMATION disclosed by PBM to Commissioner or QHBP offering entity under subsection being confidential and not disclosed by Commissioner or QHBP offering entity in form disclosing identity of specific PBM or prices charged by PBM or specific retailer, manufacturer or wholesaler ; Other provision of law,
Index of Sec 133. ...INFORMATION related to other planning tools ;
Index of Sec 138. ...INFORMATION including options to maintain ; Information presented under paragraph not presuming withdrawal of treatment and including end-of-life planning
Index of Sec 138. ...INFORMATION provided to meet requirements of subsection not including advanced directives or other planning tools listing or describing as option suicide ;
Index of Sec 138. ...COMPLIANCE with entity's determination and subparagraph ; Submitting information to entity documenting
Index of 0INFORMATION under subtitle C ; Assistance to individuals in presenting
Index of Sec 144. ...INFORMATION under subtitle C ; Assistance to individuals in presenting
Index of Sec 144. ...INFORMATION under subtitle C ; Assistance to individuals in presenting
Index of Sec 144. ...INFORMATION as Secretary requiring ; Eligible employment-based plan submitting to Secretary application for participation in program and containing
Index of Sec 164. ...INFORMATION as Secretary requiring ; Eligible employment-based plan submitting to Secretary application for participation in program and containing
Index of Sec 164. ...INFORMATION as Secretary requiring ; Eligible employment-based plan submitting to Secretary application for participation in program and containing
Index of Sec 166. ...HEALTH and health care ; Including information necessary to administer risk pooling mechanism described in section 206(b) and information to address disparities in
Index of Sec 204. ...HEALTH and health care ; Including information necessary to administer risk pooling mechanism described in section 206(b) and information to address disparities in
Index of Sec 204. ...HEALTH and health care ; Including information necessary to administer risk pooling mechanism described in section 206(b) and information to address disparities in
Index of Sec 204. ...INFORMATION as Commissioner requiring ; QHBP offering entity submitting to Commissioner bid at time and containing
Index of Sec 204. ...INFORMATION as Commissioner requiring ; QHBP offering entity submitting to Commissioner bid at time and containing
Index of Sec 204. ...INFORMATION as Commissioner requiring ; QHBP offering entity submitting to Commissioner bid at time and containing
Index of Sec 204. ...COMPARATIVE manner and including information on benefits premiums, cost-sharing, quality, provider networks and consumer satisfaction ; Information to be provided in
Index of Sec 205. ...COMPARATIVE manner and including information on benefits premiums, cost-sharing, quality, provider networks and consumer satisfaction ; Information to be provided in
Index of Sec 205. ...COMPARATIVE manner and including information on benefits premiums, cost-sharing, quality, provider networks and consumer satisfaction ; Information to be provided in
Index of Sec 205. ...HEALTH benefits planing and file complaints ; Providing for operation of toll-free telephone hotline to respond to requests for assistance and maintaining Internet website through individuals obtaining information on coverage under Exchange-participating
Index of Sec 205. ...HEALTH benefits planing and file complaints ; Providing for operation of toll-free telephone hotline to respond to requests for assistance and maintaining Internet website through individuals obtaining information on coverage under Exchange-participating
Index of Sec 205. ...HEALTH benefits planing and file complaints ; Providing for operation of toll-free telephone hotline to respond to requests for assistance and maintaining Internet website through individuals obtaining information on coverage under Exchange-participating
Index of Sec 205. ...INFORMATION as Secretary requiring ; State seeking incentive payment under subsection submitting to Secretary application and containing
Index of Sec 208. ...INFORMATION contained in application ; Permitting to verify
Index of Sec 245. ...INFORMATION contained in application ; Permitting to verify
Index of Sec 245. ...INFORMATION contained in application ; Permitting to verify
Index of Sec 245. ...INFORMATION so disclosed to verify information ; Commissioner using
Index of Sec 245. ...INFORMATION so disclosed to verify information ; Commissioner using
Index of Sec 245. ...INFORMATION so disclosed to verify information ; Commissioner using
Index of Sec 245. ...INFORMATION required to be shown on return with respect to individual ;
Index of Sec 401. ...INFORMATION required ; Extension permitted where Notice of additional
Index of Sec 139. ...INFORMATION being necessary to complete review and making determination on request ; Determining that additional
Index of Sec 139. ...INFORMATION required ; Extension permitted where Notice of additional
Index of 0INFORMATION being necessary to complete review and making determination on request ; Determining that additional
Index of 0INFORMATION to be provided to person making denial in order to make decision appeal ; Additional necessary
Index of Sec 139. ...DISSEMINATION of information to prospective enrollees on enrollment process including before open enrollment period ; Commissioner providing for broad
Index of Sec 205. ...DISSEMINATION of information to prospective enrollees on enrollment process including before open enrollment period ; Commissioner providing for broad
Index of Sec 205. ...DISSEMINATION of information to prospective enrollees on enrollment process including before open enrollment period ; Commissioner providing for broad
Index of Sec 205. ...CONSUMER information, outreach and assistance in enrollment of small employers being members arrangement under Exchange participating health benefits planing ; Commissioner entering into contracts with small employer benefit arrangements to provide
Index of Sec 209. ...INFORMATION being reasonably necessary to make determination ; No event later than 3 business days after date of receipt of
Index of Sec 139. ...INFORMATION being reasonably necessary to make determination ; Possible in accordance with medical exigencies of case and no event later than 1 business day after date of receipt of
Index of Sec 139. ...INFORMATION being reasonably necessary to make determination ; Utilization review program making determination concerning services and providing notice of determination to individual or individual's designee and individual's health care provider by telephone and printed form within 30 days of date of receipt of
Index of Sec 139. ...DISSEMINATION of information related to end-of-life planning to individuals seeking enrollment in Exchange-participating health benefits planing offered through Exchange ; Providing for
Index of Sec 138. ...DISSEMINATION of information under subsection and providing assistance as described in paragraph ; Commissioner working with other appropriate entities to facilitate
Index of Sec 205. ...DISSEMINATION of information under subsection and providing assistance as described in paragraph ; Commissioner working with other appropriate entities to facilitate
Index of Sec 205. ...DISSEMINATION of information under subsection and providing assistance as described in paragraph ; Commissioner working with other appropriate entities to facilitate
Index of Sec 205. ...INFORMATION ; Certification criteria messaging formating, coding and code sets adopted or established by Secretary for electronic exchange and use of
Index of Sec 163. ...INFORMATION ; Certification criteria messaging formating, coding and code sets adopted or established by Secretary for electronic exchange and use of
Index of Sec 164. ...INFORMATION regarding efforts and procedures to be undertaken by employer to correct failure ; Secretary informing employer in writing of failureing and providing employer
Index of Sec 321. ...INFORMATION regarding efforts and procedures to be undertaken by employer to correct failure ; Secretary informing employer in writing of failureing and providing employer
Index of Sec 321. ...INFORMATION regarding efforts and procedures to be undertaken by employer to correct failure ; Secretary informing employer in writing of failureing and providing employer
Index of Sec 323. ...INFORMATION regarding efforts and procedures to be undertaken by employer to correct failure ; Secretary informing employer in writing of failureing and providing employer
Index of Sec 323. ...INFORMATION including options to maintain ; Information presented under paragraph not presuming withdrawal of treatment and including end-of-life planning
Index of Sec 138. ...INFORMATION consistent with limitations described in section 1902(a)(7) of Social Security Act Nothing in section to be construed as permitting memorandum to modify or vitiate requirement of State Medicaid plan ; Memorandum permitting exchange of
Index of Sec 205. ...INFORMATION consistent with limitations described in section 1902(a)(7) of Social Security Act Nothing in section to be construed as permitting memorandum to modify or vitiate requirement of State Medicaid plan ; Memorandum permitting exchange of
Index of Sec 205. ...INFORMATION consistent with limitations described in section 1902(a)(7) of Social Security Act Nothing in section to be construed as permitting memorandum to modify or vitiate requirement of State Medicaid plan ; Memorandum permitting exchange of
Index of Sec 205. ...INFORMATION ; Condition of contracting PBM required to provide annually to Commissioner and QHBP offering entity offering plan following
Index of Sec 133. ...INFORMATION relating to violation ; Attorney general of State
Index of Sec 153. ...INFORMATION relating to violation ; Attorney general of State
Index of Sec 153. ...INFORMATION relating to violation ; Attorney general of State
Index of Sec 153. ...HEALTH information ; Part C of title XI of Social Security Act relating to standards for protections against wrongful disclosure of individually identifiable
Index of Sec 228. ...INFORMATION prohibited in paragraph in advanced directives or other planning tools ; Requiring inclusion of
Index of Sec 138. ...INFORMATION regarding change ; Significant change in family income of individual and
Index of Sec 245. ...INFORMATION regarding change ; Significant change in family income of individual and
Index of Sec 245. ...INFORMATION regarding change ; Significant change in family income of individual and
Index of Sec 245. ...INFORMATION supplied with respect to individual whose denial of claim for benefits appealed ; Personal health and medical
Index of 0INFORMATION to be transmitted between plan or issuer and requester by telephone, facsimile or other similarly expeditious available method ; Necessary
Index of 0INCOME of individual ; Commissioner receiving new information from individual regarding family
Index of Sec 245. ...INCOME of individual ; Commissioner receiving new information from individual regarding family
Index of Sec 245. ...INCOME of individual ; Commissioner receiving new information from individual regarding family
Index of Sec 245. ...INFORMATION as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other
Index of Sec 133. ...INFORMATION as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other
Index of Sec 133. ...INFORMATION as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other
Index of Sec 133. ...INFORMATION as prescribed by Secretary by regulation ; Other
Index of Sec 431. ...INFORMATION relating or fact ; Taxable year with respect to which preceding
Index of Sec 431. ...INFORMATION containing patient identifiable and prescriber-identifiable data maintained in accordance with section ; Qualified health benefits planning ensuring that records relative to prescription
Index of Sec 138. ...INFORMATION ; Commissioner working with other appropriate entities to facilitate provision of
Index of Sec 205. ...INFORMATION ; Commissioner working with other appropriate entities to facilitate provision of
Index of Sec 205. ...INFORMATION ; Commissioner working with other appropriate entities to facilitate provision of
Index of Sec 205. ...INFORMATION needed to seek appeal of decision or determination ; Helping individuals determining relevant
Index of Sec 144. ...INFORMATION needed to seek appeal of decision or determination ; Helping individuals determining relevant
Index of Sec 144. ...INFORMATION needed to seek appeal of decision or determination ; Helping individuals determining relevant
Index of Sec 144. ...AFFORDABILITY credit described in subtitle C of title II of America's Affordable Health Choices acting of 2009 ; Return information of taxpayer whose income being relevant in determining
Index of Sec 431. ...HEALTH insurance exchange ; Return information disclosed under subparagraph to be used by officers and employees of Health Choices Administration or State-based
Index of Sec 431. ...HEALTH and health care ; Including information necessary to administer risk pooling mechanism described in section 206(b) and information to address disparities in
Index of Sec 204. ...HEALTH and health care ; Including information necessary to administer risk pooling mechanism described in section 206(b) and information to address disparities in
Index of Sec 204. ...HEALTH and health care ; Including information necessary to administer risk pooling mechanism described in section 206(b) and information to address disparities in
Index of Sec 204. ...INFORMATION ; Deadline specified in subparagraph being 14 days after date program receiving specified additional
Index of Sec 139. ...INFORMATION ; Deadline specified in subparagraph being 14 days after date plan or entity receiving specified additional
Index of 0INFORMATION ; Verifiable information required to document change and process for submission of
Index of Sec 245. ...INFORMATION ; Verifiable information required to document change and process for submission of
Index of Sec 245. ...INFORMATION ; Verifiable information required to document change and process for submission of
Index of Sec 245. ...INFORMATION described in subparagraph being developed using plain language ; Ensuring that Internet website described in subparagraph and
Index of Sec 205. ...INFORMATION described in subparagraph being developed using plain language ; Ensuring that Internet website described in subparagraph and
Index of Sec 205. ...INFORMATION described in subparagraph being developed using plain language ; Ensuring that Internet website described in subparagraph and
Index of Sec 205. ...HEALTH information in section 1173 means implementation specifications ; Paragraph, striking with reference and following and inserting with reference to transaction or data element of
Index of Sec 163. ...HEALTH information in section 1173 means implementation specifications ; Paragraph, striking with reference and following and inserting with reference to transaction or data element of
Index of Sec 164. ...INFORMATION collected under section in manner adversely affecting individual ; Nothing in section to be construed to permit use of
Index of Sec 163. ...INFORMATION collected under section in manner adversely affecting individual ; Nothing in section to be construed to permit use of
Index of Sec 164. ...INFORMATION required to document change and process for submission of information ; Verifiable
Index of Sec 245. ...INFORMATION required to document change and process for submission of information ; Verifiable
Index of Sec 245. ...INFORMATION required to document change and process for submission of information ; Verifiable
Index of Sec 245. ...DRUG prices and spending ; Permitting Commissioner to disclose industry-wide aggregate or average information to be used in assessing overall impact of PBMS on prescription
Index of Sec 133. ...INFORMATION and provisions of plan relating to matter of externally appealable decision as determined by entity ; Plan or issuer involved providing timely access to external appeal entity to
Index of 0INFORMATION contact for person ; Name and address of person required to make return and phone number of
Index of Sec 401. ...INFORMATION as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other
Index of Sec 133. ...INFORMATION as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other
Index of Sec 133. ...INFORMATION as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other
Index of Sec 133. ...DISSEMINATION of information on Exchange-participating health benefits planing offered under title ; Commissioner providing for broad
Index of Sec 205. ...DISSEMINATION of information on Exchange-participating health benefits planing offered under title ; Commissioner providing for broad
Index of Sec 205. ...DISSEMINATION of information on Exchange-participating health benefits planing offered under title ; Commissioner providing for broad
Index of Sec 205. ...HEALTH information exchange goals ; Entity coordinating activities with Hit Policy Committee and Hit Standards Committee and complementing efforts of Office of National Healthcare Coordinator and related
Index of Sec 164. ...DISCLOSURE ; Sec 133 requiring information transparency and Plan
Index of Sec 133. ...DISCLOSURE ; Sec 133 requiring information transparency and Plan
Index of Sec 133. ...DISCLOSURE ; Sec 133 requiring information transparency and Plan
Index of Sec 133. ...INSOLVENCY in manner similar to manner in which entities receiving Federal funding under Troubled Asseal Relief Program of Secretary of Treasury ; No case public health insurance option receiving Federal funds for purposes of
Index of Sec 222. ...INSTRUMENTALITY ; Case of coverage provided by governmental unit or agency or
Index of Sec 401. ...INSULIN ; Reimbursements for medicine restricted to prescribed Drugs and
Index of Sec 442. ...INSURANCE-related terms ; Commissioner providing for development of standards for definitions of terms used in health insurance coverage including
Index of Sec 142. ...INSURANCE-related terms ; Commissioner providing for development of standards for definitions of terms used in health insurance coverage including
Index of Sec 142. ...INSURANCE-related terms ; Commissioner providing for development of standards for definitions of terms used in health insurance coverage including
Index of Sec 142. ...INSURANCE issuer offering coverage and coverage including surgical treatment in opinion of treating physician ; Coverage provided under paragraph to be subject to pre-authorization or pre-certification as required by
Index of Sec 163. ...EMPLOYMENT-based plan ; Dependent of retiree in form of deductibles, co-payments and co-insurance to be included along with amounts paid by participating
Index of Sec 164. ...EMPLOYMENT-based plan ; Dependent of retiree in form of deductibles, co-payments and co-insurance to be included along with amounts paid by participating
Index of Sec 164. ...INSURANCE or other out-of-pocket costs ; Amounts paid to participating employment-based plan under subsection to be used to lowing costs borne directly by participants and beneficiaries for health benefits provided under plan in form of premiums, co-payments, deductibles, co-
Index of Sec 164. ...INSURANCE or other out-of-pocket costs ; Amounts paid to participating employment-based plan under subsection to be used to lowing costs borne directly by participants and beneficiaries for health benefits provided under plan in form of premiums, co-payments, deductibles, co-
Index of Sec 164. ...EMPLOYMENT-based plan ; Dependent of retiree in form of deductibles, co-payments and co-insurance to be included along with amounts paid by participating
Index of Sec 166. ...INSURANCE or other out-of-pocket costs ; Amounts paid to participating employment-based plan under subsection to be used to lowing costs borne directly by participants and beneficiaries for health benefits provided under plan in form of premiums, co-payments, deductibles, co-
Index of Sec 166. ...FINANCIAL viability or ability to provide timely benefits to plan participants ; Insurance commissioner for State in which plan offered that complying with subsection for year threatening
Index of Sec 209. ...INSURANCE through Health Insurance Exchange or State-based Health Insurance Exchange under section 208 ; Member-run health insurance cooperatives providing
Index of Sec 251. ...INSURANCE before date ; Not offering insurance before July 16, 2009 and cooperatives being not affiliate or successor to insurance company offering
Index of Sec 252. ...INSURANCE in State in which offering insurance ; Licencing to offer
Index of Sec 252. ...INSURANCE constituting medical care ; Allowing as deduction under section amount equal to amount paid during taxable year for
Index of Sec 461. ...INSURANCE ; Nothing in division to be construed as affecting offering of health benefits in form of excepted benefits if benefits offered under separate policy, contract or certificate of
Index of Sec 121. ...INSURANCE ; Nothing in division to be construed as affecting offering of health benefits in form of excepted benefits if benefits offered under separate policy, contract or certificate of
Index of Sec 121. ...INSURANCE ; Nothing in division to be construed as affecting offering of health benefits in form of excepted benefits if benefits offered under separate policy, contract or certificate of
Index of Sec 121. ...CHILD'S congenital or developmental deformity, disease or injury ; Group health plan and health insurance issuer offering group health insurance coverage providing coverage for surgical benefits providing coverage for outpatient and inpatient diagnosis and treatment of minor
Index of Sec 163. ...HEALTH insurance issuer offering coverage ;
Index of Sec 100. ...HEALTH insurance issuer offering coverage ;
Index of Sec 100. ...ETHNIC disparities ; Membership of Health benefiting Advisory Committee reflecting providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and
Index of Sec 123. ...ETHNIC disparities ; Membership of Health benefiting Advisory Committee reflecting providers, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and
Index of Sec 123. ...ETHNIC disparities ; Membership of Health benefiting Advisory Committee reflecting providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and
Index of Sec 123. ...EXPENDITURES health care service being allowable as deduction under section 213(d) of Internal Revenue Code of 1986 ; Health insurance issuer offering health insurance coverage through Health Insurance Exchange discriminating in approving or covering health care service on basis of religious or spiritual content if
Index of Sec 125. ...EXPENDITURES health care service being allowable as deduction under 213(d) of Internal Revenue Code of 1986 ; Health insurance issuer offering health insurance coverage through Exchange discriminating in approving or covering health care service on basis of religious or spiritual content if
Index of Sec 125. ...HEALTH insurance issuer offering coverage ;
Index of 0FRAUD described in subsection ; Health insurance issuer rescinding health insurance coverage only upon clear and convincing evidence of
Index of Sec 162. ...FRAUD described in subsection ; Health insurance issuer rescinding health insurance coverage only upon clear and convincing evidence of
Index of Sec 162. ...HEALTH insurance coverage for individual in individual market ; Health insurance issuer determining to rescind
Index of Sec 162. ...HEALTH insurance coverage for individual in individual market ; Health insurance issuer determining to rescind
Index of Sec 162. ...CHILD'S congenital or developmental deformity, disease or injury ; Health insurance issuer offering health insurance coverage in individual market providing coverage for surgical benefits providing coverage for outpatient and inpatient diagnosis and treatment of minor
Index of Sec 163. ...HEALTH insurance issuer under part complying with notice requirement under section 714(b) of Employee Retirement Income Security Act of 1974 with respect to requirements referred in subsection ;
Index of Sec 163. ...HEALTH insurance coverage not imposing preexisting condition exclusion of section 2701 with respect to coverage excepting to extent ; Health insurance issuer providing individual
Index of Sec 167. ...HEALTH insurance coverage to include benefits beyond essential benefits packaging ; State requiring health insurance issuer offering
Index of Sec 203. ...HEALTH insurance coverage to include benefits beyond essential benefits packaging ; State requiring health insurance issuer offering
Index of Sec 203. ...HEALTH insurance coverage to include benefits beyond essential benefits packaging ; State requiring health insurance issuer offering
Index of Sec 203. ...HEALTH insurance issuer in individual market ; Requirements of sections 2701 through 2792 of Public Health Service Act applying to public health insurance option in same manner as applying to health insurance coverage offered by
Index of Sec 227. ...ACCIDENT benefits ; Determining under terms of medical benefit, health insurance or other program under which members and dependents entitled to sick and
Index of Sec 461. ...HEALTH insurance issuer offering coverage not enrolling individual in coverageing if first effective date of coverage after first day of Y1 ; Individual
Index of Sec 102. ...HEALTH insurance issuer offering coverage not enrolling individual in coverageing if first effective date of coverage after first day of Y1 ; Individual
Index of Sec 102. ...HEALTH insurance issuer offering coverage not enrolling individual in coverageing if first effective date of coverage after first day of Y1 ; Individual
Index of Sec 102. ...INSURANCE duplicating benefits provided in single payer program prohibited ; Private
Index of Sec 253. ...HEALTH insurance to employees of employers through Health Insurance Exchange ; Commissioner establishing and carrying out program to provide to small employers counseling and technical assistance with respect to provision of
Index of Sec 206. ...INSURANCE regulators and Secretaries of Labor and Treasury ; Establishment of qualified health benefits planning standards under title including enforcement of standards in coordination with State
Index of Sec 142. ...INSURANCE regulators and Secretaries of Labor and Treasury ; Establishment of qualified health benefits planning standards under title including enforcement of standards in coordination with State
Index of Sec 142. ...INSURANCE regulators and Secretaries of Labor and Treasury ; Establishment of qualified health benefits planning standards under title including enforcement of standards in coordination with State
Index of Sec 142. ...INSURANCE regulators to terminate plans for repeated failure by offering entity to meet requirements of title ; Working with State
Index of Sec 142. ...INSURANCE regulators to terminate plans for repeated failure by offering entity to meet requirements of title ; Working with State
Index of Sec 142. ...INSURANCE regulators to terminate plans for repeated failure by offering entity to meet requirements of title ; Working with State
Index of Sec 142. ...ELECTRONIC transmission intermediary, retail ; Records described in subsection not to be licensed, transferred, used or sold by pharmacy benefits manager, insurance company,
Index of Sec 138. ...INSURANCE before date ; Not offering insurance before July 16, 2009 and cooperatives being not affiliate or successor to insurance company offering
Index of Sec 252. ...HEALTH insurance cooperatives providing insurance through Health Insurance Exchange or State-based Health Insurance Exchange under section 208 ; Member-run
Index of Sec 251. ...INSURANCE coverage ; Grants to cooperatives to assist cooperatives in meeting State solvency requirements in States in which cooperative offers or issuing
Index of Sec 252. ...EMPLOYMENT-based health plan and including public health insurance option ; Terms health benefits planning means health insurance coverage and
Index of Sec 100. ...EMPLOYMENT-based health plan and including public health insurance option ; Terms health benefits planning means health insurance coverage and
Index of Sec 100. ...EMPLOYMENT-based health plan and including public health insurance option and cooperatives under subtitle D of title II ; Terms health benefits planning means health insurance coverage and
Index of Sec 100. ...CONSUMER protections ; Purpose of title to establish standards to ensure that new health insurance coverage and employment-based health plans offered meet standards guaranteeing access to affordable coverage, essential benefits and other
Index of Sec 101. ...CONSUMER protections ; Purpose of title to establish standards to ensure that new health insurance coverage and employment-based health plans offered meet standards guaranteeing access to affordable coverage, essential benefits and other
Index of Sec 101. ...CONSUMER protections ; Purpose of title to establish standards to ensure that new health insurance coverage and employment-based health plans offered meet standards guaranteeing access to affordable coverage, essential benefits and other
Index of Sec 101. ...HEALTH insurance coverage mean health insurance coverage offered in individual market or large or small group market as defined in section 2791 of Public Health Service Act ; Terms individual health insurance coverage and group
Index of Sec 101. ...HEALTH insurance coverage mean health insurance coverage offered in individual market or large or small group market as defined in section 2791 of Public Health Service Act ; Terms individual health insurance coverage and group
Index of Sec 101. ...HEALTH insurance coverage mean health insurance coverage offered in individual market or large or small group market as defined in section 2791 of Public Health Service Act ; Terms individual health insurance coverage and group
Index of Sec 101. ...HEALTH insurance coverage and health insurance issuer having meanings given terms in section 2791 of Public Health Service Act ; Terms
Index of Sec 100. ...HEALTH insurance coverage and health insurance issuer having meanings given terms in section 2791 of Public Health Service Act ; Terms
Index of Sec 100. ...HEALTH insurance coverage and health insurance issuer having meanings given terms in section 2791 of Public Health Service Act ; Terms
Index of Sec 100. ...EMPLOYMENT-based health plan of section ; Coverage under grandfathered health insurance coverage of section 102 of America's Affordable Health Choices acting of 2009 or current
Index of Sec 401. ...COOPERATIVE ; Membership of cooperative to be making up entirely of beneficiaries of insurance coverage offered by
Index of Sec 252. ...HEALTH benefits planning ; Case of health insurance coverage offered under qualified
Index of Sec 117. ...EMPLOYMENT-based health plans ; Case of health insurance coverage not offered through Health Insurance Exchange and case of
Index of Sec 151. ...EMPLOYMENT-based health plans ; Case of health insurance coverage not offered through Health Insurance Exchange and case of
Index of Sec 151. ...EMPLOYMENT-based health plans ; Case of health insurance coverage not offered through Health Insurance Exchange and case of
Index of Sec 151. ...HEALTH insurance coverage ; Excepted benefits not included within definition of
Index of Sec 102. ...HEALTH insurance coverage ; Excepted benefits not included within definition of
Index of Sec 102. ...HEALTH insurance coverage ; Excepted benefits not included within definition of
Index of Sec 102. ...HEALTH insurance coverage offered in small group market ; 2712 and subsection and subsection of Public Health Service Act applying to individuals and employers in individual and group health insurance coverage through employment-based health plan or otherwise in same manner as sections applying to employers and
Index of Sec 112. ...HEALTH insurance coverage ; Amendments relating to preexisting condition exclusions in health insurance coverage in individual Market under grandfathered
Index of Sec 167. ...CHILD'S congenital or developmental deformity, disease or injury ; Group health plan and health insurance issuer offering group health insurance coverage providing coverage for surgical benefits providing coverage for outpatient and inpatient diagnosis and treatment of minor
Index of Sec 163. ...HEALTH insurance coverage ; Exclusion to be imposed consistent with sectioning if coverage being group
Index of Sec 167. ...HEALTH insurance coverage in group and individual Markets in Advance of applicability of new prohibition of preexisting condition exclusions ; Sec 167, limitations on preexisting condition exclusions in group health Plans and
Index of Sec 167. ...HEALTH insurance coverage including cooperative under subtitle D of title II ;
Index of Sec 100. ...HEALTH insurance coverage ; Terms servicing area and premium rating area mean with respect to
Index of Sec 100. ...HEALTH insurance coverage ; Terms servicing area and premium rating area mean with respect to
Index of Sec 100. ...HEALTH insurance coverage ; Terms servicing area and premium rating area mean with respect to
Index of Sec 100. ...HEALTH insurance coverage meaning individual health insurance coverage offered and force and effect before first day of Y1 if following conditions being met ; Term grandfathered
Index of Sec 102. ...HEALTH insurance coverage meaning individual health insurance coverage offered and force and effect before first day of Y1 if following conditions being met ; Term grandfathered
Index of Sec 102. ...HEALTH insurance coverage meaning individual health insurance coverage offered and force and effect before first day of Y1 if following conditions being met ; Term grandfathered
Index of Sec 102. ...HEALTH benefits planning ; Individual health insurance coverage not grandfathered health insurance coverage under subsection only to be offered after first day of Y1 as Exchange-participating
Index of Sec 102. ...HEALTH benefits planning ; Individual health insurance coverage not grandfathered health insurance coverage under subsection only to be offered after first day of Y1 as Exchange-participating
Index of Sec 102. ...HEALTH benefits planning ; Individual health insurance coverage not grandfathered health insurance coverage under subsection only to be offered after first day of Y1 as Exchange-participating
Index of Sec 102. ...HEALTH insurance coverage ; Excepted benefits so longing as offered and priced separately from
Index of Sec 102. ...HEALTH insurance coverage ; Excepted benefits so longing as offered and priced separately from
Index of Sec 102. ...HEALTH insurance coverage ; Excepted benefits so longing as offered and priced separately from
Index of Sec 102. ...HEALTH insurance coverage offered in large group market ; Same manner as provisions applying to
Index of Sec 114. ...HEALTH insurance coverage offered in large group market ; Same manner as provisions applying to
Index of Sec 114. ...HEALTH insurance coverage offered in large group market ; Same manner as provisions applying to
Index of Sec 114. ...EXPENDITURES health care service being allowable as deduction under section 213(d) of Internal Revenue Code of 1986 ; Health insurance issuer offering health insurance coverage through Health Insurance Exchange discriminating in approving or covering health care service on basis of religious or spiritual content if
Index of Sec 125. ...EXPENDITURES health care service being allowable as deduction under 213(d) of Internal Revenue Code of 1986 ; Health insurance issuer offering health insurance coverage through Exchange discriminating in approving or covering health care service on basis of religious or spiritual content if
Index of Sec 125. ...HEALTH insurance coverage including insurance-related terms ; Commissioner providing for development of standards for definitions of terms used in
Index of Sec 142. ...HEALTH insurance coverage including insurance-related terms ; Commissioner providing for development of standards for definitions of terms used in
Index of Sec 142. ...HEALTH insurance coverage including insurance-related terms ; Commissioner providing for development of standards for definitions of terms used in
Index of Sec 142. ...HEALTH insurance coverage offered in individual market in same manner as provisions applying to health insurance coverage offered in small or large group market ; Provisions of section 2714 applying to
Index of Sec 161. ...HEALTH insurance coverage offered in individual market in same manner as provisions applying to health insurance coverage offered in small or large group market ; Provisions of section 2714 applying to
Index of Sec 161. ...FRAUD described in subsection ; Health insurance issuer rescinding health insurance coverage only upon clear and convincing evidence of
Index of Sec 162. ...FRAUD described in subsection ; Health insurance issuer rescinding health insurance coverage only upon clear and convincing evidence of
Index of Sec 162. ...HEALTH insurance coverage for individual in individual market ; Health insurance issuer determining to rescind
Index of Sec 162. ...HEALTH insurance coverage for individual in individual market ; Health insurance issuer determining to rescind
Index of Sec 162. ...CHILD'S congenital or developmental deformity, disease or injury ; Health insurance issuer offering health insurance coverage in individual market providing coverage for surgical benefits providing coverage for outpatient and inpatient diagnosis and treatment of minor
Index of Sec 163. ...HEALTH insurance coverage offered, sold, issued, renewed, effect or operated in individual market after date ; Amendment making by subsection applying with respect to
Index of Sec 163. ...HEALTH insurance coverage through Health Insurance Exchange ; Extending to earlier of date on which individual becoming eligible for coverage under employment-based health plan or date on which individual becoming eligible for
Index of Sec 167. ...HEALTH insurance coverage in individual Market under grandfathered health insurance coverage ; Amendments relating to preexisting condition exclusions in
Index of Sec 167. ...HEALTH insurance coverage offered, sold, issued, renewed, effect or operated in individual market beginning after end of 6th calendar month following date of enactment of Act ; Amendments making by subsection applying with respect to
Index of Sec 167. ...HEALTH insurance coverage through Exchange as Exchange-eligible employer ; Plan sponsor of group health plan being multiemployer plan obtaining health insurance coverage with respect to participants in plan through Exchange to same extent as employer not described in paragraph or permitted by Commissioner to obtain
Index of Sec 202. ...HEALTH insurance coverage to include benefits beyond essential benefits packaging ; State requiring health insurance issuer offering
Index of Sec 203. ...HEALTH insurance coverage to include benefits beyond essential benefits packaging ; State requiring health insurance issuer offering
Index of Sec 203. ...HEALTH insurance coverage to include benefits beyond essential benefits packaging ; State requiring health insurance issuer offering
Index of Sec 203. ...HEALTH insurance coverage offered by health insurance issuer in individual market ; Requirements of sections 2701 through 2792 of Public Health Service Act applying to public health insurance option in same manner as applying to
Index of Sec 227. ...HEALTH insurance coverage ; Sec 6050x, Returns relating to
Index of Sec 401. ...CREDIT determined under section ; Deduction otherwise allowable with respect to amounts paid or incurred for health insurance coverage to which subsection applying to be reduced by amount of
Index of Sec 421. ...HEALTH insurance coverage offered and force and effect before first day of Y1 if following conditions being met ; Term grandfathered health insurance coverage meaning individual
Index of Sec 102. ...HEALTH insurance coverage offered and force and effect before first day of Y1 if following conditions being met ; Term grandfathered health insurance coverage meaning individual
Index of Sec 102. ...HEALTH insurance coverage offered and force and effect before first day of Y1 if following conditions being met ; Term grandfathered health insurance coverage meaning individual
Index of Sec 102. ...HEALTH benefits planning ; Individual health insurance coverage not grandfathered health insurance coverage under subsection only to be offered after first day of Y1 as Exchange-participating
Index of Sec 102. ...HEALTH benefits planning ; Individual health insurance coverage not grandfathered health insurance coverage under subsection only to be offered after first day of Y1 as Exchange-participating
Index of Sec 102. ...HEALTH benefits planning ; Individual health insurance coverage not grandfathered health insurance coverage under subsection only to be offered after first day of Y1 as Exchange-participating
Index of Sec 102. ...HEALTH insurance coverage ; Qualified health benefits planning being individual
Index of 0HEALTH insurance coverage ; Clarifiations regarding application of guaranteed RENEWABILITY of individual
Index of Sec 162. ...HEALTH insurance coverage ; Clarifiations regarding application of guaranteed RENEWABILITY of individual
Index of Sec 162. ...HEALTH insurance coverage not imposing preexisting condition exclusion of section 2701 with respect to coverage excepting to extent ; Health insurance issuer providing individual
Index of Sec 167. ...HEALTH insurance coverage providing benefits different from provided under coverage referred in subparagraph with respect to condition ; Seeks to enroll under other individual
Index of Sec 167. ...HEALTH insurance coverage offered in individual market or large or small group market as defined in section 2791 of Public Health Service Act ; Terms individual health insurance coverage and group health insurance coverage mean
Index of Sec 101. ...HEALTH insurance coverage offered in individual market or large or small group market as defined in section 2791 of Public Health Service Act ; Terms individual health insurance coverage and group health insurance coverage mean
Index of Sec 101. ...HEALTH insurance coverage offered in individual market or large or small group market as defined in section 2791 of Public Health Service Act ; Terms individual health insurance coverage and group health insurance coverage mean
Index of Sec 101. ...INSURANCE coverage ; For-profit intending to offer or issues
Index of Sec 252. ...HEALTH insurance coverage including public health insurance option ; Quality
Index of Sec 201. ...HEALTH insurance coverage including public health insurance option ; Quality
Index of Sec 201. ...HEALTH insurance coverage including public health insurance option ; Quality
Index of Sec 201. ...HEALTH insurance coverage without changing premium for enrollees in same risk group at same rate as specified by Commissioner ; Issuer not varying percentage increase in premium for risk group of enrollees in specific grandfathered
Index of Sec 102. ...HEALTH insurance coverage without changing premium for enrollees in same risk group at same rate as specified by Commissioner ; Issuer not varying percentage increase in premium for risk group of enrollees in specific grandfathered
Index of Sec 102. ...HEALTH insurance coverage without changing premium for enrollees in same risk group at same rate as specified by Commissioner ; Issuer not varying percentage increase in premium for risk group of enrollees in specific grandfathered
Index of Sec 102. ...EMPLOYMENT-based health plan or otherwise in same manner as sections applying to employers and health insurance coverage offered in small group market ; 2712 and subsection and subsection of Public Health Service Act applying to individuals and employers in individual and group health insurance coverage through
Index of Sec 112. ...EMPLOYMENT-based health plan or otherwise excepting that section 2712(b)(1) applying only if issuer providing enrollee with notice of non-payment of premiums and grace period during that enrollees having opportunity to correct nonpayment ; 2712 and subsection and subsection of Public Health Service Act applying to individuals and employers in individual and group health insurance coverage through
Index of Sec 112. ...EMPLOYMENT-based health plan or otherwise excepting that section 2712(b)(1) applying only if issuer providing enrollee with notice of non-payment of premiums and grace period during that enrollees having opportunity to correct nonpayment ; 2712 and subsection and subsection of Public Health Service Act applying to individuals and employers in individual and group health insurance coverage through
Index of Sec 112. ...HEALTH insurance coverage under State law for State ; Entity to be licensed to offer
Index of Sec 204. ...HEALTH insurance coverage under State law for State ; Entity to be licensed to offer
Index of Sec 204. ...HEALTH insurance coverage under State law for State ; Entity to be licensed to offer
Index of Sec 204. ...HEALTH insurance denials and Delays of necessary treatment for Children with deformities ; Sec 163 ending
Index of Sec 163. ...HEALTH insurance exchange ; Activities of cooperative consisting of issuance of qualified health benefit plans through Health Insurance Exchange or State-based
Index of Sec 252. ...HEALTH insurance exchange approved for operation under section 208 of Act ; Including State-based
Index of Sec 401. ...HEALTH insurance exchange ; Return information disclosed under subparagraph to be used by officers and employees of Health Choices Administration or State-based
Index of Sec 431. ...HEALTH insurance Exchange ; Application to qualified health Benefits planing not offered through
Index of Sec 134. ...HEALTH insurance Exchange ; Application to qualified health Benefits planing not offered through
Index of Sec 134. ...HEALTH insurance Exchange ; Application to qualified health Benefits planing not offered through
Index of Sec 134. ...COOPERATIVE ; Governing documents of cooperatives incorporating ethical and conflict of interest standards designed to protect against insurance industry involvement and interference in governance of
Index of Sec 252. ...HEALTH insurance limitations on imposition of preexisting condition exclusions ; Applicability of group
Index of Sec 167. ...HEALTH insurance limitations on imposition of preexisting condition exclusions ; Application of group
Index of Sec 167. ...HEALTH insurance marketplace ; Requirements reforming
Index of Sec 101. ...HEALTH insurance marketplace ; Requirements reforming
Index of Sec 101. ...HEALTH insurance marketplace ; Requirements reforming
Index of Sec 101. ...HEALTH insurance option and cooperatives under subtitle D of title II ; Terms health benefits planning means health insurance coverage and employment-based health plan and including public
Index of Sec 100. ...HEALTH insurance option and cooperatives under subtitle D of title II ; Term qualified health benefits planning meaning health benefiting plan meeting requirements plan under title I and including public
Index of Sec 100. ...HEALTH insurance option ; Terms health benefits planning means health insurance coverage and employment-based health plan and including public
Index of Sec 100. ...HEALTH insurance option ; Terms health benefits planning means health insurance coverage and employment-based health plan and including public
Index of Sec 100. ...HEALTH insurance option ; Term qualified health benefits planning meaning health benefiting plan meeting requirements plan under title I and including public
Index of Sec 100. ...HEALTH insurance option ; Term qualified health benefits planning meaning health benefiting plan meeting requirements plan under title I and including public
Index of Sec 100. ...HEALTH insurance option as provided under subtitle B of title II ; Term public health insurance option meaning public
Index of Sec 100. ...HEALTH insurance option as provided under subtitle B of title II ; Term public health insurance option meaning public
Index of Sec 100. ...HEALTH insurance option as provided under subtitle B of title II ; Term public health insurance option meaning public
Index of Sec 100. ...HEALTH insurance option not varying excepting as following ; Premium rate charged for insured qualified health benefits planning and coverage under public
Index of Sec 113. ...HEALTH insurance option providing coverage for services described in paragraph ; Public
Index of Sec 122. ...HEALTH insurance option ; Quality health insurance coverage including public
Index of Sec 201. ...HEALTH insurance option ; Quality health insurance coverage including public
Index of Sec 201. ...HEALTH insurance option ; Quality health insurance coverage including public
Index of Sec 201. ...HEALTH insurance option ; Nothing in division to be construed to affect role of enrollment agents and brokers under State law including with regard to enrollment of individuals and employers in qualified health benefits planing including public
Index of Sec 205. ...HEALTH benefits ; Public health insurance option complying with requirements being applicable under title to Exchange-participating
Index of Sec 221. ...HEALTH benefits ; Public health insurance option complying with requirements being applicable under title to Exchange-participating
Index of Sec 221. ...HEALTH benefits ; Public health insurance option complying with requirements being applicable under title to Exchange-participating
Index of Sec 221. ...CONTRACTS under subsection of section ; Secretary entering into contracts for purpose of performing administrative functions of section 1874a of Social Security Act with respect to public health insurance option in same manner as Secretary entering into
Index of Sec 221. ...CONTRACTS under subsection of section ; Secretary entering into contracts for purpose of performing administrative functions of section 1874a of Social Security Act with respect to public health insurance option in same manner as Secretary entering into
Index of Sec 221. ...CONTRACTS under subsection of section ; Secretary entering into contracts for purpose of performing administrative functions of section 1874a of Social Security Act with respect to public health insurance option in same manner as Secretary entering into
Index of Sec 221. ...HEALTH insurance option and other purposes under subtitle including to improve quality and reducing racial ; Requiring to establish premiums and payment rates for public
Index of Sec 221. ...HEALTH insurance option and other purposes under subtitle including to improve quality and reducing racial ; Requiring to establish premiums and payment rates for public
Index of Sec 221. ...HEALTH and health care based on race ; Requiring to establish premiums and payment rates for public health insurance option and other purposes under subtitle including to improve quality and reducing disparities in
Index of Sec 221. ...HEALTH insurance option and individuals enrolled under option under title in same manner as provisions applying to Medicare and Medicare beneficiaries ; Provisions of Medicare relating to access of Medicare beneficiaries to Federal courts for enforcement of rights under Medicare applying to public
Index of Sec 221. ...HEALTH insurance option and individuals enrolled under option under title in same manner as provisions applying to Medicare and Medicare beneficiaries ; Provisions of Medicare relating to access of Medicare beneficiaries to Federal courts for enforcement of rights under Medicare applying to public
Index of Sec 221. ...HEALTH insurance option and individuals enrolled under option under title in same manner as provisions applying to Medicare and Medicare beneficiaries ; Provisions of Medicare relating to access of Medicare beneficiaries to Federal courts for enforcement of rights under Medicare applying to public
Index of Sec 221. ...HEALTH insurance option ; Health benefits provided by public
Index of Sec 222. ...HEALTH insurance option ; Health benefits provided by public
Index of Sec 222. ...HEALTH insurance option ; Health benefits provided by public
Index of Sec 222. ...HEALTH insurance option ; Administrative costs related to operating public
Index of Sec 222. ...HEALTH insurance option ; Administrative costs related to operating public
Index of Sec 222. ...HEALTH insurance option ; Administrative costs related to operating public
Index of Sec 222. ...HEALTH insurance option receiving Federal funds for purposes of insolvency in manner similar to manner in which entities receiving Federal funding under Troubled Asseal Relief Program of Secretary of Treasury ; No case public
Index of Sec 222. ...HEALTH care providers consistent with section and changing payment rates in accordance with section 224 ; Secretary establishing payment rates for public health insurance option for services and
Index of Sec 223. ...HEALTH care providers consistent with section and changing payment rates in accordance with section 224 ; Secretary establishing payment rates for public health insurance option for services and
Index of Sec 223. ...HEALTH insurance option unless opting out in process established by Secretary consistent with subsection ; Health care providers participating in Medicare participating providers in public
Index of Sec 223. ...HEALTH care practitioner participating in medicareing and public health insurance option ; Services described in subparagraph being items and professional services under public health insurance option by physician or other
Index of Sec 223. ...HEALTH care practitioner participating in medicareing and public health insurance option ; Services described in subparagraph being items and professional services under public health insurance option by physician or other
Index of Sec 223. ...HEALTH insurance option ; Providers described in subparagraph to be provided 1-year period prior to first day of Y1 to opt out of participating in public
Index of Sec 223. ...HEALTH insurance option ; No provider to be subject to penalty for not participating in public
Index of Sec 223. ...BACK ; Providers participating in Medicare choosing to opt out of participating in public health insurance option opting
Index of Sec 223. ...HEALTH insurance option unless opting out in process established by Secretary ; Health care providers participating under Medicare participating providers in public
Index of Sec 223. ...HEALTH insurance option unless opting out in process established by Secretary ; Health care providers participating under Medicare participating providers in public
Index of Sec 223. ...HEALTH insurance option ; Secretary utilizing innovative payment mechanisms and policies to determine payments for items and services under public
Index of Sec 224. ...HEALTH insurance option ; Secretary utilizing innovative payment mechanisms and policies to determine payments for items and services under public
Index of Sec 224. ...HEALTH insurance option ; Secretary utilizing innovative payment mechanisms and policies to determine payments for items and services under public
Index of Sec 224. ...HEALTH and value ; Public health insurance option modifying cost sharing and payment rates to encourage use of services promoting
Index of Sec 224. ...HEALTH and value ; Public health insurance option modifying cost sharing and payment rates to encourage use of services promoting
Index of Sec 224. ...HEALTH and value ; Public health insurance option modifying cost sharing and payment rates to encourage use of services promoting
Index of Sec 224. ...GEOGRAPHIC areas ; Nothing in subtitle preventing Secretary from varying payments based on different payment structure models under public health insurance option for different
Index of Sec 224. ...GEOGRAPHIC areas ; Nothing in subtitle preventing Secretary from varying payments based on different payment structure models under public health insurance option for different
Index of Sec 224. ...COMPETITIVE disadvantage ; Secretary delaying implementation reform in geographic areas in which implementation placing public health insurance option at
Index of Sec 224. ...GEOGRAPHIC areas ; Nothing in subtitle preventing Secretary from varying payments based on different payment structure models under public health insurance option for different
Index of Sec 224. ...HEALTH insurance option unless provider appropriately licensed or certified under State law ; Secretary not allowing health care provider to participate in public
Index of Sec 225. ...HEALTH insurance option unless provider appropriately licensed, certified or otherwise permitted to practice under State law ; Secretary not allowing health care provider to participate in public
Index of Sec 225. ...HEALTH insurance option unless provider appropriately licensed or certified under State law ; Secretary not allowing health care provider to participate in public
Index of Sec 225. ...HEALTH insurance option under which payment only to be available if provider agreeing to accept payment rate established under section 223 as payment in full ; Secretary providing for participation of health care providers under public
Index of Sec 225. ...HEALTH insurance option under which payment only to be available if provider agreeing to accept payment rate established under section 223 as payment in full ; Secretary providing for participation of health care providers under public
Index of Sec 225. ...HEALTH care program ; Secretary excluding from participation under public health insurance option health care provider excluded from participation in Federal
Index of Sec 225. ...HEALTH care program ; Secretary excluding from participation under public health insurance option health care provider excluded from participation in Federal
Index of Sec 225. ...HEALTH care program ; Secretary excluding from participation under public health insurance option health care provider excluded from participation in Federal
Index of Sec 225. ...HEALTH insurance coverage offered by health insurance issuer in individual market ; Requirements of sections 2701 through 2792 of Public Health Service Act applying to public health insurance option in same manner as applying to
Index of Sec 227. ...HEALTH insurance option in same manner as part applying to other health plans ; Applying to public
Index of Sec 228. ...HEALTH insurance option ; Nothing in division to be construed as requiring anyone to enroll in public
Index of Sec 229. ...HEALTH insurance option or National Health Exchange ; State single payer system operating in State instead of public
Index of Sec 251. ...HEALTH insurance programs under title XVIII of Social Security Act ; Term Medicare meaning
Index of Sec 100. ...HEALTH insurance programs under title XVIII of Social Security Act ; Term Medicare meaning
Index of Sec 100. ...HEALTH insurance programs under title XVIII of Social Security Act ; Term Medicare meaning
Index of Sec 100. ...HEALTH insurance requirements ; Commissioner undertaking activities in accordance with subtitle to promote accountability of QHBP offering entities in meeting Federal
Index of Sec 142. ...HEALTH insurance requirements ; Commissioner undertaking activities in accordance with subtitle to promote accountability of QHBP offering entities in meeting Federal
Index of Sec 142. ...HEALTH insurance requirements ; Commissioner undertaking activities in accordance with subtitle to promote accountability of QHBP offering entities in meeting Federal
Index of Sec 142. ...HEALTH insurance rescission Abuse ; Sec 162 ending
Index of Sec 162. ...HEALTH insurance rescission Abuse ; Sec 162 ending
Index of Sec 162. ...INSURANCE risk to entity ; Secretary having same authority with respect to public health insurance option as Secretary under subsections and section 1874a of Social Security Act with respect to title XVIII of Act contracting under subsection not involving transfer of
Index of Sec 221. ...INSURANCE risk to entity ; Secretary having same authority with respect to public health insurance option as Secretary under subsections and section 1874a of Social Security Act with respect to title XVIII of Act contracting under subsection not involving transfer of
Index of Sec 221. ...INSURANCE risk to entity ; Secretary having same authority with respect to public health insurance option as Secretary under subsections and section 1874a of Social Security Act with respect to title XVIII of Act contracting under subsection not involving transfer of
Index of Sec 221. ...INTEGRATION ; Nothing in subtitle to be construed as preventing State governments from taking actions to permit
Index of Sec 252. ...INTENTIONAL hastening of death regardless of legality ; Assisting suicide or
Index of Sec 138. ...COOPERATIVE ; No member having more than 5 percent voting interest in
Index of Sec 209. ...INTEREST received or accrued by taxpayer during taxable year being exempt from tax ; Increasing by amount of
Index of Sec 401. ...INTEREST with related party as determined under regulations ; Peer or entity not otherwise conflict of
Index of 0INTEREST in duties and ensuring effective enforcement ; Commissioner working in coordination with existing Federal and State entities to maximum extent feasible consistent with division and manner preventing conflicts of
Index of Sec 143. ...INTEREST in duties and ensuring effective enforcement ; Commissioner working in coordination with existing Federal and State entities to maximum extent feasible consistent with division and manner preventing conflicts of
Index of Sec 143. ...INTEREST in duties and ensuring effective enforcement ; Commissioner working in coordination with existing Federal and State entities to maximum extent feasible consistent with division and manner preventing conflicts of
Index of Sec 143. ...INTEREST ; Term modified adjusted gross income means adjusted gross income reduced by deduction allowed for investment
Index of Sec 441. ...INTEREST in conduct of external appeal activities ; Terms and conditions of contract under paragraph to be consistent with standards appropriate Secretary establishing to assure being no real or apparent conflict of
Index of 0INTEREST policies demonstrating commitment to open ; Entity supporting nondiscrimination and conflict of
Index of Sec 164. ...COOPERATIVE ; Governing documents of cooperatives incorporating ethical and conflict of interest standards designed to protect against insurance industry involvement and interference in governance of
Index of Sec 252. ...INTERNAL claims and appeals processing that initially incorporating claims and appealing procedures set forth at section 2560.503 -1 of title 29 ; Qualified health benefits planning QHBP offering entity providing
Index of Sec 132. ...INTERNAL claims and appeals processing that initially incorporating claims and appealing procedures set forth at section 2560.503 -1 of title 29 ; Qualified health benefits planning QHBP offering entity providing
Index of Sec 132. ...INTERNAL review ; Deadline specified in subparagraph being 14 days after date of receipt of request for
Index of 0INTERNAL review under subsection ; Plan or entity waiving rights for
Index of 0INTERNAL review under section 139a ; Term including failure to meet applicable deadline for
Index of 0INTERNAL review under section 140 ; Plan or entity conditioning use of external appeal process in case of externally appealable decision upon final decision in
Index of 0INTERNAL review under section 140 and guidelines or standards used by plan or QHBP offering entity in reaching decision ; Decision making by plan or QHBP offering entity upon
Index of 0JOB losses negatively impacting employer or community in which employer located ; Secretary granting waiver within 30 days after submission of application if application reasonably demonstrating to Secretary meeting requirements of part resulting in
Index of Sec 311. ...ETHNIC disparities ; Membership of Health benefiting Advisory Committee reflecting providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and
Index of Sec 123. ...ETHNIC disparities ; Membership of Health benefiting Advisory Committee reflecting providers, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and
Index of Sec 123. ...ETHNIC disparities ; Membership of Health benefiting Advisory Committee reflecting providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and
Index of Sec 123. ...LEGALITY ; Assisting suicide or intentional hastening of death regardless of
Index of Sec 138. ...LIABILITY law complying with subsection ; Alternative medical
Index of Sec 208. ...LIABILITY law complying with subsection if Secretary satisfied that State ; Secretary determining that State's alternative medical
Index of Sec 208. ...LIABILITY law containing one or combiations of following litigation alternatives ; Alternative medical
Index of Sec 208. ...LIABILITY laws complying with subsection ; Secretary submitting to Congress annual report on progress States making in adopting and implementing alternative medical
Index of Sec 208. ...LIABILITY reforms as specified in subsection ; State being eligible to receive incentive payment for enacting and implementing medical
Index of Sec 208. ...LOAN or grant received by cooperative under section ; Repaying total amount of
Index of Sec 252. ...LOAN not to be awarded under section with respect to cooperative unless following conditions being met ; Grant or
Index of Sec 252. ...LOANS to cooperatives to assist cooperatives with start up costs ;
Index of Sec 252. ...LOANS for establishment and initial operation ; Establishing Consumer operated and oriented Plan program under which Commissioner making grants and
Index of Sec 251. ...LOANS under section ; Appropriating $5,000,000,000 for period of fiscal years 2010 through 2014 to provide for grants and
Index of Sec 252. ...MAIL order or Internet pharmacy or other similar entity excepting for limited purposes ;
Index of Sec 138. ...DRUG dispensed when available ; Information on overall percentage of generic drugs dispensed under contract at retail and mail order pharmacies and percentage of cases in which generic
Index of Sec 133. ...MAIL order and retail pharmacies ; Information on volume of prescriptions under contract filled via
Index of Sec 133. ...MALICE or gross misconduct in performance of dutying, functioning or activity ; Violating criminal law being civilly liable under law of United States or State if due care exercised in performance of dutying, functioning or activity and no actual
Index of 0MALPRACTICE to be fairly compensated ; Ensuring quality healthcare being readily available by providing alternative framework to reduce costs of defensive medicine and allowing victims of
Index of Sec 208. ...MEDICAID and Chip ; Special duties related to
Index of Sec 205. ...MEDICAID and Chip ; Special duties related to
Index of Sec 205. ...MEDICAID and Chip ; Special duties related to
Index of Sec 205. ...MEDICAID Screen and enrolling obligation ;
Index of Sec 241. ...MEDICAID Screen and enrolling obligation ;
Index of Sec 241. ...MEDICAID Screen and enrolling obligation ;
Index of Sec 241. ...PROFESSIONAL practice ; Providing payment for items and services described in subsection in accordance with generally accepted standards of medical or other appropriate clinical or
Index of Sec 122. ...PROFESSIONAL practice ; Providing payment for items and services described in subsection in accordance with generally accepted standards of medical or other appropriate clinical or
Index of Sec 122. ...PROFESSIONAL practice ; Providing payment for items and services described in subsection in accordance with generally accepted standards of medical or other appropriate clinical or
Index of Sec 122. ...DISABILITIES, representatives of relevant governmental agencies and one practicing physician or other health professional and expert on children's health and representing balance among various sectors of health care system so ;
Index of Sec 123. ...MEDICAL advice, diagnosis, care or treatment recommended or received as of enrollment date ; During period of enrollment having condition For which no
Index of Sec 167. ...MEDICAL assistance under Medicaid ; Term Medicaid eligible individual meaning individual being eligible for
Index of Sec 205. ...MEDICAL assistance under Medicaid ; Term Medicaid eligible individual meaning individual being eligible for
Index of Sec 205. ...MEDICAL assistance under Medicaid ; Term Medicaid eligible individual meaning individual being eligible for
Index of Sec 205. ...ACCIDENT benefits ; Determining under terms of medical benefit, health insurance or other program under which members and dependents entitled to sick and
Index of Sec 461. ...HEALTH benefits planning ; Duration or scope of medical benefits otherwise covered under qualified
Index of Sec 138. ...MEDICAL care consistent with section 221(a) ; Secretary continuing to use administrative process to set rates in order to promote payment accuracy to ensure adequate beneficiary access to providers and promoting affordablility and efficient delivery of
Index of Sec 223. ...MEDICAL care consistent with section 221(a) ; Secretary continuing to use administrative process to set rates in order to promote payment accuracy to ensure adequate beneficiary access to providers and promoting affordability and efficient delivery of
Index of Sec 223. ...MEDICAL care ; Allowing as deduction under section amount equal to amount paid during taxable year for insurance constituting
Index of Sec 461. ...MEDICAL care component of Consumer Price Index for year involved ; Amounts to be adjusted year based on percentage increase in
Index of Sec 164. ...MEDICAL care component of Consumer Price Index for year involved ; Amounts to be adjusted year based on percentage increase in
Index of Sec 164. ...MEDICAL care component of Consumer Price Index for year involved ; Amounts to be adjusted year based on percentage increase in
Index of Sec 166. ...MEDICAL condition and relevant and reliable evidence entity obtaining under subparagraph ; Patient's
Index of 0MEDICAL exigencies of case and no event later than deadline specified in subparagraph ; Possible in accordance with
Index of Sec 139. ...INFORMATION being reasonably necessary to make determination ; Possible in accordance with medical exigencies of case and no event later than 1 business day after date of receipt of
Index of Sec 139. ...MEDICAL exigencies of case but not later than deadline specified in subparagraph ; Receiving request for review of denial of claim in accordance with
Index of 0DRUG or insulin ; Reimbursement for expenses incurred for medicine or drug to be treated as reimbursement for medical expenses only if medicineing or drugging being prescribed
Index of Sec 442. ...MEDICAL expenses otherwise qualifying ; Secretary of Treasury issuing guidance of general applicability providing that
Index of Sec 461. ...MEDICAL inflation for 12-month period ending in June of prior year ; Annual increase in premiums charged under Exchange-participating health benefits planning not exceeding 150 percent of annual percentage increase in
Index of Sec 209. ...MEDICAL judgment ; Case involving
Index of 0MEDICAL judgment ; Benefit covered involving
Index of 0MEDICAL judgment ; Specific exclusions or express limitations on amount, duration or scope of coverage not involving
Index of 0MEDICAL loss ratio being less than percentage specified by Commissioner ; Plan year in which qualified health benefits planning that entity offers having
Index of Sec 116. ...MEDICAL loss ratio as defined by Commissioner ; Qualified health benefits planning meeting
Index of Sec 116. ...MEDICAL loss ratio as defined by Commissioner ; Qualified health benefits planning meeting
Index of Sec 116. ...PAYMENT sufficient to meet ; Issuer providing in manner specified by Secretary for rebates to enrollees of
Index of Sec 161. ...PAYMENT sufficient to meet ; Issuer providing in manner specified by Secretary for rebates to enrollees of
Index of Sec 161. ...MEDICAL necessity, medically necessary or appropriate or experimental ; External appeal entity considering language in plan or coverage document relating to definitions of terms
Index of 0ACCOUNT as of time of entity's determination ; External appeal entity determining whether plan or issuer's decision in accordance with medical needs of patient involved taking into
Index of 0INSULIN ; Reimbursements for medicine restricted to prescribed Drugs and
Index of Sec 442. ...DRUG only if medicineing or drugging being prescribed drug or insulin ; Term including amount paid for medicine or
Index of Sec 442. ...DRUG only if medicineing or drugging being prescribed drug or insulin ; Term including amount paid for medicine or
Index of Sec 442. ...DRUG or insulin ; Reimbursement for expenses incurred for medicine or drug to be treated as reimbursement for medical expenses only if medicineing or drugging being prescribed
Index of Sec 442. ...MALPRACTICE to be fairly compensated ; Ensuring quality healthcare being readily available by providing alternative framework to reduce costs of defensive medicine and allowing victims of
Index of Sec 208. ...MEDICINE ; Identification of Providers trained and accredited in integrative
Index of Sec 133. ...HEALTH medicine ; Qualified health benefit plan including in disclosure required under subsection identification to enrollees of providers of services under plan trained and accredited in integrative
Index of Sec 133. ...HEALTH and substance abuse services recommended by Task Force on Clinical Preventive Services and mental health and substance abuse services with compelling research or evidence including screening ; Including services recommended with grade of A or B by Task Force on Clinical Preventive Services and including mental
Index of Sec 122. ...BEHAVIORAL health treatments ; Mental health and substance use disorder services including
Index of Sec 122. ...MISCONDUCT in performance of dutying, functioning or activity ; Violating criminal law being civilly liable under law of United States or State if due care exercised in performance of dutying, functioning or activity and no actual malice or gross
Index of 0CIVIL monetary and programmatic penalties for non-compliance consistent with existing laws and regulations and fair and reasonable appeals processing building off of enforcement provisions under part ; Enforcement process including timely investigation of complaints, random audits to ensure compliance,
Index of Sec 163. ...CIVIL monetary and programmatic penalties for non-compliance consistent with existing laws and regulations and fair and reasonable appeals processing building off of enforcement provisions under part ; Enforcement process including timely investigation of complaints, random audits to ensure compliance,
Index of Sec 164. ...NONPROFIT entity meeting following criteria ; Secretary taking into account development of operating rules developed by
Index of Sec 164. ...TAX to be imposed by paragraph on failure during period ; No
Index of Sec 411. ...TAX treatment being not adequately disclosed in return nor in statement attached to return ; Term nondisclosed noneconomic substance transaction meaning portion of transaction described in subsection with respect to which relevant facts affecting
Index of Sec 453. ...HEALTH benefits planing offered through Exchange ; Providing for dissemination of information related to end-of-life planning to individuals seeking enrollment in Exchange-participating
Index of Sec 138. ...OF-life planning document ; Requiring individual to complete advanced directive or physician's order for life sustaining treatment or other end-
Index of Sec 138. ...INFORMATION as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other
Index of Sec 133. ...INFORMATION as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other
Index of Sec 133. ...INFORMATION as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other
Index of Sec 133. ...HEALTH plan exceeding 11 percent of current family income ; Of-pocket cost-sharing for yearing or preceding year for coverage under group
Index of Sec 242. ...OF-pocket costs ; Amounts paid to participating employment-based plan under subsection to be used to lowing costs borne directly by participants and beneficiaries for health benefits provided under plan in form of premiums, co-payments, deductibles, co-insurance or other out-
Index of Sec 164. ...OF-pocket costs ; Amounts paid to participating employment-based plan under subsection to be used to lowing costs borne directly by participants and beneficiaries for health benefits provided under plan in form of premiums, co-payments, deductibles, co-insurance or other out-
Index of Sec 164. ...OF-pocket costs ; Amounts paid to participating employment-based plan under subsection to be used to lowing costs borne directly by participants and beneficiaries for health benefits provided under plan in form of premiums, co-payments, deductibles, co-insurance or other out-
Index of Sec 166. ...OF-living adjustment determined under section 1(f)(3) for calendar year in which taxable year begining ; Cost-
Index of Sec 441. ...ON-line system whereby individual selecting by name ; Commissioner establishing
Index of Sec 115. ...CHILD'S congenital or developmental deformity, disease or injury ; Group health plan and health insurance issuer offering group health insurance coverage providing coverage for surgical benefits providing coverage for outpatient and inpatient diagnosis and treatment of minor
Index of Sec 163. ...CHILD'S congenital or developmental deformity, disease or injury ; Health insurance issuer offering health insurance coverage in individual market providing coverage for surgical benefits providing coverage for outpatient and inpatient diagnosis and treatment of minor
Index of Sec 163. ...HOSPITAL and outpatient clinic services including emergency department services ; Outpatient
Index of Sec 122. ...HOSPITAL and outpatient clinic services including emergency department services ; Outpatient
Index of Sec 122. ...HOSPITAL and outpatient clinic services including emergency department services ; Outpatient
Index of Sec 122. ...OUTPATIENT services with covered entities ; Entity contracting for
Index of Sec 204. ...OUTPATIENT services with covered entities ; Entity contracting for
Index of Sec 204. ...OUTPATIENT services with covered entities ; Entity contracting for
Index of Sec 204. ...OWNERSHIP changed or transferred ; Transfer of prescription records occurring in event pharmacy
Index of Sec 138. ...ABORTION on minor ; Coverage or procedural requirements on abortions including parental notification or consent for performance of
Index of Sec 156. ...PARTNERSHIP or other entity to be treated as member of controlled group of entities if entity controlled ;
Index of Sec 451. ...PAYMENT for items and services described in subsection in accordance with generally accepted standards of medical or other appropriate clinical or professional practice ; Providing
Index of Sec 122. ...PAYMENT for items and services described in subsection in accordance with generally accepted standards of medical or other appropriate clinical or professional practice ; Providing
Index of Sec 122. ...PAYMENT for items and services described in subsection in accordance with generally accepted standards of medical or other appropriate clinical or professional practice ; Providing
Index of Sec 122. ...PAYMENT to plan or entity of filing fee not exceeding $25 ; Plan or entity conditioning use of external appeal process upon
Index of 0PAYMENT of filing fee in case of individual participant, beneficiary or enrollee certifying that individual being indigent ; Plan or issuer not requiring
Index of 0PAYMENT of filing fee under paragraph if recommendation of external appeal entity to reverse or modify denial of claim for benefits being subject of appeal ; Plan or entity refunding
Index of 0ELECTRONIC funds transferring or electronic remittance in form as specified in X12 835 Health Care Payment and Remittance Advice or subsequent standard ; Payment being other than
Index of Sec 165. ...PAYMENT to be made for services furnished during year ;
Index of Sec 225. ...PAYMENT to be made for services furnished during year in one of 2 classes ;
Index of Sec 225. ...PAYMENT to be made for services furnished during year in one of 2 classes ;
Index of Sec 225. ...PAYMENT in full ; Physicians agreeing to accept payment rate established under section 223 as
Index of Sec 225. ...PAYMENT in full ; Physicians agreeing to accept payment rate established under section 223 as
Index of Sec 225. ...PAYMENT in full ; Secretary providing for participation of health care providers under public health insurance option under which payment only to be available if provider agreeing to accept payment rate established under section 223 as
Index of Sec 225. ...PAYMENT in full ; Secretary providing for participation of health care providers under public health insurance option under which payment only to be available if provider agreeing to accept payment rate established under section 223 as
Index of Sec 225. ...PAYMENT for services described in section 122(d)(4)(a) ; Affordability credit not to be used for
Index of Sec 241. ...ACTUARIAL value of benefits under plan provided under section 203(c)(2)(b) resulting from reduction in cost-sharing described in subsection ; Commissioner providing for payment to offering entity of amount equivalent to increased
Index of Sec 244. ...ACTUARIAL value of benefits under plan provided under section 203(c)(2)(b) resulting from reduction in cost-sharing described in subsection ; Commissioner providing for payment to offering entity of amount equivalent to increased
Index of Sec 244. ...ACTUARIAL value of benefits under plan provided under section 203(c)(2)(b) resulting from reduction in cost-sharing described in subsection ; Commissioner providing for payment to offering entity of amount equivalent to increased
Index of Sec 244. ...FOREIGN parent corporation ; Withholding tax imposed under chapter 3 with respect to payment not to be reduced under treaty of United States unless withholding tax to be reduced under treaty of United States if payment being made directly to
Index of Sec 451. ...PAYMENT making ; Term deductible related-party payment meaning
Index of Sec 451. ...PAYMENT making for benefit of employee or eligible beneficiary ;
Index of Sec 461. ...ACCIDENT benefits to members association and dependents ; Purposes of providing for payment of sick and
Index of Sec 461. ...PAYMENT and delivery system reform successful in improving quality and reducing costing ; Secretary finding
Index of Sec 224. ...PAYMENT and delivery system reforms under section and seeking to implement reforms subjecting to following ; Secretary monitoring and evaluating progress of
Index of Sec 224. ...PAYMENT of premiums and grace period during that enrollee having opportunity to correct nonpayment ; Excepting that section 2712(b)(1) applying only if issuer providing enrollee with notice of non-
Index of Sec 112. ...PAYMENT of premiums and grace period during that enrollees having opportunity to correct nonpayment ; 2712 and subsection and subsection of Public Health Service Act applying to individuals and employers in individual and group health insurance coverage through employment-based health plan or otherwise excepting that section 2712(b)(1) applying only if issuer providing enrollee with notice of non-
Index of Sec 112. ...PAYMENT of premiums and grace period during that enrollees having opportunity to correct nonpayment ; 2712 and subsection and subsection of Public Health Service Act applying to individuals and employers in individual and group health insurance coverage through employment-based health plan or otherwise excepting that section 2712(b)(1) applying only if issuer providing enrollee with notice of non-
Index of Sec 112. ...CONTRACT received from pharmaceutical manufacturers including rebates ; Estimate of aggregate average payment per prescription under
Index of Sec 133. ...PAYMENT as result of application of subtitle ; No case affordable credit eligible individual receiving cash
Index of Sec 241. ...PAYMENT as result of application of subtitle ; No case affordable credit eligible individual receiving cash
Index of Sec 241. ...PAYMENT as result of application of subtitle ; No case affordable credit eligible individual receiving cash
Index of Sec 241. ...PAYMENT sufficient to meet ; QHBP offering entity offering plan providing for rebates to enrollees of
Index of Sec 116. ...PAYMENT sufficient to meet ; QHBP offering entity providing in manner specified by Commissioner for rebates to enrollees of
Index of Sec 116. ...PAYMENT sufficient to meet ; QHBP offering entity providing in manner specified by Commissioner for rebates to enrollees of
Index of Sec 116. ...PAYMENT sufficient to meet ; Issuer providing in manner specified by Secretary for rebates to enrollees of
Index of Sec 161. ...PAYMENT sufficient to meet ; Issuer providing in manner specified by Secretary for rebates to enrollees of
Index of Sec 161. ...PAYMENT ; Case of deductible related-party
Index of Sec 451. ...PAYMENT making ; Term deductible related-party payment meaning
Index of Sec 451. ...PAYMENT ; Respect to deductible related-party
Index of Sec 451. ...PAYMENT ; Exchange-eligible participation status and establishing grace periods for premium
Index of Sec 202. ...PAYMENT ; Exchange-eligible participation status and establishing grace periods for premium
Index of Sec 202. ...PAYMENT ; Exchange-eligible participation status and establishing grace periods for premium
Index of Sec 202. ...PAYMENT differential for covered services or spending for non-covered services ; Term cost-sharing including deductibles, coinsurance, copayments and similar charges but not including premiums or network
Index of Sec 100. ...PAYMENT differential for covered services or spending for non-covered services ; Term cost-sharing including deductibles, coinsurance, copayments and similar charges but not including premiums or network
Index of Sec 100. ...PAYMENT differential for covered services or spending for non-covered services ; Term cost-sharing including deductibles, coinsurance, copayments and similar charges but not including premiums or network
Index of Sec 100. ...PAYMENTS ; Administrative and other payments from pharmaceutical manufacturers and description of types of payments and amount of payments shared with plan and description of percentage of prescriptions For which PBM receiving
Index of Sec 133. ...EMPLOYMENT-based plan ; Dependent of retiree in form of deductibles, co-payments and co-insurance to be included along with amounts paid by participating
Index of Sec 164. ...EMPLOYMENT-based plan ; Dependent of retiree in form of deductibles, co-payments and co-insurance to be included along with amounts paid by participating
Index of Sec 164. ...INSURANCE or other out-of-pocket costs ; Amounts paid to participating employment-based plan under subsection to be used to lowing costs borne directly by participants and beneficiaries for health benefits provided under plan in form of premiums, co-payments, deductibles, co-
Index of Sec 164. ...INSURANCE or other out-of-pocket costs ; Amounts paid to participating employment-based plan under subsection to be used to lowing costs borne directly by participants and beneficiaries for health benefits provided under plan in form of premiums, co-payments, deductibles, co-
Index of Sec 164. ...EMPLOYMENT-based plan ; Dependent of retiree in form of deductibles, co-payments and co-insurance to be included along with amounts paid by participating
Index of Sec 166. ...INSURANCE or other out-of-pocket costs ; Amounts paid to participating employment-based plan under subsection to be used to lowing costs borne directly by participants and beneficiaries for health benefits provided under plan in form of premiums, co-payments, deductibles, co-
Index of Sec 166. ...PAYMENTS to operate Health Insurance Exchange ; Amounts as Commissioner determining being necessary to make
Index of Sec 207. ...PAYMENTS to operate Health Insurance Exchange ; Amounts as Commissioner determining being necessary to make
Index of Sec 207. ...PAYMENTS to operate Health Insurance Exchange ; Amounts as Commissioner determining being necessary to make
Index of Sec 207. ...PAYMENTS being excessive or deficient ; Nothing in subtitle to be construed as limiting Secretary's authority to correct for
Index of Sec 223. ...PAYMENTS being excessive or deficient ; Nothing in subtitle to be construed as limiting Secretary's authority to correct for
Index of Sec 223. ...PAYMENTS to provide for more efficient delivery of services ; Nothing in subtitle to be construed as affecting authority of Secretary to establish payment rates including
Index of Sec 223. ...PAYMENTS to provide for more efficient delivery of services ; Nothing in subtitle to be construed as affecting authority of Secretary to establish payment rates including
Index of Sec 223. ...HEALTH insurance option ; Secretary utilizing innovative payment mechanisms and policies to determine payments for items and services under public
Index of Sec 224. ...HEALTH insurance option ; Secretary utilizing innovative payment mechanisms and policies to determine payments for items and services under public
Index of Sec 224. ...HEALTH insurance option ; Secretary utilizing innovative payment mechanisms and policies to determine payments for items and services under public
Index of Sec 224. ...GEOGRAPHIC areas ; Nothing in subtitle preventing Secretary from varying payments based on different payment structure models under public health insurance option for different
Index of Sec 224. ...GEOGRAPHIC areas ; Nothing in subtitle preventing Secretary from varying payments based on different payment structure models under public health insurance option for different
Index of Sec 224. ...GEOGRAPHIC areas ; Nothing in subtitle preventing Secretary from varying payments based on different payment structure models under public health insurance option for different
Index of Sec 224. ...PAYMENTS making after date of enactment of Act ; Amendment making by section applying to
Index of Sec 451. ...PAYMENTS or premiums described in section ; Section 1854(g) of Social Security Act applying to receipts described in previous sentence in same manner as section applying to
Index of Sec 222. ...PAYMENTS or premiums described in section ; Section 1854(g) of Social Security Act applying to receipts described in previous sentence in same manner as section applying to
Index of Sec 222. ...PAYMENTS or premiums described in section ; Section 1854(g) of Social Security Act applying to receipts described in previous sentence in same manner as section applying to
Index of Sec 222. ...PAYMENTS making from Trust Fund under subsection plus ; Amount equivalent to amount of
Index of Sec 207. ...PAYMENTS making from Trust Fund under subsection plus ; Amount equivalent to amount of
Index of Sec 207. ...PAYMENTS making from Trust Fund under subsection plus ; Amount equivalent to amount of
Index of Sec 207. ...PAYMENTS by plans ; Secretary developing mechanism to monitor appropriate use of
Index of Sec 164. ...PAYMENTS by plans ; Secretary developing mechanism to monitor appropriate use of
Index of Sec 164. ...PAYMENTS by plans ; Secretary developing mechanism to monitor appropriate use of
Index of Sec 166. ...AFFORDABILITY credits on behalf of individuals being not lawfully present in United States ; Nothing in subtitle allowing Federal payments for
Index of Sec 246. ...AFFORDABILITY credits on behalf of individuals being not lawfully present in United States ; Nothing in subtitle allowing Federal payments for
Index of Sec 246. ...AFFORDABILITY credits on behalf of individuals being not lawfully present in United States ; Nothing in subtitle allowing Federal payments for
Index of Sec 246. ...PAYMENTS, accountable care organizations, value-based ; Payment mechanisms and policies under section including patient-centered medical home and other care management
Index of Sec 224. ...PAYMENTS, accountable care organizations, value-based ; Payment mechanisms and policies under section including patient-centered medical home and other care management
Index of Sec 224. ...PAYMENTS, accountable care organizations, value-based ; Payment mechanisms and policies under section including patient-centered medical home and other care management
Index of Sec 224. ...INFORMATION as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other
Index of Sec 133. ...INFORMATION as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other
Index of Sec 133. ...INFORMATION as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other
Index of Sec 133. ...AFFORDABLILITY and efficient delivery of medical care consistent with section 221(a) ; Secretary continuing to use administrative process to set rates in order to promote payment accuracy to ensure adequate beneficiary access to providers and promoting
Index of Sec 223. ...AFFORDABILITY and efficient delivery of medical care consistent with section 221(a) ; Secretary continuing to use administrative process to set rates in order to promote payment accuracy to ensure adequate beneficiary access to providers and promoting
Index of Sec 223. ...HOME and other care management payments, accountable care organizations, value-based ; Payment mechanisms and policies under section including patient-centered medical
Index of Sec 224. ...HOME and other care management payments, accountable care organizations, value-based ; Payment mechanisms and policies under section including patient-centered medical
Index of Sec 224. ...HOME and other care management payments, accountable care organizations, value-based ; Payment mechanisms and policies under section including patient-centered medical
Index of Sec 224. ...HEALTH insurance option ; Secretary utilizing innovative payment mechanisms and policies to determine payments for items and services under public
Index of Sec 224. ...HEALTH insurance option ; Secretary utilizing innovative payment mechanisms and policies to determine payments for items and services under public
Index of Sec 224. ...HEALTH insurance option ; Secretary utilizing innovative payment mechanisms and policies to determine payments for items and services under public
Index of Sec 224. ...PAYMENT methods ; Nothing in subsection to be construed as preventing use of innovative
Index of Sec 223. ...DISCLOSURE, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other information as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial
Index of Sec 133. ...DISCLOSURE, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other information as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial
Index of Sec 133. ...DISCLOSURE, data on enrollment, data on disenrollment, data on number of claims denials, data on rating practices, information on cost-sharing and payments with respect out-of-network coverage and other information as determined appropriate by Commissioner ; Qualified health benefits planning complying with standards established by Commissioner for accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial
Index of Sec 133. ...PAYMENT in full ; Physicians agreeing to accept payment rate established under section 223 as
Index of Sec 225. ...PAYMENT in full ; Physicians agreeing to accept payment rate established under section 223 as
Index of Sec 225. ...PAYMENT in full ; Secretary providing for participation of health care providers under public health insurance option under which payment only to be available if provider agreeing to accept payment rate established under section 223 as
Index of Sec 225. ...PAYMENT in full ; Secretary providing for participation of health care providers under public health insurance option under which payment only to be available if provider agreeing to accept payment rate established under section 223 as
Index of Sec 225. ...HEALTH care providers consistent with section and changing payment rates in accordance with section 224 ; Secretary establishing payment rates for public health insurance option for services and
Index of Sec 223. ...HEALTH care providers consistent with section and changing payment rates in accordance with section 224 ; Secretary establishing payment rates for public health insurance option for services and
Index of Sec 223. ...PAYMENT rates being not lower ; Secretary negotiating rates in manner resulting in
Index of Sec 223. ...PAYMENT rates for similar services and providers under parts A and B of Medicare ; During Y1, Y2 and Y3 Secretary basing payment rates under section for services and providers described in paragraph on
Index of Sec 223. ...PAYMENT rates for similar services and providers under parts A and B of Medicare ; During Y1, Y2 and Y3 Secretary basing payment rates under section for services and providers described in paragraph on
Index of Sec 223. ...PAYMENT rates under parts A and B of Medicare applying under subtitle ; Secretary determining extent to which Medicare adjustments applicable to base
Index of Sec 223. ...PAYMENT rates under parts A and B of Medicare applying under subtitle ; Secretary determining extent to which Medicare adjustments applicable to base
Index of Sec 223. ...ACCOMMODATE payments for services ; Secretary modifying payment rates described in paragraph in order to
Index of Sec 223. ...ACCOMMODATE payments for services ; Secretary modifying payment rates described in paragraph in order to
Index of Sec 223. ...PAYMENT rates under section for prescription drugs not paid under part A or part B of Medicare at rates negotiated by Secretary ;
Index of Sec 223. ...PAYMENT rates under section for prescription drugs not paid under part A or part B of Medicare at rates negotiated by Secretary ;
Index of Sec 223. ...PAYMENT rates being 5 percent greater than rates established under subsection ; Secretary providing Y2 and Y3 for
Index of Sec 223. ...PAYMENT rates being 5 percent greater than rates established under subsection ; Secretary providing Y2 and Y3 for
Index of Sec 223. ...PAYMENT rates including payments to provide for more efficient delivery of services ; Nothing in subtitle to be construed as affecting authority of Secretary to establish
Index of Sec 223. ...PAYMENT rates including payments to provide for more efficient delivery of services ; Nothing in subtitle to be construed as affecting authority of Secretary to establish
Index of Sec 223. ...HEALTH and value ; Public health insurance option modifying cost sharing and payment rates to encourage use of services promoting
Index of Sec 224. ...HEALTH and value ; Public health insurance option modifying cost sharing and payment rates to encourage use of services promoting
Index of Sec 224. ...HEALTH and value ; Public health insurance option modifying cost sharing and payment rates to encourage use of services promoting
Index of Sec 224. ...CAPITATION and direct contracting with providers ; Bundling of services, differential payment rates, performance or utilization based payments, partial
Index of Sec 224. ...CAPITATION and direct contracting with providers ; Bundling of services, differential payment rates, performance or utilization based payments, partial
Index of Sec 224. ...CAPITATION and direct contracting with providers ; Bundling of services, differential payment rates, performance or utilization based payments, partial
Index of Sec 224. ...PAYMENT rates under subparagraph ; Pediatrician and other health care practitioner being type of practitioner not typically participating in Medicare to be eligible for increased
Index of Sec 223. ...PAYMENT rates under subparagraph ; Pediatrician and other health care practitioner being type of practitioner not typically participating in Medicare to be eligible for increased
Index of Sec 223. ...PAYMENT rates under section ; Chapter 5 of title 5, United States Code applying to process for initial establishment of
Index of Sec 223. ...PAYMENT rates under section ; Chapter 5 of title 5, United States Code applying to process for initial establishment of
Index of Sec 223. ...HEALTH insurance option and other purposes under subtitle including to improve quality and reducing racial ; Requiring to establish premiums and payment rates for public
Index of Sec 221. ...HEALTH insurance option and other purposes under subtitle including to improve quality and reducing racial ; Requiring to establish premiums and payment rates for public
Index of Sec 221. ...HEALTH and health care based on race ; Requiring to establish premiums and payment rates for public health insurance option and other purposes under subtitle including to improve quality and reducing disparities in
Index of Sec 221. ...PAYMENT rates for practitioners' services otherwise established under fee schedule under section 1848 of Social Security Act to be applied without regard to provisions under subsection of sectioning and updating under subsection under section for year as applied under paragraph to be not less than 1 percent ;
Index of Sec 223. ...PAYMENT rates for practitioners' services otherwise established under fee schedule under section 1848 of Social Security Act to be applied without regard to provisions under subsection of sectioning and updating under subsection under section for year as applied under paragraph to be not less than 1 percent ;
Index of Sec 223. ...GEOGRAPHIC areas ; Nothing in subtitle preventing Secretary from varying payments based on different payment structure models under public health insurance option for different
Index of Sec 224. ...GEOGRAPHIC areas ; Nothing in subtitle preventing Secretary from varying payments based on different payment structure models under public health insurance option for different
Index of Sec 224. ...GEOGRAPHIC areas ; Nothing in subtitle preventing Secretary from varying payments based on different payment structure models under public health insurance option for different
Index of Sec 224. ...PAYMENTS and amount of payments shared with plan and description of percentage of prescriptions For which PBM receiving payments ; Administrative and other payments from pharmaceutical manufacturers and description of types of
Index of Sec 133. ...AT-risk populations and covered individuals with chronic conditions or severe illnesses including gender-specific criteria and pediatric-specific criteria where available and appropriate ; Criteria including written clinical review criteria based on valid clinical evidence where available and directed specifically at meeting needs of
Index of Sec 139. ...PERIODIC investigations to discover noncompliance ;
Index of Sec 321. ...PERIODIC investigations to discover noncompliance ;
Index of Sec 321. ...COMPLIANCE with health coverage participation requirements ; Periodic investigations to determine
Index of Sec 323. ...COMPLIANCE with health coverage participation requirements ; Periodic investigations to determine
Index of Sec 323. ...HEALTH benefits planing ; Commissioner providing for periodic surveys of Exchange-eligible individuals and employers concerning satisfaction of individuals and employers with Health Insurance Exchange and Exchange-participating
Index of Sec 202. ...HEALTH benefits planing ; Commissioner providing for periodic surveys of Exchange-eligible individuals and employers concerning satisfaction of individuals and employers with Health Insurance Exchange and Exchange-participating
Index of Sec 202. ...HEALTH benefits planing ; Commissioner providing for periodic surveys of Exchange-eligible individuals and employers concerning satisfaction of individuals and employers with Health Insurance Exchange and Exchange-participating
Index of Sec 202. ...PERSONNEL qualified and received appropriate training in conduct of activities under program ; Utilization review program providing for conduct of utilization review activities only through
Index of Sec 139. ...PERSONNEL performing utilization review activities under program being reasonably accessible by toll-free telephone during normal business hours to discuss patient care and allowing response to telephone requests and appropriate provision being made to receive and respond promptly to calls received during other hours ; Program providing that appropriate
Index of Sec 139. ...PERSONNEL employed in accordance with requirements of title 5, United States coding in case of sections 208 and 241(b)(2) ; Including use of
Index of Sec 142. ...PERSONNEL employed in accordance with requirements of title 5, United States coding in case of sections 208 and 241(b)(2) ; Including use of
Index of Sec 142. ...PERSONNEL employed in accordance with requirements of title 5, United States coding in case of sections 208 and 241(b)(2) ; Including use of
Index of Sec 142. ...PERSONNEL employed in accordance with standards prescribed by Office of Personnel Management pursuant to section 208 of Intergovernmental Personnel Act of 1970 42 USC 4728 ; Use of State
Index of Sec 142. ...PERSONNEL employed in accordance with standards prescribed by Office of Personnel Management pursuant to section 208 of Intergovernmental Personnel Act of 1970 42 USC 4728 ; Use of State
Index of Sec 142. ...PERSONNEL employed in accordance with standards prescribed by Office of Personnel Management pursuant to section 208 of Intergovernmental Personnel Act of 1970 42 USC 4728 ; Use of State
Index of Sec 142. ...PHARMACEUTICAL manufacturers including rebates ; Estimate of aggregate average payment per prescription under contract received from
Index of Sec 133. ...HEALTH care professional or evaluating effectiveness of professional pharmaceutical detailing sales forcing ; Influencing or evaluating prescribing behavior of individual
Index of Sec 138. ...MAIL order or Internet pharmacy or other similar entity excepting for limited purposes ;
Index of Sec 138. ...DRUG coverage provided under plan or controlling costs of prescription drug coverage ; Qualified health benefits planning entering into contract with pharmacy benefit managers to manage prescription
Index of Sec 133. ...ELECTRONIC transmission intermediary, retail ; Records described in subsection not to be licensed, transferred, used or sold by pharmacy benefits manager, insurance company,
Index of Sec 138. ...PLANNING tools ; Information related to other
Index of Sec 138. ...PLANNING tools listing or describing as option suicide ; Information provided to meet requirements of subsection not including advanced directives or other
Index of Sec 138. ...PLANNING tools ; Requiring inclusion of information prohibited in paragraph in advanced directives or other
Index of Sec 138. ...POLITICAL subdivision of State establishing or maintaining plan ; State or
Index of Sec 100. ...POLITICAL subdivision of State establishing or maintaining plan ; State or
Index of Sec 100. ...POLITICAL subdivision of State establishing or maintaining plan ; State or
Index of Sec 100. ...POLITICAL subdivision to extent ; Section superseding provision of law of State or
Index of Sec 167. ...DISABILITY, socioeconomic status, rural, urban or other geographic setting and other population or subpopulation as determined appropriate by Secretary ; Primary language, sex, sexual orientation, gender identity,
Index of Sec 221. ...HEALTH care system affecting differences in costs ; Nothing in paragraph to be construed to preclude allowance for normal variations in population demographics, health status and other factors exogenous to
Index of Sec 252. ...POSSESSION of United States ; Term State including District of Columbia, Puerto Rico and other territory or
Index of Sec 208. ...ACCEPTABLE coverage during taxable year ; Individual being bona fide resident of possession of United States for taxable year to be treated for purposes of section as covered by
Index of Sec 401. ...HEALTH care ; Term advanced directive including living or durable power of attorney for
Index of Sec 138. ...HEALTH benefits ; Group health plan described in subsection containing provision reserving general power to amend or terminate plan or provision specifically authorizing plan to make post-retirement reductions in retiree
Index of Sec 165. ...ABORTION ; No preemption of State laws regarding
Index of Sec 156. ...PRENATAL care ; Cost reduction estimated to result from services including
Index of Sec 113. ...PREVENTIVE items and services ; No cost-sharing under essential benefits packaging for
Index of Sec 122. ...PREVENTIVE items and services ; No cost-sharing under essential benefits packaging for
Index of Sec 122. ...PREVENTIVE items and services ; No cost-sharing under essential benefits packaging for
Index of Sec 122. ...PRIMARY insured and name of other individual obtaining coverage under policy ; Name, address and tin of
Index of Sec 401. ...PRIMARY insured whose name required to be set forth in returning written statement showing ; Every person required to make return under subsection furnishing to
Index of Sec 401. ...DISABILITY, socioeconomic status, rural, urban or other geographic setting and other population or subpopulation as determined appropriate by Secretary ; Primary language, sex, sexual orientation, gender identity,
Index of Sec 221. ...PRIMARY purpose of providing affordable employee benefits to members ; Consisting solely of members and operated for
Index of Sec 209. ...PRIMARY responsibility to create low-cost plan without compromising quality or access to care ; Secretary's
Index of Sec 221. ...PRIMARY responsibility to create low-cost plan without compromising quality or access to care ; Secretary's
Index of Sec 221. ...PRIMARY responsibility to create low-cost plan without comprimising quality or access to care ; Secretary's
Index of Sec 221. ...PRIVACY and security law ; Using and disclosed in manner meeting HIPAA
Index of Sec 163. ...PRIVACY and security law ; Using and disclosed in manner meeting HIPAA
Index of Sec 164. ...PRIVACY or security standard adopted under section 3004 of Act ; Including
Index of Sec 163. ...PRIVACY or security standard adopted under section 3004 of Act ; Including
Index of Sec 164. ...HEALTH and representing balance among various sectors of health care system so ; Disabilities, representatives of relevant governmental agencies and one practicing physician or other health professional and expert on children's
Index of Sec 123. ...HEALTH and representing balance among various sectors of health care system so ; Disabilities, representatives of relevant governmental agencies and one practicing physician or other health professional and expert on children's
Index of Sec 123. ...HEALTH and representing balance among various sectors of health care system so ; Disabilities, representatives of relevant governmental agencies and one practicing physician or other health professional and expert on children's
Index of Sec 123. ...HEALTH care professional or evaluating effectiveness of professional pharmaceutical detailing sales forcing ; Influencing or evaluating prescribing behavior of individual
Index of Sec 138. ...PROFESSIONAL consensus conferences conducted or financed in whole or part by one or more government agencies ; Results of
Index of 0PROFESSIONAL practice ; Providing payment for items and services described in subsection in accordance with generally accepted standards of medical or other appropriate clinical or
Index of Sec 122. ...PROFESSIONAL practice ; Providing payment for items and services described in subsection in accordance with generally accepted standards of medical or other appropriate clinical or
Index of Sec 122. ...PROFESSIONAL practice ; Providing payment for items and services described in subsection in accordance with generally accepted standards of medical or other appropriate clinical or
Index of Sec 122. ...PROFESSIONAL services to entity ; No qualified external appeal entity having contract with qualified health benefits planning under part and no person employed entitying or furnishing
Index of 0HEALTH care practitioner participating in medicareing and public health insurance option ; Services described in subparagraph being items and professional services under public health insurance option by physician or other
Index of Sec 223. ...HEALTH care practitioner participating in medicareing and public health insurance option ; Services described in subparagraph being items and professional services under public health insurance option by physician or other
Index of Sec 223. ...AFFORDABILITY credits ; Commissioner establishing effective methods ensuring that individuals with limited English proficiency being able to apply for
Index of Sec 241. ...AFFORDABILITY credits ; Commissioner establishing effective methods ensuring that individuals with limited English proficiency being able to apply for
Index of Sec 241. ...AFFORDABILITY credits ; Commissioner establishing effective methods ensuring that individuals with limited English proficiency being able to apply for
Index of Sec 241. ...AFFORDABILITY credits under subtitle ; Commissioner through Health Insurance Exchange or another public entity under arrangement making with Commissioner making determination as to eligibility of individual for
Index of Sec 241. ...AFFORDABILITY credits under subtitle ; Commissioner through Health Insurance Exchange or another public entity under arrangement making with Commissioner making determination as to eligibility of individual for
Index of Sec 241. ...AFFORDABILITY credits under subtitle ; Commissioner through Health Insurance Exchange or another public entity under arrangement making with Commissioner making determination as to eligibility of individual for
Index of Sec 241. ...PUBLIC input as part of developing recommendations under subsection ; Health benefiting Advisory Committee allowing for
Index of Sec 123. ...PUBLIC input as part of developing recommendations under subsection ; Health benefiting Advisory Committee allowing for
Index of Sec 123. ...PUBLIC input as part of developing recommendations under subsection ; Health benefiting Advisory Committee allowing for
Index of Sec 123. ...PUBLIC option ; Sec 227, Sense of House regarding enrollment of Members in
Index of Sec 227. ...PUBLIC reviews and updating of operating rules ; Entity allowing for
Index of Sec 164. ...PUBLIC set of guiding principles ensuring operating rules and process being open and transparent ; Entity in place
Index of Sec 164. ...PERSONNEL employed in accordance with standards prescribed by Office of Personnel Management pursuant to section 208 of Intergovernmental Personnel Act of 1970 42 USC 4728 ; Use of State
Index of Sec 142. ...PERSONNEL employed in accordance with standards prescribed by Office of Personnel Management pursuant to section 208 of Intergovernmental Personnel Act of 1970 42 USC 4728 ; Use of State
Index of Sec 142. ...PERSONNEL employed in accordance with standards prescribed by Office of Personnel Management pursuant to section 208 of Intergovernmental Personnel Act of 1970 42 USC 4728 ; Use of State
Index of Sec 142. ...ACCEPTABLE coverage so long as Secretary of Labor determining that coverage for employees being substantially equivalent or greater than coverage provided for employees pursuant to essential benefits packaging ; Coverage provided pursuant to Hawaii Prepaid Health Care Act to be treated as qualified health benefits planning providing
Index of Sec 156. ...COLLECTIVE bargaining agreements between employee representatives and one or more employers ratified before date of enactment of Act ; Case of group health plan maintained pursuant to one or more
Index of Sec 166. ...COLLECTIVE bargaining agreement ; Plan amendment making pursuant to collective bargaining agreement relating to plan amending plan solely to conform to requirement added by amendments making by paragraphs and subsection not to be treated as termination of
Index of Sec 166. ...COLLECTIVE bargaining agreements between employee representatives and one or more employers ratified before date of enactment of Act ; Case of group health plan maintained pursuant to one or more
Index of Sec 167. ...COLLECTIVE bargaining agreement ; Plan amendment making pursuant to collective bargaining agreement relating to plan amending plan solely to conform to requirement added by amendments making by section not to be treated as termination of
Index of Sec 167. ...TITLE I of Employee Retirement Income Security Act of 1974 ; Term cobra continations coverage meaning continations coverage provided pursuant to part 6 of subtitle B of
Index of Sec 167. ...CHILD health plan under titling as in effect in 2011 ; Basing on findings in report under paragraph and changes making pursuant to recommendations in report that coverage being comparable to coverage provided to children under average State
Index of Sec 202. ...VOLUNTARY basis and consistent with standards established pursuant to section 1709 of Public Health Service Act ; Data collection conducted on
Index of Sec 221. ...CHILD support order ; Respect to period during that health coverage for child to be provided by individual pursuant to
Index of Sec 401. ...RACIAL ; Requiring to establish premiums and payment rates for public health insurance option and other purposes under subtitle including to improve quality and reducing
Index of Sec 221. ...RACIAL ; Requiring to establish premiums and payment rates for public health insurance option and other purposes under subtitle including to improve quality and reducing
Index of Sec 221. ...ETHNIC disparities ; Membership of Health benefiting Advisory Committee reflecting providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and
Index of Sec 123. ...ETHNIC disparities ; Membership of Health benefiting Advisory Committee reflecting providers, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and
Index of Sec 123. ...ETHNIC disparities ; Membership of Health benefiting Advisory Committee reflecting providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and
Index of Sec 123. ...ACCOUNT health care providers used by individual involved or other relevant factors as Commissioner specifying ; Process involving random assignment or other form of assignment taking into
Index of Sec 205. ...ACCOUNT health care providers used by individual involved or other relevant factors as Commissioner specifying ; Process involving random assignment or other form of assignment taking into
Index of Sec 205. ...ACCOUNT health care providers used by individual involved or other relevant factors as Commissioner specifying ; Process involving random assignment or other form of assignment taking into
Index of Sec 205. ...CIVIL monetary and programmatic penalties for non-compliance consistent with existing laws and regulations and fair and reasonable appeals processing building off of enforcement provisions under part ; Enforcement process including timely investigation of complaints, random audits to ensure compliance,
Index of Sec 163. ...CIVIL monetary and programmatic penalties for non-compliance consistent with existing laws and regulations and fair and reasonable appeals processing building off of enforcement provisions under part ; Enforcement process including timely investigation of complaints, random audits to ensure compliance,
Index of Sec 164. ...PAYMENT sufficient to meet ; QHBP offering entity offering plan providing for rebates to enrollees of
Index of Sec 116. ...PAYMENT sufficient to meet ; QHBP offering entity providing in manner specified by Commissioner for rebates to enrollees of
Index of Sec 116. ...PAYMENT sufficient to meet ; QHBP offering entity providing in manner specified by Commissioner for rebates to enrollees of
Index of Sec 116. ...REBATES ; Estimate of aggregate average payment per prescription under contract received from pharmaceutical manufacturers including
Index of Sec 133. ...PAYMENT sufficient to meet ; Issuer providing in manner specified by Secretary for rebates to enrollees of
Index of Sec 161. ...PAYMENT sufficient to meet ; Issuer providing in manner specified by Secretary for rebates to enrollees of
Index of Sec 161. ...ABNORMAL structures of body causes by congenital defects, developmental abnormalities, trauma, infection, tumors or disease ; Term treatment including reconstructive surgical procedures performed on
Index of Sec 163. ...ABNORMAL structures of body causes by congenital defects, developmental abnormalities, trauma, infection, tumors or disease ; Treatment including reconstructive surgical procedures performed on
Index of Sec 163. ...CIVIL penalty in amount of up to $1,000 day from date on which determination transmitted to plan by external review entity until date refusal to provide benefit corrected ; Refusal to be liable to aggrieved participant, beneficiary or enrollee for
Index of 0REFUSAL of benefit determining by external appeal entity in violation of terms of plan ; Plaintiff alleging that person referred in paragraph taking action resulting in
Index of 0REFUSAL to authorize benefit determined by external appeal entity in violation of terms plan or title ; Patterning or practicing of repeated
Index of 0ABORTION ; Willingness or refusal to provide
Index of Sec 156. ...REIMBURSEMENT for costs of examinations and audit of QHBP offering entities ; Commissioner authorized to recoup from qualified health benefits planing
Index of Sec 142. ...REIMBURSEMENT for costs of examinations and audit of QHBP offering entities ; Commissioner authorized to recoup from qualified health benefits planing
Index of Sec 142. ...REIMBURSEMENT for costs of examinations and audit of QHBP offering entities ; Commissioner authorized to recoup from qualified health benefits planing
Index of Sec 142. ...EMPLOYMENT-based plans with cost of providing health benefits to retirees and eligible spouses surviving spouses and dependents of retirees ; Secretary of Health and Human Services establishing temporary reinsurance program to provide reimbursement to assist participating
Index of Sec 164. ...EMPLOYMENT-based plans with cost of providing health benefits to retirees and eligible spouses surviving spouses and dependents of retirees ; Secretary of Health and Human Services establishing temporary reinsurance program to provide reimbursement to assist participating
Index of Sec 164. ...DOCUMENTATION of actual costs of items and services For which claim submitted ; Participating employment-based plan submitting claims for reimbursement to Secretary containing
Index of Sec 164. ...DOCUMENTATION of actual costs of items and services For which claim submitted ; Participating employment-based plan submitting claims for reimbursement to Secretary containing
Index of Sec 164. ...EMPLOYMENT-based plans with cost of providing health benefits to retirees and eligible spouses surviving spouses and dependents of retirees ; Secretary of Health and Human Services establishing temporary reinsurance program to provide reimbursement to assist participating
Index of Sec 166. ...DOCUMENTATION of actual costs of items and services For which claim submitted ; Participating employment-based plan submitting claims for reimbursement to Secretary containing
Index of Sec 166. ...DRUG or insulin ; Reimbursement for expenses incurred for medicine or drug to be treated as reimbursement for medical expenses only if medicineing or drugging being prescribed
Index of Sec 442. ...EMPLOYEE'S flexible spending arrangement ; Reimbursement from flexible spending arrangement under regulations in effect on date of enactment in Act to be reimbursed from
Index of Sec 461. ...EMPLOYEE'S health reimbursement arrangement ; Reimbursement from health reimbursement arrangement under regulations in effect on date of enactment in Act to be reimbursed from
Index of Sec 461. ...INSULIN ; Reimbursements for medicine restricted to prescribed Drugs and
Index of Sec 442. ...EMPLOYEE'S health reimbursement arrangement ; Reimbursement from health reimbursement arrangement under regulations in effect on date of enactment in Act to be reimbursed from
Index of Sec 461. ...REIMBURSEMENT arrangements between planning and provider ; Qualified health benefits planning complying with standards established by Commissioner to ensure transparency to health care provider relating to
Index of Sec 133. ...REIMBURSEMENT arrangements between planning and provider ; Qualified health benefits planning complying with standards established by Commissioner to ensure transparency to health care provider relating to
Index of Sec 133. ...REIMBURSEMENT arrangements between planning and provider ; Qualified health benefits planning complying with standards established by Commissioner to ensure transparency to health care provider relating to
Index of Sec 133. ...HEALTH reimbursement arrangements ; Health flexible spending arrangements and
Index of Sec 442. ...HEALTH care providers to increase meaningful use of electronic health records by providers ; Recommendations concerning whether qualified health benefits planing increasing reimbursement rates to
Index of Sec 157. ...REIMBURSEMENT rates for meaningful use ; Qualifying health benefits planing offering higher
Index of Sec 157. ...HEALTH care providers ; Commissioner requiring that qualified health benefits planing increase reimbursement rates for
Index of Sec 157. ...REINSURANCE program ; Term participating employment-based plan meaning eligible employment-based plan participating in
Index of Sec 164. ...REINSURANCE program ; Term participating employment-based plan meaning eligible employment-based plan participating in
Index of Sec 164. ...REINSURANCE program ; Appropriating or credited to Trust Fund as provided in subsection to enable Secretary to carry out
Index of Sec 164. ...REINSURANCE program ; Appropriating or credited to Trust Fund as provided in subsection to enable Secretary to carry out
Index of Sec 164. ...REINSURANCE program and used to carry out program ; Amounts in Trust Fund appropriated to provide funding to carry out
Index of Sec 164. ...REINSURANCE program and used to carry out program ; Amounts in Trust Fund appropriated to provide funding to carry out
Index of Sec 164. ...EXPENDITURES under reinsurance program not exceeding funds available under subsection ; Secretary having authority to stop taking applications for participation in program or taking other steps in reducing expenditures under reinsurance program in order to ensure that
Index of Sec 164. ...EXPENDITURES under reinsurance program not exceeding funds available under subsection ; Secretary having authority to stop taking applications for participation in program or taking other steps in reducing expenditures under reinsurance program in order to ensure that
Index of Sec 164. ...REINSURANCE program ; Term participating employment-based plan meaning eligible employment-based plan participating in
Index of Sec 166. ...REINSURANCE program ; Appropriating or credited to Trust Fund as provided in subsection to enable Secretary to carry out
Index of Sec 166. ...REINSURANCE program and used to carry out program ; Amounts in Trust Fund appropriated to provide funding to carry out
Index of Sec 166. ...EXPENDITURES under reinsurance program not exceeding funds available under subsection ; Secretary having authority to stop taking applications for participation in program or taking other steps in reducing expenditures under reinsurance program in order to ensure that
Index of Sec 166. ...EMPLOYMENT-based plans with cost of providing health benefits to retirees and eligible spouses surviving spouses and dependents of retirees ; Secretary of Health and Human Services establishing temporary reinsurance program to provide reimbursement to assist participating
Index of Sec 164. ...EMPLOYMENT-based plans with cost of providing health benefits to retirees and eligible spouses surviving spouses and dependents of retirees ; Secretary of Health and Human Services establishing temporary reinsurance program to provide reimbursement to assist participating
Index of Sec 164. ...EMPLOYMENT-based plans with cost of providing health benefits to retirees and eligible spouses surviving spouses and dependents of retirees ; Secretary of Health and Human Services establishing temporary reinsurance program to provide reimbursement to assist participating
Index of Sec 166. ...INFORMATION containing patient identifiable and prescriber-identifiable data maintained in accordance with section ; Qualified health benefits planning ensuring that records relative to prescription
Index of Sec 138. ...DISCRIMINATION in health Care Services based on religious or spiritual content ; Sec 125, prohibition of
Index of Sec 125. ...DISCRIMINATION in health Care Services based on religious or spiritual content ; Sec 125, prohibition of
Index of Sec 125. ...RELIGIOUS sect or division described in section 1402(g)(1) and adherent of established tenets or teachings of sect or division as described in section ; Subsection not applying to individual for perioding if individual in effect exemption certifying that individual being member of recognized
Index of Sec 401. ...REMITTANCE in form as specified in X12 835 Health Care Payment and Remittance Advice or subsequent standard ; Payment being other than electronic funds transferring or electronic
Index of Sec 165. ...REPLICABILITY or published in peer-reviewed journals ; Meet professionally recognized standards of validity and
Index of 0RESCISSION after continuing in force ; Including without
Index of Sec 162. ...RESCISSION after continuing in force ; Including without
Index of Sec 162. ...RESCISSION and opportunity for review of determination by independent ; Rescission taking effect issuer providing individual with notice of proposed
Index of Sec 162. ...RESCISSION and opportunity for review of determination by independent ; Rescission taking effect issuer providing individual with notice of proposed
Index of Sec 162. ...RESCISSION and opportunity for review of determination by independent ; Rescission taking effect issuer providing individual with notice of proposed
Index of Sec 162. ...RESCISSION and opportunity for review of determination by independent ; Rescission taking effect issuer providing individual with notice of proposed
Index of Sec 162. ...RESCISSIONS ; Secretarial guidance regarding
Index of Sec 162. ...RESCISSIONS ; Secretarial guidance regarding
Index of Sec 162. ...FRAUD as defined in sections 2712(b)(2) of Act ; Rescissions of coverage to be prohibited excepting in cases of
Index of Sec 112. ...FRAUD as defined in sections 2712(b)(2) of Act ; Rescissions of coverage to be prohibited excepting in cases of
Index of Sec 112. ...FRAUD as defined in sections 2712(b)(2) of Act ; Rescissions of coverage to be prohibited excepting in cases of
Index of Sec 112. ...RESPONSIBILITIES for entities transmitting or receiving data ; Policies defining transaction related rights and
Index of Sec 163. ...RESPONSIBILITIES for entities transmitting or receiving data ; Policies defining transaction related rights and
Index of Sec 164. ...RESPONSIBILITY among workers, employers and government ; Initiates shared
Index of Sec 100. ...RESPONSIBILITY among workers, employers and government ; Initiates shared
Index of Sec 100. ...RESPONSIBILITY among workers, employers and government ; Initiates shared
Index of Sec 100. ...RESPONSIBILITY under subpart B of part 6 of subtitle B of title I of Employee Retirement Income Security Act of 1974 ; Regulations, rulings and interpretations issued by officers relating to same matter over which two or more of officers having
Index of Sec 324. ...RESPONSIBILITY under subpart B of part 6 of subtitle B of title I of Employee Retirement Income Security Act of 1974 ; Regulations, rulings and interpretations issued by officers relating to same matter over which two or more of officers having
Index of Sec 324. ...RESPONSIBILITY under subpart B of part 6 of subtitle B of title I of Employee Retirement Income Security Act of 1974 ; Regulations, rulings and interpretations issued by officers relating to same matter over which two or more of officers having
Index of Sec 324. ...RESPONSIBILITY to contribute towards Employee and dependent coverage ; Sec 312, Employer
Index of Sec 312. ...RESPONSIBILITY to contribute towards Employee and dependent coverage ; Sec 312, Employer
Index of Sec 312. ...RESPONSIBILITY to contribute towards Employee and dependent coverage ; Sec 312, Employer
Index of Sec 312. ...HEALTH coverage ; Election of Employer responsibility to provide
Index of Sec 411. ...ACCEPTABLE coverage ; Individual's responsibility to obtain
Index of Sec 301. ...ACCEPTABLE coverage ; Individual's responsibility to obtain
Index of Sec 301. ...ACCEPTABLE coverage ; Individual's responsibility to obtain
Index of Sec 301. ...RETAIL ; Records described in subsection not to be licensed, transferred, used or sold by pharmacy benefits manager, insurance company, electronic transmission intermediary,
Index of Sec 138. ...RETAIL pharmacies ; Information on volume of prescriptions under contract filled via mail order and
Index of Sec 133. ...RETIREMENT unless reduction being made with respect to active participants ; Reduction affecting benefits provided to participant or beneficiary as of date participant retired for purposes of plan and reduction occuring after participant's
Index of Sec 165. ...HEALTH benefits ; Group health plan described in subsection containing provision reserving general power to amend or terminate plan or provision specifically authorizing plan to make post-retirement reductions in retiree
Index of Sec 165. ...RETIREMENT systems referred in subparagraphs ; Paragraph of subsection applying by treating services as not covered by
Index of Sec 412. ...REVOCATION of waiver granted under section upon determination making by Secretary ; Secretary providing for
Index of Sec 251. ...RISK of self-insured employers not to be able to pay obligations or otherwise becoming financially insolvent ;
Index of Sec 113. ...RISK of self-insured employers not to be able to pay obligations or otherwise becoming financially insolvent ;
Index of Sec 113. ...RISK of self-insured employers not to be able to pay obligations or otherwise becoming financially insolvent ;
Index of Sec 113. ...HEALTH and health care ; Including information necessary to administer risk pooling mechanism described in section 206(b) and information to address disparities in
Index of Sec 204. ...HEALTH and health care ; Including information necessary to administer risk pooling mechanism described in section 206(b) and information to address disparities in
Index of Sec 204. ...HEALTH and health care ; Including information necessary to administer risk pooling mechanism described in section 206(b) and information to address disparities in
Index of Sec 204. ...RISK pooling mechanism as Commissioner establishing under section 206(b) ; Entity participating in
Index of Sec 204. ...RISK pooling mechanism as Commissioner establishing under section 206(b) ; Entity participating in
Index of Sec 204. ...RISK pooling mechanism as Commissioner establishing under section 206(b) ; Entity participating in
Index of Sec 204. ...HEALTH benefits planing offered by entities so as to minimizing impact of adverse selection of enrollees among plans offered by entities ; Commissioner establishing mechanism whereby being adjustment making of premium amounting payable among QHBP offering entities offering Exchange-participating health benefits planing of premiums collected for plans taking into account differences in risk characteristics of individuals and employers enrolled under different Exchange-participating
Index of Sec 206. ...HEALTH benefits planing offered by entities so as to minimizing impact of adverse selection of enrollees among plans offered by entities ; Commissioner establishing mechanism whereby being adjustment making of premium amounting payable among QHBP offering entities offering Exchange-participating health benefits planing of premiums collected for plans taking into account differences in risk characteristics of individuals and employers enrolled under different Exchange-participating
Index of Sec 206. ...HEALTH benefits planing offered by entities so as to minimizing impact of adverse selection of enrollees among plans offered by entities ; Commissioner establishing mechanism whereby being adjustment making of premium amounting payable among QHBP offering entities offering Exchange-participating health benefits planing of premiums collected for plans taking into account differences in risk characteristics of individuals and employers enrolled under different Exchange-participating
Index of Sec 206. ...RISK of death ; Use increasing
Index of Sec 138. ...CONSUMER protections under subtitle D of title I ; Includ establishment of risk pooling mechanism under section 206 and
Index of Sec 201. ...CONSUMER protections under subtitle D of title I ; Includ establishment of risk pooling mechanism under section 206 and
Index of Sec 201. ...CONSUMER protections under subtitle D of title I ; Includ establishment of risk pooling mechanism under section 206 and
Index of Sec 201. ...HEALTH benefits planning of QHBP offering entity ; Clause not applying if Commissioner determining that delay in termination posing imminent and serious risk to health of individuals enrolled under qualified
Index of Sec 204. ...HEALTH benefits planning of QHBP offering entity ; Clause not applying if Commissioner determining that delay in termination posing imminent and serious risk to health of individuals enrolled under qualified
Index of Sec 204. ...HEALTH benefits planning of QHBP offering entity ; Clause not applying if Commissioner determining that delay in termination posing imminent and serious risk to health of individuals enrolled under qualified
Index of Sec 204. ...HEALTH insurance coverage without changing premium for enrollees in same risk group at same rate as specified by Commissioner ; Issuer not varying percentage increase in premium for risk group of enrollees in specific grandfathered
Index of Sec 102. ...HEALTH insurance coverage without changing premium for enrollees in same risk group at same rate as specified by Commissioner ; Issuer not varying percentage increase in premium for risk group of enrollees in specific grandfathered
Index of Sec 102. ...HEALTH insurance coverage without changing premium for enrollees in same risk group at same rate as specified by Commissioner ; Issuer not varying percentage increase in premium for risk group of enrollees in specific grandfathered
Index of Sec 102. ...RISK group at same rate as specified by Commissioner ; Issuer not varying percentage increase in premium for risk group of enrollees in specific grandfathered health insurance coverage without changing premium for enrollees in same
Index of Sec 102. ...RISK group at same rate as specified by Commissioner ; Issuer not varying percentage increase in premium for risk group of enrollees in specific grandfathered health insurance coverage without changing premium for enrollees in same
Index of Sec 102. ...RISK group at same rate as specified by Commissioner ; Issuer not varying percentage increase in premium for risk group of enrollees in specific grandfathered health insurance coverage without changing premium for enrollees in same
Index of Sec 102. ...HEALTH benefits planning offered by employer and instead to enroll in Exchange-participating health benefits planning ; Health Choices Commissioner to have authority to set standards for determining whether employers or insurers undertaking actions to affect risk pool within Health Insurance Exchange by inducing individuals to decline coverage under qualified
Index of Sec 314. ...HEALTH benefits planning offered by employer and instead to enroll in Exchange-participating health benefits planning ; Health Choices Commissioner to have authority to set standards for determining whether employers or insurers undertaking actions to affect risk pool within Health Insurance Exchange by inducing individuals to decline coverage under qualified
Index of Sec 314. ...HEALTH benefits planning offered by employer and instead to enroll in Exchange-participating health benefits planning ; Health Choices Commissioner to have authority to set standards for determining whether employers or insurers undertaking actions to affect risk pool within Health Insurance Exchange by inducing individuals to decline coverage under qualified
Index of Sec 314. ...RISK pools of large group insurers and self-insured employers ; Report including recommendations Commissioner deeming appropriate to ensure that law not providing incentives for small and mid-size employers to self-insuring or creating adverse selection in
Index of Sec 113. ...RISK pools of large group insurers and self-insured employers ; Report including recommendations Commissioner deeming appropriate to ensure that law not providing incentives for small and mid-size employers to self-insuring or creating adverse selection in
Index of Sec 113. ...RISK pools of large group insurers and self-insured employers ; Report including recommendations Commissioner deeming appropriate to ensure that law not providing incentives for small and mid-size employers to self-insuring or creating adverse selection in
Index of Sec 113. ...ROBUST requiring minimal augmentation by paper transactions or clarifiations by further communications ; Efficient and
Index of Sec 163. ...ROBUST requiring minimal augmentation by paper transactions or clarifiations by further communications ; Efficient and
Index of Sec 164. ...DISABILITY, socioeconomic status, rural, urban or other geographic setting and other population or subpopulation as determined appropriate by Secretary ; Primary language, sex, sexual orientation, gender identity,
Index of Sec 221. ...RURAL area and practicing in rural area for 5-year period preceding date ; Date of appointment, practice in
Index of Sec 123. ...RURAL area for 5-year period preceding date ; Date of appointment, practice in rural area and practicing in
Index of Sec 123. ...SALARY and funding limited to services ; Participation by health maintenance organizations limited to non-profit health maintenance organizations owning own delivery facilities and employing physicians on
Index of Sec 253. ...SAVINGS in previous year under division resulting from application of provisions described in subparagraph and reporting estimate to Commissioner ; Chief Actuary of Centers of Medicare and Medicaid Services estimating amount of
Index of Sec 243. ...SAVINGS ; Adjustments based on excess federal health Reform
Index of Sec 441. ...SAVINGS being more than $175,000,000,000, paragraphs and subsection of subsection not applying to taxable year beginning after December 31 ; Excess Federal health reform
Index of Sec 441. ...SAVINGS ; Adjustments based on federal health Reform
Index of Sec 441. ...SAVINGS meaning sum of amounts described in subparagraphs and paragraph ; Term Federal health reform
Index of Sec 441. ...DISABILITY, socioeconomic status, rural, urban or other geographic setting and other population or subpopulation as determined appropriate by Secretary ; Primary language, sex, sexual orientation, gender identity,
Index of Sec 221. ...DISABILITY, socioeconomic status, rural, urban or other geographic setting and other population or subpopulation as determined appropriate by Secretary ; Primary language, sex, sexual orientation, gender identity,
Index of Sec 221. ...HEALTH care providers by Veterans Administration ; Software making available to
Index of Sec 157. ...COOPERATIVE offers or issuing insurance coverage ; Grants to cooperatives to assist cooperatives in meeting State solvency requirements in States in which
Index of Sec 252. ...SPECIFIC retailer, manufacturer or wholesaler ; Other provision of law, information disclosed by PBM to Commissioner or QHBP offering entity under subsection being confidential and not disclosed by Commissioner or QHBP offering entity in form disclosing identity of specific PBM or prices charged by PBM or
Index of Sec 133. ...BENEFICIARY identification card ; Including whether individual being eligible for specific service with specific physician at specific facility including utilization of machine-readable health plan
Index of Sec 163. ...BENEFICIARY identification card ; Including whether individual being eligible for specific service with specific physician at specific facility including utilization of machine-readable health plan
Index of Sec 164. ...SPECIFIC criteria and pediatric-specific criteria where available and appropriate ; Criteria including written clinical review criteria based on valid clinical evidence where available and directed specifically at meeting needs of at-risk populations and covered individuals with chronic conditions or severe illnesses including gender-
Index of Sec 139. ...MEDICAL judgment ; Specific exclusions or express limitations on amount, duration or scope of coverage not involving
Index of 0BENEFICIARY identification card ; Including whether individual being eligible for specific service with specific physician at specific facility including utilization of machine-readable health plan
Index of Sec 163. ...BENEFICIARY identification card ; Including whether individual being eligible for specific service with specific physician at specific facility including utilization of machine-readable health plan
Index of Sec 164. ...SPECIFIC methodolology for establishing rates or calculation of rates ;
Index of Sec 223. ...SPECIFIC methodolology for establishing rates or calculation of rates ;
Index of Sec 223. ...SPECIFIC retailer, manufacturer or wholesaler ; Other provision of law, information disclosed by PBM to Commissioner or QHBP offering entity under subsection being confidential and not disclosed by Commissioner or QHBP offering entity in form disclosing identity of specific PBM or prices charged by PBM or
Index of Sec 133. ...BENEFICIARY identification card ; Including whether individual being eligible for specific service with specific physician at specific facility including utilization of machine-readable health plan
Index of Sec 163. ...BENEFICIARY identification card ; Including whether individual being eligible for specific service with specific physician at specific facility including utilization of machine-readable health plan
Index of Sec 164. ...SPECIFIC standards, criteria or procedures used for utilization review for procedures, treatment and services delivered to enrollee during same course of treatment ; Program not revising or modifying
Index of Sec 139. ...COLLECTIVE bargaining over terms and conditions of employment related to health care ; Nothing in division to be construed to alter of supercede statutory or other obligation to engage in
Index of Sec 154. ...COLLECTIVE bargaining over terms and conditions of employment related to health care ; Nothing in division to be construed to alter or supercede statutory or other obligation to engage in
Index of Sec 154. ...COLLECTIVE bargaining over terms and conditions of employment related to health care ; Nothing in division to be construed to alter of supercede statutory or other obligation to engage in
Index of Sec 154. ...SUBJECT ; Requiring health plan created or regulated under Act to
Index of Sec 157. ...SUBJECT of appeal ; Plan or entity refunding payment of filing fee under paragraph if recommendation of external appeal entity to reverse or modify denial of claim for benefits being
Index of 0PAYMENTS in cases involving individuals and multiple plan coverage ; Commissioner establishing standards for coordination and subrogation of benefits and reimbursement of
Index of Sec 136. ...PAYMENTS in cases involving individuals and multiple plan coverage ; Commissioner establishing standards for coordination and subrogation of benefits and reimbursement of
Index of Sec 136. ...PAYMENTS in cases involving individuals and multiple plan coverage ; Commissioner establishing standards for coordination and subrogation of benefits and reimbursement of
Index of Sec 136. ...CHILD'S congenital or developmental deformity, disease or injury ; Group health plan and health insurance issuer offering group health insurance coverage providing coverage for surgical benefits providing coverage for outpatient and inpatient diagnosis and treatment of minor
Index of Sec 163. ...CHILD'S congenital or developmental deformity, disease or injury ; Health insurance issuer offering health insurance coverage in individual market providing coverage for surgical benefits providing coverage for outpatient and inpatient diagnosis and treatment of minor
Index of Sec 163. ...SURGICAL treatment in opinion of treating physician ; Coverage provided under paragraph to be subject to pre-authorization or pre-certification as required by plan or issuer and coverage including
Index of Sec 163. ...SURGICAL treatment in opinion of treating physician ; Coverage provided under paragraph to be subject to pre-authorization or pre-certification as required by insurance issuer offering coverage and coverage including
Index of Sec 163. ...SUSPENSION of enrollment of individuals under plan after date Commissioner notifies entity of determination under paragraph and Commissioner satisfied that basis for determination corrected and not likely to recur ;
Index of Sec 142. ...SUSPENSION of enrollment of individuals under plan after date Commissioner notifies entity of determination under paragraph and Commissioner satisfied that basis for determination corrected and not likely to recur ;
Index of Sec 142. ...SUSPENSION of enrollment of individuals under plan after date Commissioner notifies entity of determination under paragraph and Commissioner satisfied that basis for determination corrected and not likely to recur ;
Index of Sec 142. ...PAYMENT to entity under Health Insurance Exchange for individuals enrolled in plan after date Commissioner notifies entity of determination under paragraph and Secretary satisfied that basis for determination corrected and not likely to recur ; Suspension of
Index of Sec 142. ...PAYMENT to entity under Health Insurance Exchange for individuals enrolled in plan after date Commissioner notifies entity of determination under paragraph and Secretary satisfied that basis for determination corrected and not likely to recur ; Suspension of
Index of Sec 142. ...PAYMENT to entity under Health Insurance Exchange for individuals enrolled in plan after date Commissioner notifies entity of determination under paragraph and Secretary satisfied that basis for determination corrected and not likely to recur ; Suspension of
Index of Sec 142. ...TAX imposed under subsection with respect to taxpayer for taxable year not exceeding applicable national average premium for taxable year ;
Index of Sec 401. ...TAX imposed under subsection with respect to taxpayer for taxable year not exceeding amount ;
Index of Sec 401. ...TAX ; Increasing by amount of interest received or accrued by taxpayer during taxable year being exempt from
Index of Sec 401. ...CREDIT under chapter or purposes of section 55 ; Tax imposed under section not to be treated as tax imposed by chapter for purposes of determining amount of
Index of Sec 401. ...ACCEPTABLE coverage ; Exemption from tax imposed under subsection in cases of de minimis lapses of
Index of Sec 401. ...TAX imposed by subsection for failures during taxable year of employer not exceeding amount equal to lesser ;
Index of Sec 411. ...CIVIL penalty collected under section 502(c) of Employee Retirement Income Security Act of 1974 or sectioning 2793(g) of Public Health Service Act with respect to failure ; Tax imposed under paragraph with respect to failure to be reduced by amount of
Index of Sec 411. ...ACCOUNT under section ; Only amounts taking into account in connection with tax imposed under section 871(b) to be taken into
Index of Sec 441. ...CREDIT under chapter or purposes of section 55 ; Tax imposed under section not to be treated as tax imposed by chapter for purposes of determining amount of
Index of Sec 441. ...FOREIGN parent corporation ; Withholding tax imposed under chapter 3 with respect to payment not to be reduced under treaty of United States unless withholding tax to be reduced under treaty of United States if payment being made directly to
Index of Sec 451. ...TAX of $100 for day in period beginning on date ; Imposing failure with respect employee
Index of Sec 411. ...EXCISE tax on other failures of electing employers to comply with requirements ;
Index of Sec 322. ...EMPLOYMENT ; Imposing on every nonelecting employer excise tax equalling to 8 percent of wages paid with respect to
Index of Sec 412. ...EXCISE tax equalling to 8 percent ; Imposing on every nonelecting employer
Index of Sec 412. ...TAX to be imposed by paragraph on failure during period ; No
Index of Sec 411. ...TAX to be imposed by paragraph on failureing ; No
Index of Sec 411. ...TAX for purposes of section 15 of Internal Revenue Code of 1986 ; Amendment making by subsection not to be treated as change in rate of
Index of Sec 401. ...TAX for purposes of section 15 of Internal Revenue Code of 1986 ; Amendment making by subsection not to be treated as change in rate of
Index of Sec 441. ...ACCOUNT for purposes of subsection if amendment or supplement filed after earlier of date taxpayer being first contacted by Secretary regarding examination of return or other date as specified by Secretary ; No event amending or supplementing to return of tax to be taken into
Index of Sec 453. ...ECONOMIC substance or lacking business purpose ; Term economic substance doctrine meaning common law doctrine under which tax benefits under subtitle A with respect to transaction being not allowable if transaction not to have
Index of Sec 452. ...ECONOMIC substance or failing to meet requirements of similar rule of law ; Disallowance of claimed tax benefits by reason of transaction lacking
Index of Sec 453. ...TAX benefits to be allowed if transaction respected ; Potential for profit of transaction to be taken into account in determining whether requirements of subparagraphs and paragraph being met with respect to transaction only if present value of reasonably expected pre-tax profit from transaction being substantial in relation to present value of expected net
Index of Sec 452. ...TAX benefits to be allowed if transaction respected ; Potential for profit of transaction to be taken into account in determining whether requirements of subparagraphs and paragraph being met with respect to transaction only if present value of reasonably expected pre-tax profit from transaction being substantial in relation to present value of expected net
Index of Sec 452. ...TAX profit under subparagraph ; Fees and other transaction expenses and foreign taxes to be taken into account as expenses in determining pre-
Index of Sec 452. ...TAX treatment being not adequately disclosed in return nor in statement attached to return ; Term nondisclosed noneconomic substance transaction meaning portion of transaction described in subsection with respect to which relevant facts affecting
Index of Sec 453. ...TELEPHONE and printed form ; Utilization review program making determination concerning authorization and providing notice of determination to individual or individual's designee and individual's health care provider by
Index of Sec 139. ...HEALTH care provider ; Plan providing by telephone and printed form notice of concurrent review determination to individual or individual's designee and individual's
Index of Sec 139. ...INFORMATION being reasonably necessary to make determination ; Utilization review program making determination concerning services and providing notice of determination to individual or individual's designee and individual's health care provider by telephone and printed form within 30 days of date of receipt of
Index of Sec 139. ...TELEPHONE, facsimile or other similarly expeditious available method ; Necessary information to be transmitted between plan or issuer and requester by
Index of 0TELEPHONE during normal business hours to discuss patient care and allowing response to telephone requests and appropriate provision being made to receive and respond promptly to calls received during other hours ; Program providing that appropriate personnel performing utilization review activities under program being reasonably accessible by toll-free
Index of Sec 139. ...HEALTH benefits planing and file complaints ; Providing for operation of toll-free telephone hotline to respond to requests for assistance and maintaining Internet website through individuals obtaining information on coverage under Exchange-participating
Index of Sec 205. ...HEALTH benefits planing and file complaints ; Providing for operation of toll-free telephone hotline to respond to requests for assistance and maintaining Internet website through individuals obtaining information on coverage under Exchange-participating
Index of Sec 205. ...HEALTH benefits planing and file complaints ; Providing for operation of toll-free telephone hotline to respond to requests for assistance and maintaining Internet website through individuals obtaining information on coverage under Exchange-participating
Index of Sec 205. ...TESTIFY in proceeding concerning violation ;
Index of Sec 153. ...TESTIFY in proceeding concerning violation ;
Index of Sec 153. ...TESTIFY in proceeding concerning violation ;
Index of Sec 153. ...PRIMARY insured and name of other individual obtaining coverage under policy ; Name, address and tin of
Index of Sec 401. ...TITLE ; Claim for benefits and including failure to provide benefits required to be provided under
Index of Sec 139. ...INSURANCE regulators and Secretaries of Labor and Treasury ; Establishment of qualified health benefits planning standards under title including enforcement of standards in coordination with State
Index of Sec 142. ...INSURANCE regulators and Secretaries of Labor and Treasury ; Establishment of qualified health benefits planning standards under title including enforcement of standards in coordination with State
Index of Sec 142. ...INSURANCE regulators and Secretaries of Labor and Treasury ; Establishment of qualified health benefits planning standards under title including enforcement of standards in coordination with State
Index of Sec 142. ...TITLE being further amended by inserting after section 2753 following new section ;
Index of Sec 161. ...TITLE being further amended by inserting after section 2753 following new section ;
Index of Sec 161. ...TITLE ; Provisions of Federal Acquisition Regulation not applying to contracts between Commissioner and QHBP offering entities for offering of Exchange-participating health benefits planing under
Index of Sec 204. ...TITLE ; Provisions of Federal Acquisition Regulation not applying to contracts between Commissioner and QHBP offering entities for offering of Exchange-participating health benefits planing under
Index of Sec 204. ...TITLE ; Provisions of Federal Acquisition Regulation not applying to contracts between Commissioner and QHBP offering entities for offering of Exchange-participating health benefits planing under
Index of Sec 204. ...TITLE ; Commissioner providing for broad dissemination of information on Exchange-participating health benefits planing offered under
Index of Sec 205. ...TITLE ; Commissioner providing for broad dissemination of information on Exchange-participating health benefits planing offered under
Index of Sec 205. ...TITLE ; Commissioner providing for broad dissemination of information on Exchange-participating health benefits planing offered under
Index of Sec 205. ...TITLE in same manner as provisions applying to Medicare and Medicare beneficiaries ; Provisions of Medicare relating to access of Medicare beneficiaries to Federal courts for enforcement of rights under Medicare applying to public health insurance option and individuals enrolled under option under
Index of Sec 221. ...TITLE in same manner as provisions applying to Medicare and Medicare beneficiaries ; Provisions of Medicare relating to access of Medicare beneficiaries to Federal courts for enforcement of rights under Medicare applying to public health insurance option and individuals enrolled under option under
Index of Sec 221. ...TITLE in same manner as provisions applying to Medicare and Medicare beneficiaries ; Provisions of Medicare relating to access of Medicare beneficiaries to Federal courts for enforcement of rights under Medicare applying to public health insurance option and individuals enrolled under option under
Index of Sec 221. ...TITLE ; Amendments making by subsection remaining in effect until timing as benefit standards adopted subject to section 124 of
Index of Sec 163. ...COERCIVE practices to force providers not to contract with other entities offering coverage through Health Insurance Exchange ; Entity complying with other applicable requirements of title that including standards regarding billing and collection practices for premiums and related grace periods and including standards to ensure that entity not using
Index of Sec 204. ...COERCIVE practices to force providers not to contract with other entities offering coverage through Health Insurance Exchange ; Entity complying with other applicable requirements of title that including standards regarding billing and collection practices for premiums and related grace periods and including standards to ensure that entity not using
Index of Sec 204. ...COERCIVE practices to force providers not to contract with other entities offering coverage through Health Insurance Exchange ; Entity complying with other applicable requirements of title that including standards regarding billing and collection practices for premiums and related grace periods and including standards to ensure that entity not using
Index of Sec 204. ...HEALTH benefits planing and plans including marketing of plans ; Commissioner establishing processing to oversee, monitor and enforce applicable requirements of title with respect to QHBP offering entities offering Exchange-participating
Index of Sec 204. ...HEALTH benefits planing and plans including marketing of plans ; Commissioner establishing processing to oversee, monitor and enforce applicable requirements of title with respect to QHBP offering entities offering Exchange-participating
Index of Sec 204. ...HEALTH benefits planing and plans including marketing of plans ; Commissioner establishing processing to oversee, monitor and enforce applicable requirements of title with respect to QHBP offering entities offering Exchange-participating
Index of Sec 204. ...TITLE ; Commissioner terminating contract with QHBP offering entity under section for offering of Exchange-participating health benefits planning if entity failing to comply with applicable requirements of
Index of Sec 204. ...TITLE ; Commissioner terminating contract with QHBP offering entity under section for offering of Exchange-participating health benefits planning if entity failing to comply with applicable requirements of
Index of Sec 204. ...TITLE ; Commissioner terminating contract with QHBP offering entity under section for offering of Exchange-participating health benefits planning if entity failing to comply with applicable requirements of
Index of Sec 204. ...TITLE and necessary under plan or coverage for authorizing benefit ; Coverage or subtitle or failing to take action For which person being responsible under plan or
Index of 0CONSUMER protections ; Purpose of title to establish standards to ensure that new health insurance coverage and employment-based health plans offered meet standards guaranteeing access to affordable coverage, essential benefits and other
Index of Sec 101. ...CONSUMER protections ; Purpose of title to establish standards to ensure that new health insurance coverage and employment-based health plans offered meet standards guaranteeing access to affordable coverage, essential benefits and other
Index of Sec 101. ...CONSUMER protections ; Purpose of title to establish standards to ensure that new health insurance coverage and employment-based health plans offered meet standards guaranteeing access to affordable coverage, essential benefits and other
Index of Sec 101. ...TITLE ; Election to be treated as establishment and maintenance of group health plan for purposes of
Index of Sec 321. ...TITLE ; Election to be treated as establishment and maintenance of group health plan for purposes of
Index of Sec 321. ...TITLE ; Election to be treated as establishment and maintenance of group health plan for purposes of
Index of Sec 323. ...TITLE ; Election to be treated as establishment and maintenance of group health plan for purposes of
Index of Sec 323. ...TITLE ; Commissioner determining that QHBP offering entity violating requirement of
Index of Sec 142. ...TITLE ; Commissioner determining that QHBP offering entity violating requirement of
Index of Sec 142. ...TITLE ; Commissioner determining that QHBP offering entity violating requirement of
Index of Sec 142. ...TITLE ; Working with State insurance regulators to terminate plans for repeated failure by offering entity to meet requirements of
Index of Sec 142. ...TITLE ; Working with State insurance regulators to terminate plans for repeated failure by offering entity to meet requirements of
Index of Sec 142. ...TITLE ; Working with State insurance regulators to terminate plans for repeated failure by offering entity to meet requirements of
Index of Sec 142. ...TITLE I of Employee Retirement Income Security Act of 1974 or State law excepting insofar as requirements preventing application of requirement of division as determined by Commissioner ; Requirements of title not superceding requirements applicable under titles XXII and XXVII of Public Health Service Act, parts 6 and 7 of subtitle B of
Index of Sec 151. ...TITLE I of Employee Retirement Income Security Act of 1974 or State law excepting insofar as requirements preventing application of requirement of division as determined by Commissioner ; Requirements of title not superceding requirements applicable under titles XXII and XXVII of Public Health Service Act, parts 6 and 7 of subtitle B of
Index of Sec 151. ...TITLE I of Employee Retirement Income Security Act of 1974 or State law excepting insofar as requirements preventing application of requirement of division as determined by Commissioner ; Requirements of title not superceding requirements applicable under titles XXII and XXVII of Public Health Service Act, parts 6 and 7 of subtitle B of
Index of Sec 151. ...TITLE not superceding requirements applicable under title XXVII of Public Health Service Act or State law ; Requirements of
Index of Sec 151. ...TITLE not superceding requirements applicable under title XXVII of Public Health Service Act or State law ; Requirements of
Index of Sec 151. ...TITLE not superceding requirements applicable under title XXVII of Public Health Service Act or State law ; Requirements of
Index of Sec 151. ...TITLE and titling I ; Establishing standards necessary to implement requirements of
Index of Sec 204. ...TITLE and titling I ; Establishing standards necessary to implement requirements of
Index of Sec 204. ...TITLE and titling I ; Establishing standards necessary to implement requirements of
Index of Sec 204. ...TITLE ; Affordabilty credits under subtitle not to be treated to be benefit provided under section 403 of
Index of Sec 242. ...TITLE ; Affordability credits under subtitle not to be treated to be benefit provided under section 403 of
Index of Sec 242. ...TITLE ; Affordability credits under subtitle not to be treated to be benefit provided under section 403 of
Index of Sec 242. ...TITLE and titling I for purposes of subtitle ; Certifying QHBP offering entities and qualified health benefits planing as meeting standards and requirements of
Index of Sec 204. ...TITLE and titling I for purposes of subtitle ; Certifying QHBP offering entities and qualified health benefits planing as meeting standards and requirements of
Index of Sec 204. ...TITLE and titling I for purposes of subtitle ; Certifying QHBP offering entities and qualified health benefits planing as meeting standards and requirements of
Index of Sec 204. ...TITLE ; Patterning or practicing of repeated refusal to authorize benefit determined by external appeal entity in violation of terms plan or
Index of 0TITLE 10, United States coding ; Nothing in section to be construed as affecting authority under title 38, United States Code or chapter 55 of
Index of Sec 202. ...TITLE 29 ; Qualified health benefits planning QHBP offering entity providing internal claims and appeals processing that initially incorporating claims and appealing procedures set forth at section 2560.503 -1 of
Index of Sec 132. ...TITLE 29 ; Qualified health benefits planning QHBP offering entity providing internal claims and appeals processing that initially incorporating claims and appealing procedures set forth at section 2560.503 -1 of
Index of Sec 132. ...TITLE 10, United States coding ; Nothing in section to be construed as affecting authority under title 38, United States Code or chapter 55 of
Index of Sec 202. ...TITLE 38 of Code ; Including similar coverage furnished under section 1781 of
Index of Sec 202. ...TITLE 38 of Code ; Including similar coverage furnished under section 1781 of
Index of Sec 202. ...TITLE 38 of Code ; Including similar coverage furnished under section 1781 of
Index of Sec 202. ...TITLE 38 of Code ; Including similar coverage furnished under section 1781 of
Index of Sec 401. ...PAYMENT rates under section ; Chapter 5 of title 5, United States Code applying to process for initial establishment of
Index of Sec 223. ...PAYMENT rates under section ; Chapter 5 of title 5, United States Code applying to process for initial establishment of
Index of Sec 223. ...TITLE 5, United States coding ; Including health benefiting plan offered under chapter 89 of
Index of Sec 100. ...TITLE 5, United States coding ; Including health benefiting plan offered under chapter 89 of
Index of Sec 100. ...TITLE 5, United States coding ; Including health benefiting plan offered under chapter 89 of
Index of Sec 100. ...TITLE 5, United States Code or State program providing comparable continations coverage ; Section 4980b of Internal Revenue Code of 1986 of sectioning insofar as relating to pediatric vaccines or section 905a of
Index of Sec 167. ...TITLE 5, United States coding in case of sections 208 and 241(b)(2) ; Including use of personnel employed in accordance with requirements of
Index of Sec 142. ...TITLE 5, United States coding in case of sections 208 and 241(b)(2) ; Including use of personnel employed in accordance with requirements of
Index of Sec 142. ...TITLE 5, United States coding in case of sections 208 and 241(b)(2) ; Including use of personnel employed in accordance with requirements of
Index of Sec 142. ...TITLE and enforcement of standards ; Including concerning standards for insured qualified health benefits planing under
Index of Sec 143. ...TITLE and enforcement of standards ; Including concerning standards for insured qualified health benefits planing under
Index of Sec 143. ...TITLE and enforcement of standards ; Including concerning standards for insured qualified health benefits planing under
Index of Sec 143. ...HEALTH benefits ; Public health insurance option complying with requirements being applicable under title to Exchange-participating
Index of Sec 221. ...HEALTH benefits ; Public health insurance option complying with requirements being applicable under title to Exchange-participating
Index of Sec 221. ...HEALTH benefits ; Public health insurance option complying with requirements being applicable under title to Exchange-participating
Index of Sec 221. ...HEALTH insurance option ; Term qualified health benefits planning meaning health benefiting plan meeting requirements plan under title I and including public
Index of Sec 100. ...HEALTH insurance option and cooperatives under subtitle D of title II ; Term qualified health benefits planning meaning health benefiting plan meeting requirements plan under title I and including public
Index of Sec 100. ...HEALTH insurance option ; Term qualified health benefits planning meaning health benefiting plan meeting requirements plan under title I and including public
Index of Sec 100. ...HEALTH benefits planning ; Basic plan offering essential benefits packaging required under title I for qualified
Index of Sec 203. ...HEALTH benefits planning ; Basic plan offering essential benefits packaging required under title I for qualified
Index of Sec 203. ...HEALTH benefits planning ; Basic plan offering essential benefits packaging required under title I for qualified
Index of Sec 203. ...TITLE I and section ; Commissioner specifying benefits to be made available under Exchange-participating health benefits planing during plan year, consistent with subtitle C of
Index of Sec 203. ...TITLE I and section ; Commissioner specifying benefits to be made available under Exchange-participating health benefits planing during plan year, consistent with subtitle C of
Index of Sec 203. ...TITLE I and section ; Commissioner specifying benefits to be made available under Exchange-participating health benefits planing during plan year, consistent with subtitle C of
Index of Sec 203. ...TITLE I of Employee Retirement Income Security Act of 1974 ; Term cobra continations coverage meaning continations coverage provided pursuant to part 6 of subtitle B of
Index of Sec 167. ...TITLE I ; Consistent with subsection and subtitling C of
Index of Sec 203. ...TITLE I ; Consistent with subsection and subtitling C of
Index of Sec 203. ...TITLE I ; Consistent with subsection and subtitling C of
Index of Sec 203. ...TITLE I of Employee Retirement Income Security Act of 1974 amended by inserting after section 714 following new section ; Part 7 of subtitle B of
Index of Sec 165. ...TITLE I of Employee Retirement Income Security Act of 1974 or State law excepting insofar as requirements preventing application of requirement of division as determined by Commissioner ; Requirements of title not superceding requirements applicable under titles XXII and XXVII of Public Health Service Act, parts 6 and 7 of subtitle B of
Index of Sec 151. ...TITLE I of Employee Retirement Income Security Act of 1974 or State law excepting insofar as requirements preventing application of requirement of division as determined by Commissioner ; Requirements of title not superceding requirements applicable under titles XXII and XXVII of Public Health Service Act, parts 6 and 7 of subtitle B of
Index of Sec 151. ...TITLE I of Employee Retirement Income Security Act of 1974 or State law excepting insofar as requirements preventing application of requirement of division as determined by Commissioner ; Requirements of title not superceding requirements applicable under titles XXII and XXVII of Public Health Service Act, parts 6 and 7 of subtitle B of
Index of Sec 151. ...TITLE I of Employee Retirement Income Security Act of 1974 ; Section 104(1) of Health Insurance Portability and Accountability Act of 1996 amended by striking subtitle and inserting provisions of part 7 of subtitle B of
Index of Sec 163. ...TITLE I of Employee Retirement Income Security Act of 1974 ; Regulations, rulings and interpretations issued by officers relating to same matter over which two or more of officers having responsibility under subpart B of part 6 of subtitle B of
Index of Sec 324. ...TITLE I of Employee Retirement Income Security Act of 1974 ; Regulations, rulings and interpretations issued by officers relating to same matter over which two or more of officers having responsibility under subpart B of part 6 of subtitle B of
Index of Sec 324. ...TITLE I of Employee Retirement Income Security Act of 1974 ; Regulations, rulings and interpretations issued by officers relating to same matter over which two or more of officers having responsibility under subpart B of part 6 of subtitle B of
Index of Sec 324. ...TITLE I of Employee Retirement Income Security Act of 1974 amended by adding at end following new part ; Subtitle B of
Index of Sec 321. ...TITLE I of Employee Retirement Income Security Act of 1974 amended by adding at end following new part ; Subtitle B of
Index of Sec 321. ...TITLE I ; Includ establishment of risk pooling mechanism under section 206 and consumer protections under subtitle D of
Index of Sec 201. ...TITLE I ; Includ establishment of risk pooling mechanism under section 206 and consumer protections under subtitle D of
Index of Sec 201. ...TITLE I ; Includ establishment of risk pooling mechanism under section 206 and consumer protections under subtitle D of
Index of Sec 201. ...TITLE I with respect to entity for violation requirement ; Nothing in subsection to be construed as preventing application of other sanctions under subtitle E of
Index of Sec 204. ...TITLE I with respect to entity for violation requirement ; Nothing in subsection to be construed as preventing application of other sanctions under subtitle E of
Index of Sec 204. ...TITLE I with respect to entity for violation requirement ; Nothing in subsection to be construed as preventing application of other sanctions under subtitle E of
Index of Sec 204. ...TITLE II of America's Affordable Health Choices acting of 2009 ; Return information of taxpayer whose income being relevant in determining affordability credit described in subtitle C of
Index of Sec 431. ...CREDIT in excess of appropriate amount ; Establishing and verifying appropriate amount of affordability credit described in subtitle C of title II of America's Affordable Health Choices acting of 2009 and providing for repayment
Index of Sec 431. ...TITLE II of division ; Increase in rates under paragraph not resulting in increase in affordability premium or cost-sharing credits under subtitle C of
Index of Sec 157. ...TITLE II ; Term public health insurance option meaning public health insurance option as provided under subtitle B of
Index of Sec 100. ...TITLE II ; Term public health insurance option meaning public health insurance option as provided under subtitle B of
Index of Sec 100. ...TITLE II ; Term public health insurance option meaning public health insurance option as provided under subtitle B of
Index of Sec 100. ...ELIGIBILITY for credits ; Administration of individual affordability credits under subtitle C of title II including determination of
Index of Sec 142. ...ELIGIBILITY for credits ; Administration of individual affordability credits under subtitle C of title II including determination of
Index of Sec 142. ...ELIGIBILITY for credits ; Administration of individual affordability credits under subtitle C of title II including determination of
Index of Sec 142. ...TITLE II not used for purposes of paying for services ; Affordability credits provided under subtitle C of
Index of Sec 203. ...TITLE II ; Terms health benefits planning means health insurance coverage and employment-based health plan and including public health insurance option and cooperatives under subtitle D of
Index of Sec 100. ...TITLE II ; Health insurance coverage including cooperative under subtitle D of
Index of Sec 100. ...TITLE II ; Term qualified health benefits planning meaning health benefiting plan meeting requirements plan under title I and including public health insurance option and cooperatives under subtitle D of
Index of Sec 100. ...TITLE III of America's Affordable Health Choices acting of 2009 ; Term health coverage participation requirements meaning requirements of part I of subtitle B of
Index of Sec 411. ...TITLE III of division A of America's Affordable Health Choices acting of 2009 ; Term health coverage participation requirements meaning requirements of part 1 of subtitle B of
Index of Sec 321. ...TITLE III of division A of America's Affordable Health Choices acting of 2009 ; Term health coverage participation requirements meaning requirements of part 1 of subtitle B of
Index of Sec 321. ...TITLE III of division A of America's Affordable Health Choices acting of 2009 ; Term health coverage participation requirements meaning requirements of part 1 of subtitle B of
Index of Sec 323. ...TITLE III of division A of America's Affordable Health Choices acting of 2009 ; Term health coverage participation requirements meaning requirements of part 1 of subtitle B of
Index of Sec 323. ...TITLE III ; Employer meeting requirements of section 312 with respect to employees of employer by offering employees option of enrolling with Exchange-participating health benefits planing through Health Insurance Exchange consistent with provisions of subtitle B of
Index of Sec 202. ...TITLE III ; Employer meeting requirements of section 312 with respect to employees of employer by offering employees option of enrolling with Exchange-participating health benefits planing through Health Insurance Exchange consistent with provisions of subtitle B of
Index of Sec 202. ...TITLE III ; Employer meeting requirements of section 312 with respect to employees of employer by offering employees option of enrolling with Exchange-participating health benefits planing through Health Insurance Exchange consistent with provisions of subtitle B of
Index of Sec 202. ...TITLE VII of Civil Rights acting of 1964 ; Nothing in section altering rights and obligations of employees and employers under
Index of Sec 156. ...DISCLOSURE of individually identifiable health information ; Part C of title XI of Social Security Act relating to standards for protections against wrongful
Index of Sec 228. ...TITLE XIX of Social Security Act ; Term Medicaid meaning State plan under
Index of Sec 100. ...TITLE XIX of Social Security Act ; Term Medicaid meaning State plan under
Index of Sec 100. ...TITLE XIX of Social Security Act ; Term Medicaid meaning State plan under
Index of Sec 100. ...TITLE XIX of Social Security Act ; Single State agency responsible for administering plan under
Index of Sec 100. ...TITLE XIX of Social Security Act ; Single State agency responsible for administering plan under
Index of Sec 100. ...TITLE XIX of Social Security Act ; Single State agency responsible for administering plan under
Index of Sec 100. ...TITLE XVIII of Social Security Act ; Term Medicare meaning health insurance programs under
Index of Sec 100. ...TITLE XVIII of Social Security Act ; Term Medicare meaning health insurance programs under
Index of Sec 100. ...TITLE XVIII of Social Security Act ; Term Medicare meaning health insurance programs under
Index of Sec 100. ...AFFORDABILITY credits under subtitle C ; Secretary of Health and Human Services submitting to Congress report comparing benefits packaging offered in 2011 to average State child health plan under title XXI of Social Security Act and benefit standards adopted under section 124 for essential benefits packaging and
Index of Sec 202. ...HEALTH benefits planning until Secretary of Health and Human Services ; No child to be eligible for coverage under title XXI of Social Security Act to be enrolled in Exchange participating
Index of Sec 202. ...TITLE XXI of Social Security Act deemed as of first day to be Exchange-eligible individual unless individual being traditional Medicaid eligible individual as of day ; Child being eligible for child health assistance under
Index of Sec 205. ...TITLE XXI of Social Security Act deemed as of first day to be Exchange-eligible individual unless individual being traditional Medicaid eligible individual as of day ; Child being eligible for child health assistance under
Index of Sec 205. ...TITLE XXI of Social Security Act deemed as of first day to be Exchange-eligible individual unless individual being traditional Medicaid eligible individual as of day ; Child being eligible for child health assistance under
Index of Sec 205. ...TITLE XXI of Social Security Act ; Commissioner establishing rules under which family income of child deemed to be no greater than family income of child as recently determined before Y1 by State under
Index of Sec 245. ...TITLE XXI of Social Security Act ; Commissioner establishing rules under which family income of child deemed to be no greater than family income of child as recently determined before Y1 by State under
Index of Sec 245. ...TITLE XXI of Social Security Act ; Commissioner establishing rules under which family income of child deemed to be no greater than family income of child as recently determined before Y1 by State under
Index of Sec 245. ...TITLE XXVII of Public Health Service Act or State law ; Requirements of title not superceding requirements applicable under
Index of Sec 151. ...TITLE XXVII of Public Health Service Act or State law ; Requirements of title not superceding requirements applicable under
Index of Sec 151. ...TITLE XXVII of Public Health Service Act or State law ; Requirements of title not superceding requirements applicable under
Index of Sec 151. ...TITLE XXVII of Public Health Service Act amended by inserting after section 2713 following new section ;
Index of Sec 161. ...TITLE XXVII of Public Health Service Act amended by inserting after section 2713 following new section ;
Index of Sec 161. ...TITLE XXVII of Public Health Service Act amended by adding at end following new section ; Part C of
Index of Sec 323. ...TITLE XXVII of Public Health Service Act amended by adding at end following new section ; Part C of
Index of Sec 323. ...TITLE XXVII of Public Health Service Act amended by adding at end following new section ; Subpart 2 of part A of
Index of Sec 163. ...TITLE XXVII of Public Health Service Act being further amended by adding at end following new section ; Subpart 2 of part B of
Index of Sec 163. ...TELEPHONE during normal business hours to discuss patient care and allowing response to telephone requests and appropriate provision being made to receive and respond promptly to calls received during other hours ; Program providing that appropriate personnel performing utilization review activities under program being reasonably accessible by toll-free
Index of Sec 139. ...HEALTH benefits planing and file complaints ; Providing for operation of toll-free telephone hotline to respond to requests for assistance and maintaining Internet website through individuals obtaining information on coverage under Exchange-participating
Index of Sec 205. ...HEALTH benefits planing and file complaints ; Providing for operation of toll-free telephone hotline to respond to requests for assistance and maintaining Internet website through individuals obtaining information on coverage under Exchange-participating
Index of Sec 205. ...HEALTH benefits planing and file complaints ; Providing for operation of toll-free telephone hotline to respond to requests for assistance and maintaining Internet website through individuals obtaining information on coverage under Exchange-participating
Index of Sec 205. ...TRADE or business of employer during taxable year ; Term qualified employee meaning employee of employer for taxable year of employer if employee received $5,000 of compensation from employer for services performed in
Index of Sec 421. ...INCOME ; Paragraph applying only to transactions entered in connection with trade or business or activity engaged for production of
Index of Sec 452. ...HEALTH, medical and scientific matters ; Knowledgeable about health care system and received training regarding
Index of Sec 123. ...HEALTH care provider relating to reimbursement arrangements between planning and provider ; Qualified health benefits planning complying with standards established by Commissioner to ensure transparency to
Index of Sec 133. ...HEALTH care provider relating to reimbursement arrangements between planning and provider ; Qualified health benefits planning complying with standards established by Commissioner to ensure transparency to
Index of Sec 133. ...HEALTH care provider relating to reimbursement arrangements between planning and provider ; Qualified health benefits planning complying with standards established by Commissioner to ensure transparency to
Index of Sec 133. ...IN-network coverage ; Using provider network for items and services meeting standards respecting provider networks as Commissioner establishing to assure adequacy of networks in ensuring enrollee access to items and services and transparency in cost-sharing differentials between
Index of Sec 115. ...IN-network coverage ; Using provider network for items and services meeting standards respecting provider networks as Commissioner establishing to assure adequacy of networks in ensuring enrollee access to items and services and transparency in cost-sharing differentials between
Index of Sec 115. ...IN-network coverage ; Using provider network for items and services meeting standards respecting provider networks as Commissioner establishing to assure adequacy of networks in ensuring enrollee access to items and services and transparency in cost-sharing differentials between
Index of Sec 115. ...PUBLIC set of guiding principles ensuring operating rules and process being open and transparent ; Entity in place
Index of Sec 164. ...FOREIGN parent corporation ; Withholding tax imposed under chapter 3 with respect to payment not to be reduced under treaty of United States unless withholding tax to be reduced under treaty of United States if payment being made directly to
Index of Sec 451. ...TRUST ; Subsection not applying to
Index of Sec 441. ...UNDERPAYMENT penalties ; Striking gross valuation misstatement penalty in heading and inserting certain increased
Index of Sec 453. ...ECONOMIC substance ; Penalty for underpayments attributable to transactions lacking
Index of Sec 453. ...UNDERTAKEN by employer to correct failure ; Secretary informing employer in writing of failureing and providing employer information regarding efforts and procedures to be
Index of Sec 321. ...UNDERTAKEN by employer to correct failure ; Secretary informing employer in writing of failureing and providing employer information regarding efforts and procedures to be
Index of Sec 321. ...UNDERTAKEN by employer to correct failure ; Secretary informing employer in writing of failureing and providing employer information regarding efforts and procedures to be
Index of Sec 323. ...UNDERTAKEN by employer to correct failure ; Secretary informing employer in writing of failureing and providing employer information regarding efforts and procedures to be
Index of Sec 323. ...UNDERPAYMENT penalties ; Striking gross valuation misstatement penalty in heading and inserting certain increased
Index of Sec 453. ...VISION only coverage ; Nothing in subtitle to be construed as requiring individual being 21 years of age or older to be provided stand alone dental only or
Index of Sec 122. ...VISION services to be treated as satisfying essential benefits packaging under division ; Combiations of stand alone coverage described in paragraph and qualified health benefits planning without coverage of oral and
Index of Sec 122. ...VOLUNTARY basis and consistent with standards established pursuant to section 1709 of Public Health Service Act ; Data collection conducted on
Index of Sec 221. ...VOTING policy with balanced representation by critical stakeholders so ; Entity demonstrating established multi-stakeholder process creating consensus based operating rules using
Index of Sec 164. ...RESPONSIBILITY among workers, employers and government ; Initiates shared
Index of Sec 100. ...RESPONSIBILITY among workers, employers and government ; Initiates shared
Index of Sec 100. ...RESPONSIBILITY among workers, employers and government ; Initiates shared
Index of Sec 100. ...1st Session |
To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.
Mr. Dingell (for himself, Mr. Rangel, Mr. Waxman, Mr. George Miller of California, Mr. Stark, Mr. Pallone, and Mr. Andrews) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Labor, Oversight and Government Reform, and the Budget, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
(1) IN GENERAL.—The purpose of this division is to provide affordable, quality health care for all Americans and reduce the growth in health care spending.
(2) BUILDING ON CURRENT SYSTEM.—This division achieves this purpose by building on what works in today’s health care system, while repairing the aspects that are broken.
(3) INSURANCE REFORMS.—This division—
(A) enacts strong insurance market reforms;
(B) creates a new Health Insurance Exchange, with a public health insurance option alongside private plans;
(C) includes sliding scale affordability credits; and
(D) initiates shared responsibility among workers, employers, and the government;
so that all Americans have coverage of essential health benefits.
(4) HEALTH DELIVERY REFORM.—This division institutes health delivery system reforms both to increase quality and to reduce growth in health spending so that health care becomes more affordable for businesses, families, and government.
(b) Table of contents of division.—The table of contents of this division is as follows:
(c) General definitions.—Except as otherwise provided, in this division:
(1) ACCEPTABLE COVERAGE.—The term “acceptable coverage” has the meaning given such term in section 202(d)(2).
(2) BASIC PLAN.—The term “basic plan” has the meaning given such term in section 203(c).
(3) COMMISSIONER.—The term “Commissioner” means the Health Choices Commissioner established under section 141.
(4) COST-SHARING.—The term “cost-sharing” includes deductibles, coinsurance, copayments, and similar charges but does not include premiums or any network payment differential for covered services or spending for non-covered services.
(5) DEPENDENT.—The term “dependent” has the meaning given such term by the Commissioner and includes a spouse.
(6) EMPLOYMENT-BASED HEALTH PLAN.—The term “employment-based health plan”—
(A) means a group health plan (as defined in section 733(a)(1) of the Employee Retirement Income Security Act of 1974); and
(B) includes such a plan that is the following:
(i) FEDERAL, STATE, AND TRIBAL GOVERNMENTAL PLANS.—A governmental plan (as defined in section 3(32) of the Employee Retirement Income Security Act of 1974), including a health benefits plan offered under chapter 89 of title 5, United States Code.
(ii) CHURCH PLANS.—A church plan (as defined in section 3(33) of the Employee Retirement Income Security Act of 1974).
(7) ENHANCED PLAN.—The term “enhanced plan” has the meaning given such term in section 203(c).
(8) ESSENTIAL BENEFITS PACKAGE.—The term “essential benefits package” is defined in section 122(a).
(9) FAMILY.—The term “family” means an individual and includes the individual’s dependents.
(10) FEDERAL POVERTY LEVEL; FPL.—The terms “Federal poverty level” and “FPL” have the meaning given the term “poverty line” in section 673(2) of the Community Services Block Grant Act (42 U.S.C. 9902(2)), including any revision required by such section.
(11) HEALTH BENEFITS PLAN.—The terms “health benefits plan” means health insurance coverage and an employment-based health plan and includes the public health insurance option.
(12) HEALTH INSURANCE COVERAGE; HEALTH INSURANCE ISSUER.—The terms “health insurance coverage” and “health insurance issuer” have the meanings given such terms in section 2791 of the Public Health Service Act.
(13) HEALTH INSURANCE EXCHANGE.—The term “Health Insurance Exchange” means the Health Insurance Exchange established under section 201.
(14) MEDICAID.—The term “Medicaid” means a State plan under title XIX of the Social Security Act (whether or not the plan is operating under a waiver under section 1115 of such Act).
(15) MEDICARE.—The term “Medicare” means the health insurance programs under title XVIII of the Social Security Act.
(16) PLAN SPONSOR.—The term “plan sponsor” has the meaning given such term in section 3(16)(B) of the Employee Retirement Income Security Act of 1974.
(17) PLAN YEAR.—The term “plan year” means—
(A) with respect to an employment-based health plan, a plan year as specified under such plan; or
(B) with respect to a health benefits plan other than an employment-based health plan, a 12-month period as specified by the Commissioner.
(18) PREMIUM PLAN; PREMIUM-PLUS PLAN.—The terms “premium plan” and “premium-plus plan” have the meanings given such terms in section 203(c).
(19) QHBP OFFERING ENTITY.—The terms “QHBP offering entity” means, with respect to a health benefits plan that is—
(A) a group health plan (as defined, subject to subsection (d), in section 733(a)(1) of the Employee Retirement Income Security Act of 1974), the plan sponsor in relation to such group health plan, except that, in the case of a plan maintained jointly by 1 or more employers and 1 or more employee organizations and with respect to which an employer is the primary source of financing, such term means such employer;
(B) health insurance coverage, the health insurance issuer offering the coverage;
(C) the public health insurance option, the Secretary of Health and Human Services;
(D) a non-Federal governmental plan (as defined in section 2791(d) of the Public Health Service Act), the State or political subdivision of a State (or agency or instrumentality of such State or subdivision) which establishes or maintains such plan; or
(E) a Federal governmental plan (as defined in section 2791(d) of the Public Health Service Act), the appropriate Federal official.
(20) QUALIFIED HEALTH BENEFITS PLAN.—The term “qualified health benefits plan” means a health benefits plan that meets the requirements for such a plan under title I and includes the public health insurance option.
(21) PUBLIC HEALTH INSURANCE OPTION.—The term “public health insurance option” means the public health insurance option as provided under subtitle B of title II.
(22) SERVICE AREA; PREMIUM RATING AREA.—The terms “service area” and “premium rating area” mean with respect to health insurance coverage—
(A) offered other than through the Health Insurance Exchange, such an area as established by the QHBP offering entity of such coverage in accordance with applicable State law; and
(B) offered through the Health Insurance Exchange, such an area as established by such entity in accordance with applicable State law and applicable rules of the Commissioner for Exchange-participating health benefits plans.
(23) STATE.—The term “State” means the 50 States and the District of Columbia.
(24) STATE MEDICAID AGENCY.—The term “State Medicaid agency” means, with respect to a Medicaid plan, the single State agency responsible for administering such plan under title XIX of the Social Security Act.
(25) Y1, Y2, ETC..—The terms “Y1” , “Y2”, “Y3”, “Y4”, “Y5”, and similar subsequently numbered terms, mean 2013 and subsequent years, respectively.
(a) Purpose.—The purpose of this title is to establish standards to ensure that new health insurance coverage and employment-based health plans that are offered meet standards guaranteeing access to affordable coverage, essential benefits, and other consumer protections.
(b) Requirements for qualified health benefits plans.—On or after the first day of Y1, a health benefits plan shall not be a qualified health benefits plan under this division unless the plan meets the applicable requirements of the following subtitles for the type of plan and plan year involved:
(1) Subtitle B (relating to affordable coverage).
(2) Subtitle C (relating to essential benefits).
(3) Subtitle D (relating to consumer protection).
(c) Terminology.—In this division:
(1) ENROLLMENT IN EMPLOYMENT-BASED HEALTH PLANS.—An individual shall be treated as being “enrolled” in an employment-based health plan if the individual is a participant or beneficiary (as such terms are defined in section 3(7) and 3(8), respectively, of the Employee Retirement Income Security Act of 1974) in such plan.
(2) INDIVIDUAL AND GROUP HEALTH INSURANCE COVERAGE.—The terms “individual health insurance coverage” and “group health insurance coverage” mean health insurance coverage offered in the individual market or large or small group market, respectively, as defined in section 2791 of the Public Health Service Act.
(a) Grandfathered health insurance coverage defined.—Subject to the succeeding provisions of this section, for purposes of establishing acceptable coverage under this division, the term “grandfathered health insurance coverage” means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met:
(1) LIMITATION ON NEW ENROLLMENT.—
(A) IN GENERAL.—Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1.
(B) DEPENDENT COVERAGE PERMITTED.—Subparagraph (A) shall not affect the subsequent enrollment of a dependent of an individual who is covered as of such first day.
(2) LIMITATION ON CHANGES IN TERMS OR CONDITIONS.—Subject to paragraph (3) and except as required by law, the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day before the first day of Y1.
(3) RESTRICTIONS ON PREMIUM INCREASES.—The issuer cannot vary the percentage increase in the premium for a risk group of enrollees in specific grandfathered health insurance coverage without changing the premium for all enrollees in the same risk group at the same rate, as specified by the Commissioner.
(b) Grace period for current employment-based health plans.—
(A) IN GENERAL.—The Commissioner shall establish a grace period whereby, for plan years beginning after the end of the 5-year period beginning with Y1, an employment-based health plan in operation as of the day before the first day of Y1 must meet the same requirements as apply to a qualified health benefits plan under section 101, including the essential benefit package requirement under section 121.
(B) EXCEPTION FOR LIMITED BENEFITS PLANS.—Subparagraph (A) shall not apply to an employment-based health plan in which the coverage consists only of one or more of the following:
(i) Any coverage described in section 3001(a)(1)(B)(ii)(IV) of division B of the American Recovery and Reinvestment Act of 2009 (PL 111–5).
(ii) Excepted benefits (as defined in section 733(c) of the Employee Retirement Income Security Act of 1974), including coverage under a specified disease or illness policy described in paragraph (3)(A) of such section.
(iii) Such other limited benefits as the Commissioner may specify.
In no case shall an employment-based health plan in which the coverage consists only of one or more of the coverage or benefits described in clauses (i) through (iii) be treated as acceptable coverage under this division
(2) TRANSITIONAL TREATMENT AS ACCEPTABLE COVERAGE.—During the grace period specified in paragraph (1)(A), an employment-based health plan that is described in such paragraph shall be treated as acceptable coverage under this division.
(c) Limitation on individual health insurance coverage.—
(1) IN GENERAL.—Individual health insurance coverage that is not grandfathered health insurance coverage under subsection (a) may only be offered on or after the first day of Y1 as an Exchange-participating health benefits plan.
(2) SEPARATE, EXCEPTED COVERAGE PERMITTED.—Excepted benefits (as defined in section 2791(c) of the Public Health Service Act) are not included within the definition of health insurance coverage. Nothing in paragraph (1) shall prevent the offering, other than through the Health Insurance Exchange, of excepted benefits so long as it is offered and priced separately from health insurance coverage.
A qualified health benefits plan may not impose any pre-existing condition exclusion (as defined in section 2701(b)(1)(A) of the Public Health Service Act) or otherwise impose any limit or condition on the coverage under the plan with respect to an individual or dependent based on any health status-related factors (as defined in section 2791(d)(9) of the Public Health Service Act) in relation to the individual or dependent.
The requirements of sections 2711 (other than subsections (c) and (e)) and 2712 (other than paragraphs (3), and (6) of subsection (b) and subsection (e)) of the Public Health Service Act, relating to guaranteed availability and renewability of health insurance coverage, shall apply to individuals and employers in all individual and group health insurance coverage, whether offered to individuals or employers through the Health Insurance Exchange, through any employment-based health plan, or otherwise, in the same manner as such sections apply to employers and health insurance coverage offered in the small group market, except that such section 2712(b)(1) shall apply only if, before nonrenewal or discontinuation of coverage, the issuer has provided the enrollee with notice of non-payment of premiums and there is a grace period during which the enrollees has an opportunity to correct such nonpayment. Rescissions of such coverage shall be prohibited except in cases of fraud as defined in sections 2712(b)(2) of such Act.
(a) In general.—The premium rate charged for an insured qualified health benefits plan may not vary except as follows:
(1) LIMITED AGE VARIATION PERMITTED.—By age (within such age categories as the Commissioner shall specify) so long as the ratio of the highest such premium to the lowest such premium does not exceed the ratio of 2 to 1.
(2) BY AREA.—By premium rating area (as permitted by State insurance regulators or, in the case of Exchange-participating health benefits plans, as specified by the Commissioner in consultation with such regulators).
(3) BY FAMILY ENROLLMENT.—By family enrollment (such as variations within categories and compositions of families) so long as the ratio of the premium for family enrollment (or enrollments) to the premium for individual enrollment is uniform, as specified under State law and consistent with rules of the Commissioner.
(1) STUDY.—The Commissioner, in coordination with the Secretary of Health and Human Services and the Secretary of Labor, shall conduct a study of the large group insured and self-insured employer health care markets. Such study shall examine the following:
(A) The types of employers by key characteristics, including size, that purchase insured products versus those that self-insure.
(B) The similarities and differences between typical insured and self-insured health plans.
(C) The financial solvency and capital reserve levels of employers that self-insure by employer size.
(D) The risk of self-insured employers not being able to pay obligations or otherwise becoming financially insolvent.
(E) The extent to which rating rules are likely to cause adverse selection in the large group market or to encourage small and mid size employers to self-insure
(2) REPORTS.—Not later than 18 months after the date of the enactment of this Act, the Commissioner shall submit to Congress and the applicable agencies a report on the study conducted under paragraph (1). Such report shall include any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives for small and mid-size employers to self-insure or create adverse selection in the risk pools of large group insurers and self-insured employers. Not later than 18 months after the first day of Y1, the Commissioner shall submit to Congress and the applicable agencies an updated report on such study, including updates on such recommendations.
(a) Nondiscrimination in benefits.—A qualified health benefits plan shall comply with standards established by the Commissioner to prohibit discrimination in health benefits or benefit structures for qualifying health benefits plans, building from sections 702 of Employee Retirement Income Security Act of 1974, 2702 of the Public Health Service Act, and section 9802 of the Internal Revenue Code of 1986.
(b) Parity in mental health and substance abuse disorder benefits.—To the extent such provisions are not superceded by or inconsistent with subtitle C, the provisions of section 2705 (other than subsections (a)(1), (a)(2), and (c)) of section 2705 of the Public Health Service Act shall apply to a qualified health benefits plan, regardless of whether it is offered in the individual or group market, in the same manner as such provisions apply to health insurance coverage offered in the large group market.
(a) In general.—A qualified health benefits plan that uses a provider network for items and services shall meet such standards respecting provider networks as the Commissioner may establish to assure the adequacy of such networks in ensuring enrollee access to such items and services and transparency in the cost-sharing differentials between in-network coverage and out-of-network coverage.
(b) Provider network defined.—In this division, the term “provider network” means the providers with respect to which covered benefits, treatments, and services are available under a health benefits plan.
(a) In general.—A qualified health benefits plan shall meet a medical loss ratio as defined by the Commissioner. For any plan year in which the qualified health benefits plan does not meet such medical loss ratio, QHBP offering entity shall provide in a manner specified by the Commissioner for rebates to enrollees of payment sufficient to meet such loss ratio.
(b) Building on interim rules.—In implementing subsection (a), the Commissioner shall build on the definition and methodology developed by the Secretary of Health and Human Services under the amendments made by section 161 for determining how to calculate the medical loss ratio. Such methodology shall be set at the highest level medical loss ratio possible that is designed to ensure adequate participation by QHBP offering entities, competition in the health insurance market in and out of the Health Insurance Exchange, and value for consumers so that their premiums are used for services.
(a) In general.—A qualified health benefits plan shall provide coverage that at least meets the benefit standards adopted under section 124 for the essential benefits package described in section 122 for the plan year involved.
(1) NON-EXCHANGE-PARTICIPATING HEALTH BENEFITS PLANS.—In the case of a qualified health benefits plan that is not an Exchange-participating health benefits plan, such plan may offer such coverage in addition to the essential benefits package as the QHBP offering entity may specify.
(2) EXCHANGE-PARTICIPATING HEALTH BENEFITS PLANS.—In the case of an Exchange-participating health benefits plan, such plan is required under section 203 to provide specified levels of benefits and, in the case of a plan offering a premium-plus level of benefits, provide additional benefits.
(3) CONTINUATION OF OFFERING OF SEPARATE EXCEPTED BENEFITS COVERAGE.—Nothing in this division shall be construed as affecting the offering of health benefits in the form of excepted benefits (described in section 102(b)(1)(B)(ii)) if such benefits are offered under a separate policy, contract, or certificate of insurance.
(c) No restrictions on coverage unrelated to clinical appropriateness.—A qualified health benefits plan may not impose any restriction (other than cost-sharing) unrelated to clinical appropriateness on the coverage of the health care items and services.
(a) In general.—In this division, the term “essential benefits package” means health benefits coverage, consistent with standards adopted under section 124 to ensure the provision of quality health care and financial security, that—
(1) provides payment for the items and services described in subsection (b) in accordance with generally accepted standards of medical or other appropriate clinical or professional practice;
(2) limits cost-sharing for such covered health care items and services in accordance with such benefit standards, consistent with subsection (c);
(3) does not impose any annual or lifetime limit on the coverage of covered health care items and services;
(4) complies with section 115(a) (relating to network adequacy); and
(5) is equivalent, as certified by Office of the Actuary of the Centers for Medicare & Medicaid Services, to the average prevailing employer-sponsored coverage.
(b) Minimum services to be covered.—The items and services described in this subsection are the following:
(1) Hospitalization.
(2) Outpatient hospital and outpatient clinic services, including emergency department services.
(3) Professional services of physicians and other health professionals.
(4) Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care in institutional settings, physician offices, patients’ homes or place of residence, or other settings, as appropriate.
(5) Prescription drugs.
(6) Rehabilitative and habilitative services.
(7) Mental health and substance use disorder services.
(8) Preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services and those vaccines recommended for use by the Director of the Centers for Disease Control and Prevention.
(9) Maternity care.
(10) Well baby and well child care and oral health, vision, and hearing services, equipment, and supplies at least for children under 21 years of age.
(c) Requirements relating to cost-sharing and minimum actuarial value.—
(1) NO COST-SHARING FOR PREVENTIVE SERVICES.—There shall be no cost-sharing under the essential benefits package for preventive items and services (as specified under the benefit standards), including well baby and well child care.
(A) ANNUAL LIMITATION.—The cost-sharing incurred under the essential benefits package with respect to an individual (or family) for a year does not exceed the applicable level specified in subparagraph (B).
(B) APPLICABLE LEVEL.—The applicable level specified in this subparagraph for Y1 is $5,000 for an individual and $10,000 for a family. Such levels shall be increased (rounded to the nearest $100) for each subsequent year by the annual percentage increase in the Consumer Price Index (United States city average) applicable to such year.
(C) USE OF COPAYMENTS.—In establishing cost-sharing levels for basic, enhanced, and premium plans under this subsection, the Secretary shall, to the maximum extent possible, use only copayments and not coinsurance.
(A) IN GENERAL.—The cost-sharing under the essential benefits package shall be designed to provide a level of coverage that is designed to provide benefits that are actuarially equivalent to approximately 70 percent of the full actuarial value of the benefits provided under the reference benefits package described in subparagraph (B).
(B) REFERENCE BENEFITS PACKAGE DESCRIBED.—The reference benefits package described in this subparagraph is the essential benefits package if there were no cost-sharing imposed.
(1) IN GENERAL.—There is established a private-public advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans.
(2) CHAIR.—The Surgeon General shall be a member and the chair of the Health Benefits Advisory Committee.
(3) MEMBERSHIP.—The Health Benefits Advisory Committee shall be composed of the following members, in addition to the Surgeon General:
(A) 9 members who are not Federal employees or officers and who are appointed by the President.
(B) 9 members who are not Federal employees or officers and who are appointed by the Comptroller General of the United States in a manner similar to the manner in which the Comptroller General appoints members to the Medicare Payment Advisory Commission under section 1805(c) of the Social Security Act.
(C) Such even number of members (not to exceed 8) who are Federal employees and officers, as the President may appoint.
Such initial appointments shall be made not later than 60 days after the date of the enactment of this Act.
(4) TERMS.—Each member of the Health Benefits Advisory Committee shall serve a 3-year term on the Committee, except that the terms of the initial members shall be adjusted in order to provide for a staggered term of appointment for all such members.
(5) PARTICIPATION.—The membership of the Health Benefits Advisory Committee shall at least reflect providers, consumer representatives, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and ethnic disparities, experts in care for those with disabilities, representatives of relevant governmental agencies. and at least one practicing physician or other health professional and an expert on children’s health and shall represent a balance among various sectors of the health care system so that no single sector unduly influences the recommendations of such Committee.
(1) RECOMMENDATIONS ON BENEFIT STANDARDS.—The Health Benefits Advisory Committee shall recommend to the Secretary of Health and Human Services (in this subtitle referred to as the “Secretary”) benefit standards (as defined in paragraph (4)), and periodic updates to such standards. In developing such recommendations, the Committee shall take into account innovation in health care and consider how such standards could reduce health disparities.
(2) DEADLINE.—The Health Benefits Advisory Committee shall recommend initial benefit standards to the Secretary not later than 1 year after the date of the enactment of this Act.
(3) PUBLIC INPUT.—The Health Benefits Advisory Committee shall allow for public input as a part of developing recommendations under this subsection.
(4) BENEFIT STANDARDS DEFINED.—In this subtitle, the term “benefit standards” means standards respecting—
(A) the essential benefits package described in section 122, including categories of covered treatments, items and services within benefit classes, and cost-sharing; and
(B) the cost-sharing levels for enhanced plans and premium plans (as provided under section 203(c)) consistent with paragraph (5).
(5) LEVELS OF COST-SHARING FOR ENHANCED AND PREMIUM PLANS.—
(A) ENHANCED PLAN.—The level of cost-sharing for enhanced plans shall be designed so that such plans have benefits that are actuarially equivalent to approximately 85 percent of the actuarial value of the benefits provided under the reference benefits package described in section 122(c)(3)(B).
(B) PREMIUM PLAN.—The level of cost-sharing for premium plans shall be designed so that such plans have benefits that are actuarially equivalent to approximately 95 percent of the actuarial value of the benefits provided under the reference benefits package described in section 122(c)(3)(B).
(1) PER DIEM PAY.—Each member of the Health Benefits Advisory Committee shall receive travel expenses, including per diem in accordance with applicable provisions under subchapter I of chapter 57 of title 5, United States Code, and shall otherwise serve without additional pay.
(2) MEMBERS NOT TREATED AS FEDERAL EMPLOYEES.—Members of the Health Benefits Advisory Committee shall not be considered employees of the Federal government solely by reason of any service on the Committee.
(3) APPLICATION OF FACA.—The Federal Advisory Committee Act (5 U.S.C. App.), other than section 14, shall apply to the Health Benefits Advisory Committee.
(d) Publication.—The Secretary shall provide for publication in the Federal Register and the posting on the Internet website of the Department of Health and Human Services of all recommendations made by the Health Benefits Advisory Committee under this section.
(a) Process for Adoption of Recommendations.—
(1) REVIEW OF RECOMMENDED STANDARDS.—Not later than 45 days after the date of receipt of benefit standards recommended under section 123 (including such standards as modified under paragraph (2)(B)), the Secretary shall review such standards and shall determine whether to propose adoption of such standards as a package.
(2) DETERMINATION TO ADOPT STANDARDS.—If the Secretary determines—
(A) to propose adoption of benefit standards so recommended as a package, the Secretary shall, by regulation under section 553 of title 5, United States Code, propose adoption such standards; or
(B) not to propose adoption of such standards as a package, the Secretary shall notify the Health Benefits Advisory Committee in writing of such determination and the reasons for not proposing the adoption of such recommendation and provide the Committee with a further opportunity to modify its previous recommendations and submit new recommendations to the Secretary on a timely basis.
(3) CONTINGENCY.—If, because of the application of paragraph (2)(B), the Secretary would otherwise be unable to propose initial adoption of such recommended standards by the deadline specified in subsection (b)(1), the Secretary shall, by regulation under section 553 of title 5, United States Code, propose adoption of initial benefit standards by such deadline.
(4) PUBLICATION.—The Secretary shall provide for publication in the Federal Register of all determinations made by the Secretary under this subsection.
(1) INITIAL STANDARDS.—Not later than 18 months after the date of the enactment of this Act, the Secretary shall, through the rulemaking process consistent with subsection (a), adopt an initial set of benefit standards.
(2) PERIODIC UPDATING STANDARDS.—Under subsection (a), the Secretary shall provide for the periodic updating of the benefit standards previously adopted under this section.
(3) REQUIREMENT.—The Secretary may not adopt any benefit standards for an essential benefits package or for level of cost-sharing that are inconsistent with the requirements for such a package or level under sections 122 and 123(b)(5).
The Commissioner shall establish uniform marketing standards that all insured QHBP offering entities shall meet.
(a) In general.—A QHBP offering entity shall provide for timely grievance and appeals mechanisms that the Commissioner shall establish.
(b) Internal claims and appeals process.—Under a qualified health benefits plan the QHBP offering entity shall provide an internal claims and appeals process that initially incorporates the claims and appeals procedures (including urgent claims) set forth at section 2560.503–1 of title 29, Code of Federal Regulations, as published on November 21, 2000 (65 Fed. Reg. 70246) and shall update such process in accordance with any standards that the Commissioner may establish.
(1) IN GENERAL.—The Commissioner shall establish an external review process (including procedures for expedited reviews of urgent claims) that provides for an impartial, independent, and de novo review of denied claims under this division.
(2) REQUIRING FAIR GRIEVANCE AND APPEALS MECHANISMS.—A determination made, with respect to a qualified health benefits plan offered by a QHBP offering entity, under the external review process established under this subsection shall be binding on the plan and the entity.
(d) Construction.—Nothing in this section shall be construed as affecting the availability of judicial review under State law for adverse decisions under subsection (b) or (c), subject to section 151.
(a) Accurate and timely disclosure.—
(1) IN GENERAL.—A qualified health benefits plan shall comply with standards established by the Commissioner for the accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on the number of claims denials, data on rating practices, information on cost-sharing and payments with respect to any out-of-network coverage, and other information as determined appropriate by the Commissioner. The Commissioner shall require that such disclosure be provided in plain language.
(2) PLAIN LANGUAGE.—In this subsection, the term “plain language” means language that the intended audience, including individuals with limited English proficiency, can readily understand and use because that language is clean, concise, well-organized, and follows other best practices of plain language writing.
(3) GUIDANCE.—The Commissioner shall develop and issue guidance on best practices of plain language writing.
(b) Contracting reimbursement.—A qualified health benefits plan shall comply with standards established by the Commissioner to ensure transparency to each health care provider relating to reimbursement arrangements between such plan and such provider.
(c) Advance notice of plan changes.—A change in a qualified health benefits plan shall not be made without such reasonable and timely advance notice to enrollees of such change.
The requirements of the previous provisions of this subtitle shall apply to qualified health benefits plans that are not being offered through the Health Insurance Exchange only to the extent specified by the Commissioner.
A QHBP offering entity shall comply with the requirements of section 1857(f) of the Social Security Act with respect to a qualified health benefits plan it offers in the same manner an Medicare Advantage organization is required to comply with such requirements with respect to a Medicare Advantage plan it offers under part C of Medicare.
The Commissioner shall establish standards for the coordination and subrogation of benefits and reimbursement of payments in cases involving individuals and multiple plan coverage.
A QHBP offering entity is required to comply with standards for electronic financial and administrative transactions under section 1173A of the Social Security Act, added by section 163(a).
(a) In general.—There is hereby established, as an independent agency in the executive branch of the Government, a Health Choices Administration (in this division referred to as the “Administration”).
(1) IN GENERAL.—The Administration shall be headed by a Health Choices Commissioner (in this division referred to as the “Commissioner”) who shall be appointed by the President, by and with the advice and consent of the Senate.
(2) COMPENSATION; ETC.—The provisions of paragraphs (2), (5), and (7) of subsection (a) (relating to compensation, terms, general powers, rulemaking, and delegation) of section 702 of the Social Security Act (42 U.S.C. 902) shall apply to the Commissioner and the Administration in the same manner as such provisions apply to the Commissioner of Social Security and the Social Security Administration.
(a) Duties.—The Commissioner is responsible for carrying out the following functions under this division:
(1) QUALIFIED PLAN STANDARDS.—The establishment of qualified health benefits plan standards under this title, including the enforcement of such standards in coordination with State insurance regulators and the Secretaries of Labor and the Treasury.
(2) HEALTH INSURANCE EXCHANGE.—The establishment and operation of a Health Insurance Exchange under subtitle A of title II.
(3) INDIVIDUAL AFFORDABILITY CREDITS.—The administration of individual affordability credits under subtitle C of title II, including determination of eligibility for such credits.
(4) ADDITIONAL FUNCTIONS.—Such additional functions as may be specified in this division.
(b) Promoting accountability.—
(1) IN GENERAL.—The Commissioner shall undertake activities in accordance with this subtitle to promote accountability of QHBP offering entities in meeting Federal health insurance requirements, regardless of whether such accountability is with respect to qualified health benefits plans offered through the Health Insurance Exchange or outside of such Exchange.
(2) COMPLIANCE EXAMINATION AND AUDITS.—
(A) IN GENERAL.—The commissioner shall, in coordination with States, conduct audits of qualified health benefits plan compliance with Federal requirements. Such audits may include random compliance audits and targeted audits in response to complaints or other suspected non-compliance.
(B) RECOUPMENT OF COSTS IN CONNECTION WITH EXAMINATION AND AUDITS.—The Commissioner is authorized to recoup from qualified health benefits plans reimbursement for the costs of such examinations and audit of such QHBP offering entities.
(c) Data collection.—The Commissioner shall collect data for purposes of carrying out the Commissioner’s duties, including for purposes of promoting quality and value, protecting consumers, and addressing disparities in health and health care and may share such data with the Secretary of Health and Human Services.
(1) IN GENERAL.—In the case that the Commissioner determines that a QHBP offering entity violates a requirement of this title, the Commissioner may, in coordination with State insurance regulators and the Secretary of Labor, provide, in addition to any other remedies authorized by law, for any of the remedies described in paragraph (2).
(2) REMEDIES.—The remedies described in this paragraph, with respect to a qualified health benefits plan offered by a QHBP offering entity, are—
(A) civil money penalties of not more than the amount that would be applicable under similar circumstances for similar violations under section 1857(g) of the Social Security Act;
(B) suspension of enrollment of individuals under such plan after the date the Commissioner notifies the entity of a determination under paragraph (1) and until the Commissioner is satisfied that the basis for such determination has been corrected and is not likely to recur;
(C) in the case of an Exchange-participating health benefits plan, suspension of payment to the entity under the Health Insurance Exchange for individuals enrolled in such plan after the date the Commissioner notifies the entity of a determination under paragraph (1) and until the Secretary is satisfied that the basis for such determination has been corrected and is not likely to recur; or
(D) working with State insurance regulators to terminate plans for repeated failure by the offering entity to meet the requirements of this title.
(e) Standard definitions of insurance and medical terms.—The Commissioner shall provide for the development of standards for the definitions of terms used in health insurance coverage, including insurance-related terms.
(f) Efficiency in administration.—The Commissioner shall issue regulations for the effective and efficient administration of the Health Insurance Exchange and affordability credits under subtitle C, including, with respect to the determination of eligibility for affordability credits, the use of personnel who are employed in accordance with the requirements of title 5, United States Code, to carry out the duties of the Commissioner or, in the case of sections 208 and 241(b)(2), the use of State personnel who are employed in accordance with standards prescribed by the Office of Personnel Management pursuant to section 208 of the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728).
(a) Consultation.—In carrying out the Commissioner’s duties under this division, the Commissioner, as appropriate, shall consult with at least with the following:
(1) The National Association of Insurance Commissioners, State attorneys general, and State insurance regulators, including concerning the standards for insured qualified health benefits plans under this title and enforcement of such standards.
(2) Appropriate State agencies, specifically concerning the administration of individual affordability credits under subtitle C of title II and the offering of Exchange-participating health benefits plans, to Medicaid eligible individuals under subtitle A of such title.
(3) Other appropriate Federal agencies.
(4) Indian tribes and tribal organizations.
(5) The National Association of Insurance Commissioners for purposes of using model guidelines established by such association for purposes of subtitles B and D.
(1) IN GENERAL.—In carrying out the functions of the Commissioner, including with respect to the enforcement of the provisions of this division, the Commissioner shall work in coordination with existing Federal and State entities to the maximum extent feasible consistent with this division and in a manner that prevents conflicts of interest in duties and ensures effective enforcement.
(2) UNIFORM STANDARDS.—The Commissioner, in coordination with such entities, shall seek to achieve uniform standards that adequately protect consumers in a manner that does not unreasonably affect employers and insurers.
(a) In general.—The Commissioner shall appoint within the Health Choices Administration a Qualified Health Benefits Plan Ombudsman who shall have expertise and experience in the fields of health care and education of (and assistance to) individuals.
(b) Duties.—The Qualified Health Benefits Plan Ombudsman shall, in a linguistically appropriate manner—
(1) receive complaints, grievances, and requests for information submitted by individuals;
(2) provide assistance with respect to complaints, grievances, and requests referred to in paragraph (1), including—
(A) helping individuals determine the relevant information needed to seek an appeal of a decision or determination;
(B) assistance to such individuals with any problems arising from disenrollment from such a plan;
(C) assistance to such individuals in choosing a qualified health benefits plan in which to enroll; and
(D) assistance to such individuals in presenting information under subtitle C (relating to affordability credits); and
(3) submit annual reports to Congress and the Commissioner that describe the activities of the Ombudsman and that include such recommendations for improvement in the administration of this division as the Ombudsman determines appropriate. The Ombudsman shall not serve as an advocate for any increases in payments or new coverage of services, but may identify issues and problems in payment or coverage policies.
(a) Coverage not offered through Exchange.—
(1) IN GENERAL.—In the case of health insurance coverage not offered through the Health Insurance Exchange (whether or not offered in connection with an employment-based health plan), and in the case of employment-based health plans, the requirements of this title do not supercede any requirements applicable under titles XXII and XXVII of the Public Health Service Act, parts 6 and 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974, or State law, except insofar as such requirements prevent the application of a requirement of this division, as determined by the Commissioner.
(2) CONSTRUCTION.—Nothing in paragraph (1) shall be construed as affecting the application of section 514 of the Employee Retirement Income Security Act of 1974.
(b) Coverage offered through Exchange.—
(1) IN GENERAL.—In the case of health insurance coverage offered through the Health Insurance Exchange—
(A) the requirements of this title do not supercede any requirements (including requirements relating to genetic information nondiscrimination and mental health) applicable under title XXVII of the Public Health Service Act or under State law, except insofar as such requirements prevent the application of a requirement of this division, as determined by the Commissioner; and
(B) individual rights and remedies under State laws shall apply.
(2) CONSTRUCTION.—In the case of coverage described in paragraph (1), nothing in such paragraph shall be construed as preventing the application of rights and remedies under State laws with respect to any requirement referred to in paragraph (1)(A).
(a) In general.—Except as otherwise explicitly permitted by this Act and by subsequent regulations consistent with this Act, all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services.
(b) Implementation.—To implement the requirement set forth in subsection (a), the Secretary of Health and Human Services shall, not later than 18 months after the date of the enactment of this Act, promulgate such regulations as are necessary or appropriate to insure that all health care and related services (including insurance coverage and public health activities) covered by this Act are provided (whether directly or through contractual, licensing, or other arrangements) without regard to personal characteristics extraneous to the provision of high quality health care or related services.
(a) Retaliation prohibited.—No employer may discharge any employee or otherwise discriminate against any employee with respect to his compensation, terms, conditions, or other privileges of employment because the employee (or any person acting pursuant to a request of the employee)—
(1) provided, caused to be provided, or is about to provide or cause to be provided to the employer, the Federal Government, or the attorney general of a State information relating to any violation of, or any act or omission the employee reasonably believes to be a violation of any provision of this Act or any order, rule, or regulation promulgated under this Act;
(2) testified or is about to testify in a proceeding concerning such violation;
(3) assisted or participated or is about to assist or participate in such a proceeding; or
(4) objected to, or refused to participate in, any activity, policy, practice, or assigned task that the employee (or other such person) reasonably believed to be in violation of any provision of this Act or any order, rule, or regulation promulgated under this Act.
(b) Enforcement action.—An employee covered by this section who alleges discrimination by an employer in violation of subsection (a) may bring an action governed by the rules, procedures, legal burdens of proof, and remedies set forth in section 40(b) of the Consumer Product Safety Act (15 U.S.C. 2087(b)).
(c) Employer defined.—As used in this section, the term “employer” means any person (including one or more individuals, partnerships, associations, corporations, trusts, professional membership organization including a certification, disciplinary, or other professional body, unincorporated organizations, nongovernmental organizations, or trustees) engaged in profit or nonprofit business or industry whose activities are governed by this Act, and any agent, contractor, subcontractor, grantee, or consultant of such person.
(d) Rule of construction.—The rule of construction set forth in section 20109(h) of title 49, United States Code, shall also apply to this section.
Nothing in this division shall be construed to alter of supercede any statutory or other obligation to engage in collective bargaining over the terms and conditions of employment related to health care.
If any provision of this Act, or any application of such provision to any person or circumstance, is held to be unconstitutional, the remainder of the provisions of this Act and the application of the provision to any other person or circumstance shall not be affected.
(a) Group health insurance coverage.—Title XXVII of the Public Health Service Act is amended by inserting after section 2713 the following new section:
“(a) In general.—Each health insurance issuer that offers health insurance coverage in the small or large group market shall provide that for any plan year in which the coverage has a medical loss ratio below a level specified by the Secretary, the issuer shall provide in a manner specified by the Secretary for rebates to enrollees of payment sufficient to meet such loss ratio. Such methodology shall be set at the highest level medical loss ratio possible that is designed to ensure adequate participation by issuers, competition in the health insurance market, and value for consumers so that their premiums are used for services.
“(b) Uniform definitions.—The Secretary shall establish a uniform definition of medical loss ratio and methodology for determining how to calculate the medical loss ratio. Such methodology shall be designed to take into account the special circumstances of smaller plans, different types of plans, and newer plans.”.
(b) Individual health insurance coverage.—Such title is further amended by inserting after section 2753 the following new section:
“The provisions of section 2714 shall apply to health insurance coverage offered in the individual market in the same manner as such provisions apply to health insurance coverage offered in the small or large group market.”.
(c) Immediate implementation.—The amendments made by this section shall apply in the group and individual market for plan years beginning on or after January 1, 2011.
(a) Clarification regarding application of guaranteed renewability of individual health insurance coverage.—Section 2742 of the Public Health Service Act (42 U.S.C. 300gg–42) is amended—
(1) in its heading, by inserting “and continuation in force, including prohibition of rescission,” after “guaranteed renewability”; and
(2) in subsection (a), by inserting “, including without rescission,” after “continue in force”.
(b) Secretarial guidance regarding rescissions.—Section 2742 of such Act (42 U.S.C. 300gg–42) is amended by adding at the end the following:
“(f) Rescission.—A health insurance issuer may rescind health insurance coverage only upon clear and convincing evidence of fraud described in subsection (b)(2). The Secretary, no later than July 1, 2010, shall issue guidance implementing this requirement, including procedures for independent, external third party review.”.
(c) Opportunity for independent, external third party review in certain cases.—Subpart 1 of part B of title XXVII of such Act (42 U.S.C. 300gg–41 et seq.) is amended by adding at the end the following:
“(a) Notice and review right.—If a health insurance issuer determines to rescind health insurance coverage for an individual in the individual market, before such rescission may take effect the issuer shall provide the individual with notice of such proposed rescission and an opportunity for a review of such determination by an independent, external third party under procedures specified by the Secretary under section 2742(f).
“(b) Independent determination.—If the individual requests such review by an independent, external third party of a rescission of health insurance coverage, the coverage shall remain in effect until such third party determines that the coverage may be rescinded under the guidance issued by the Secretary under section 2742(f).”.
(d) Effective Date.—The amendments made by this section shall apply on and after October 1, 2010, with respect to health insurance coverage issued before, on, or after such date.
(a) Standardizing electronic administrative transactions.—
(1) IN GENERAL.—Part C of title XI of the Social Security Act (42 U.S.C. 1320d et seq.) is amended by inserting after section 1173 the following new section:
“(a) Standards for financial and administrative transactions.—
“(1) In general.—The Secretary shall adopt and regularly update standards consistent with the goals described in paragraph (2).
“(2) Goals for financial and administrative transactions.—The goals for standards under paragraph (1) are that such standards shall—
“(A) be unique with no conflicting or redundant standards;
“(B) be authoritative, permitting no additions or constraints for electronic transactions, including companion guides;
“(C) be comprehensive, efficient and robust, requiring minimal augmentation by paper transactions or clarification by further communications;
“(D) enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card;
“(E) enable, where feasible, near real-time adjudication of claims;
“(F) provide for timely acknowledgment, response, and status reporting applicable to any electronic transaction deemed appropriate by the Secretary;
“(G) describe all data elements (such as reason and remark codes) in unambiguous terms, not permit optional fields, require that data elements be either required or conditioned upon set values in other fields, and prohibit additional conditions; and
“(H) harmonize all common data elements across administrative and clinical transaction standards.
“(3) Time for adoption.—Not later than 2 years after the date of implementation of the X12 Version 5010 transaction standards implemented under this part, the Secretary shall adopt standards under this section.
“(4) Requirements for specific standards.—The standards under this section shall be developed, adopted, and enforced so as to—
“(A) clarify, refine, complete, and expand, as needed, the standards required under section 1173;
“(B) require paper versions of standardized transactions to comply with the same standards as to data content such that a fully compliant, equivalent electronic transaction can be populated from the data from a paper version;
“(C) enable electronic funds transfers, in order to allow automated reconciliation with the related health care payment and remittance advice;
“(D) require timely and transparent claim and denial management processes, including tracking, adjudication, and appeal processing ;
“(E) require the use of a standard electronic transaction with which health care providers may quickly and efficiently enroll with a health plan to conduct the other electronic transactions provided for in this part; and
“(F) provide for other requirements relating to administrative simplification as identified by the Secretary, in consultation with stakeholders.
“(5) Building on existing standards.—In developing the standards under this section, the Secretary shall build upon existing and planned standards.
“(6) Implementation and enforcement.—Not later than 6 months after the date of the enactment of this section, the Secretary shall submit to the appropriate committees of Congress a plan for the implementation and enforcement, by not later than 5 years after such date of enactment, of the standards under this section. Such plan shall include—
“(A) a process and timeframe with milestones for developing the complete set of standards;
“(B) an expedited upgrade program for continually developing and approving additions and modifications to the standards as often as annually to improve their quality and extend their functionality to meet evolving requirements in health care;
“(C) programs to provide incentives for, and ease the burden of, implementation for certain health care providers, with special consideration given to such providers serving rural or underserved areas and ensure coordination with standards, implementation specifications, and certification criteria being adopted under the HITECH Act;
“(D) programs to provide incentives for, and ease the burden of, health care providers who volunteer to participate in the process of setting standards for electronic transactions;
“(E) an estimate of total funds needed to ensure timely completion of the implementation plan; and
“(F) an enforcement process that includes timely investigation of complaints, random audits to ensure compliance, civil monetary and programmatic penalties for non-compliance consistent with existing laws and regulations, and a fair and reasonable appeals process building off of enforcement provisions under this part.
“(b) Limitations on use of data.—Nothing in this section shall be construed to permit the use of information collected under this section in a manner that would adversely affect any individual.
“(c) Protection of data.—The Secretary shall ensure (through the promulgation of regulations or otherwise) that all data collected pursuant to subsection (a) are—
“(1) used and disclosed in a manner that meets the HIPAA privacy and security law (as defined in section 3009(a)(2) of the Public Health Service Act), including any privacy or security standard adopted under section 3004 of such Act; and
“(2) protected from all inappropriate internal use by any entity that collects, stores, or receives the data, including use of such data in determinations of eligibility (or continued eligibility) in health plans, and from other inappropriate uses, as defined by the Secretary.”.
(2) DEFINITIONS.—Section 1171 of such Act (42 U.S.C. 1320d) is amended—
(A) in paragraph (7), by striking “with reference to” and all that follows and inserting “with reference to a transaction or data element of health information in section 1173 means implementation specifications, certification criteria, operating rules, messaging formats, codes, and code sets adopted or established by the Secretary for the electronic exchange and use of information”; and
(B) by adding at the end the following new paragraph:
“(9) Operating rules.—The term ‘operating rules’ means business rules for using and processing transactions. Operating rules should address the following:
“(A) Requirements for data content using available and established national standards.
“(B) Infrastructure requirements that establish best practices for streamlining data flow to yield timely execution of transactions.
“(C) Policies defining the transaction related rights and responsibilities for entities that are transmitting or receiving data.”.
(3) CONFORMING AMENDMENT.—Section 1179(a) of such Act (42 U.S.C. 1320d–8(a)) is amended, in the matter before paragraph (1)—
(A) by inserting “on behalf of an individual” after “1978)”; and
(B) by inserting “on behalf of an individual” after “for a financial institution” and
(b) Standards for claims attachments and coordination of benefits .—
(1) STANDARD FOR HEALTH CLAIMS ATTACHMENTS.—Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall promulgate a final rule to establish a standard for health claims attachment transaction described in section 1173(a)(2)(B) of the Social Security Act (42 U.S.C. 1320d-2(a)(2)(B)) and coordination of benefits.
(2) REVISION IN PROCESSING PAYMENT TRANSACTIONS BY FINANCIAL INSTITUTIONS.—
(A) IN GENERAL.—Section 1179 of the Social Security Act (42 U.S.C. 1320d–8) is amended, in the matter before paragraph (1)—
(i) by striking “or is engaged” and inserting “and is engaged”; and
(ii) by inserting “(other than as a business associate for a covered entity)” after “for a financial institution”.
(B) EFFECTIVE DATE.—The amendments made by paragraph (1) shall apply to transactions occurring on or after such date (not later than 6 months after the date of the enactment of this Act) as the Secretary of Health and Human Services shall specify.
(1) IN GENERAL.—Not later than 90 days after the date of the enactment of this Act, the Secretary of Health and Human Services shall establish a temporary reinsurance program (in this section referred to as the “reinsurance program”) to provide reimbursement to assist participating employment-based plans with the cost of providing health benefits to retirees and to eligible spouses, surviving spouses and dependents of such retirees.
(2) DEFINITIONS.—For purposes of this section:
(A) The term “eligible employment-based plan” means a group health benefits plan that—
(i) is maintained by one or more employers, former employers or employee associations, or a voluntary employees’ beneficiary association, or a committee or board of individuals appointed to administer such plan, and
(ii) provides health benefits to retirees.
(B) The term “health benefits” means medical, surgical, hospital, prescription drug, and such other benefits as shall be determined by the Secretary, whether self-funded or delivered through the purchase of insurance or otherwise.
(C) The term “participating employment-based plan” means an eligible employment-based plan that is participating in the reinsurance program.
(D) The term “retiree” means, with respect to a participating employment-benefit plan, an individual who—
(i) is 55 years of age or older;
(ii) is not eligible for coverage under title XVIII of the Social Security Act; and
(iii) is not an active employee of an employer maintaining the plan or of any employer that makes or has made substantial contributions to fund such plan.
(E) The term “Secretary” means Secretary of Health and Human Services.
(b) Participation.—To be eligible to participate in the reinsurance program, an eligible employment-based plan shall submit to the Secretary an application for participation in the program, at such time, in such manner, and containing such information as the Secretary shall require.
(A) IN GENERAL.—Under the reinsurance program, a participating employment-based plan shall submit claims for reimbursement to the Secretary which shall contain documentation of the actual costs of the items and services for which each claim is being submitted.
(B) BASIS FOR CLAIMS.—Each claim submitted under subparagraph (A) shall be based on the actual amount expended by the participating employment-based plan involved within the plan year for the appropriate employment based health benefits provided to a retiree or to the spouse, surviving spouse, or dependent of a retiree. In determining the amount of any claim for purposes of this subsection, the participating employment-based plan shall take into account any negotiated price concessions (such as discounts, direct or indirect subsidies, rebates, and direct or indirect remunerations) obtained by such plan with respect to such health benefits. For purposes of calculating the amount of any claim, the costs paid by the retiree or by the spouse, surviving spouse, or dependent of the retiree in the form of deductibles, co-payments, and co-insurance shall be included along with the amounts paid by the participating employment-based plan.
(2) PROGRAM PAYMENTS AND LIMIT.—If the Secretary determines that a participating employment-based plan has submitted a valid claim under paragraph (1), the Secretary shall reimburse such plan for 80 percent of that portion of the costs attributable to such claim that exceeds $15,000, but is less than $90,000. Such amounts shall be adjusted each year based on the percentage increase in the medical care component of the Consumer Price Index (rounded to the nearest multiple of $1,000) for the year involved.
(3) USE OF PAYMENTS.—Amounts paid to a participating employment-based plan under this subsection shall be used to lower the costs borne directly by the participants and beneficiaries for health benefits provided under such plan in the form of premiums, co-payments, deductibles, co-insurance, or other out-of-pocket costs. Such payments shall not be used to reduce the costs of an employer maintaining the participating employment-based plan. The Secretary shall develop a mechanism to monitor the appropriate use of such payments by such plans.
(4) APPEALS AND PROGRAM PROTECTIONS.—The Secretary shall establish—
(A) an appeals process to permit participating employment-based plans to appeal a determination of the Secretary with respect to claims submitted under this section; and
(B) procedures to protect against fraud, waste, and abuse under the program.
(5) AUDITS.—The Secretary shall conduct annual audits of claims data submitted by participating employment-based plans under this section to ensure that they are in compliance with the requirements of this section.
(d) Retiree Reserve Trust Fund.—
(A) IN GENERAL.—There is established in the Treasury of the United States a trust fund to be known as the “Retiree Reserve Trust Fund” (referred to in this section as the “Trust Fund”), that shall consist of such amounts as may be appropriated or credited to the Trust Fund as provided for in this subsection to enable the Secretary to carry out the reinsurance program. Such amounts shall remain available until expended.
(B) FUNDING.—There are hereby appropriated to the Trust Fund, out of any moneys in the Treasury not otherwise appropriated, an amount requested by the Secretary as necessary to carry out this section, except that the total of all such amounts requested shall not exceed $10,000,000,000.
(C) APPROPRIATIONS FROM THE TRUST FUND.—
(i) IN GENERAL.—Amounts in the Trust Fund are appropriated to provide funding to carry out the reinsurance program and shall be used to carry out such program.
(ii) BUDGETARY IMPLICATIONS.—Amounts appropriated under clause (i), and outlays flowing from such appropriations, shall not be taken into account for purposes of any budget enforcement procedures including allocations under section 302(a) and (b) of the Balanced Budget and Emergency Deficit Control Act and budget resolutions for fiscal years during which appropriations are made from the Trust Fund.
(iii) LIMITATION TO AVAILABLE FUNDS.—The Secretary has the authority to stop taking applications for participation in the program or take such other steps in reducing expenditures under the reinsurance program in order to ensure that expenditures under the reinsurance program do not exceed the funds available under this subsection.
(a) Establishment.—There is established within the Health Choices Administration and under the direction of the Commissioner a Health Insurance Exchange in order to facilitate access of individuals and employers, through a transparent process, to a variety of choices of affordable, quality health insurance coverage, including a public health insurance option.
(b) Outline of duties of Commissioner.—In accordance with this subtitle and in coordination with appropriate Federal and State officials as provided under section 143(b), the Commissioner shall—
(1) under section 204 establish standards for, accept bids from, and negotiate and enter into contracts with, QHBP offering entities for the offering of health benefits plans through the Health Insurance Exchange, with different levels of benefits required under section 203, and including with respect to oversight and enforcement;
(2) under section 205 facilitate outreach and enrollment in such plans of Exchange-eligible individuals and employers described in section 202; and
(3) conduct such activities related to the Health Insurance Exchange as required, including establishment of a risk pooling mechanism under section 206 and consumer protections under subtitle D of title I.
(c) Exchange-participating health benefits plan defined.—In this division, the term “Exchange-participating health benefits plan” means a qualified health benefits plan that is offered through the Health Insurance Exchange.
(a) Access to coverage.—In accordance with this section, all individuals are eligible to obtain coverage through enrollment in an Exchange-participating health benefits plan offered through the Health Insurance Exchange unless such individuals are enrolled in another qualified health benefits plan or other acceptable coverage.
(b) Definitions.—In this division:
(1) EXCHANGE-ELIGIBLE INDIVIDUAL.—The term “Exchange-eligible individual” means an individual who is eligible under this section to be enrolled through the Health Insurance Exchange in an Exchange-participating health benefits plan and, with respect to family coverage, includes dependents of such individual.
(2) EXCHANGE-ELIGIBLE EMPLOYER.—The term “Exchange-eligible employer” means an employer that is eligible under this section to enroll through the Health Insurance Exchange employees of the employer (and their dependents) in Exchange-eligible health benefits plans.
(3) EMPLOYMENT-RELATED DEFINITIONS.—The terms “employer”, “employee”, “full-time employee”, and “part-time employee” have the meanings given such terms by the Commissioner for purposes of this division.
(c) Transition.—Individuals and employers shall only be eligible to enroll or participate in the Health Insurance Exchange in accordance with the following transition schedule:
(1) FIRST YEAR.—In Y1 (as defined in section 100(c))—
(A) individuals described in subsection (d)(1), including individuals described in paragraphs (3) and (4) of subsection (d); and
(B) smallest employers described in subsection (e)(1).
(A) individuals and employers described in paragraph (1); and
(B) smaller employers described in subsection (e)(2).
(3) THIRD AND SUBSEQUENT YEARS.—In Y3 and subsequent years—
(A) individuals and employers described in paragraph (2); and
(B) larger employers as permitted by the Commissioner under subsection (e)(3).
(1) INDIVIDUAL DESCRIBED.—Subject to the succeeding provisions of this subsection, an individual described in this paragraph is an individual who—
(A) is not enrolled in coverage described in subparagraphs (C) through (F) of paragraph (2); and
(B) is not enrolled in coverage as a full-time employee (or as a dependent of such an employee) under a group health plan if the coverage and an employer contribution under the plan meet the requirements of section 312.
For purposes of subparagraph (B), in the case of an individual who is self-employed, who has at least 1 employee, and who meets the requirements of section 312, such individual shall be deemed a full-time employee described in such subparagraph.
(2) ACCEPTABLE COVERAGE.—For purposes of this division, the term “acceptable coverage” means any of the following:
(A) QUALIFIED HEALTH BENEFITS PLAN COVERAGE.—Coverage under a qualified health benefits plan.
(B) GRANDFATHERED HEALTH INSURANCE COVERAGE; COVERAGE UNDER CURRENT GROUP HEALTH PLAN.—Coverage under a grandfathered health insurance coverage (as defined in subsection (a) of section 102) or under a current group health plan (described in subsection (b) of such section).
(C) MEDICARE.—Coverage under part A of title XVIII of the Social Security Act.
(D) MEDICAID.—Coverage for medical assistance under title XIX of the Social Security Act, excluding such coverage that is only available because of the application of subsection (u), (z), or (aa) of section 1902 of such Act
(E) MEMBERS OF THE ARMED FORCES AND DEPENDENTS (INCLUDING TRICARE).—Coverage under chapter 55 of title 10, United States Code, including similar coverage furnished under section 1781 of title 38 of such Code.
(F) VA.—Coverage under the veteran’s health care program under chapter 17 of title 38, United States Code, but only if the coverage for the individual involved is determined by the Commissioner in coordination with the Secretary of Treasury to be not less than a level specified by the Commissioner and Secretary of Veteran’s Affairs, in coordination with the Secretary of Treasury, based on the individual’s priority for services as provided under section 1705(a) of such title.
(G) OTHER COVERAGE.—Such other health benefits coverage, such as a State health benefits risk pool, as the Commissioner, in coordination with the Secretary of the Treasury, recognizes for purposes of this paragraph.
The Commissioner shall make determinations under this paragraph in coordination with the Secretary of the Treasury.
(3) TREATMENT OF CERTAIN NON-TRADITIONAL MEDICAID ELIGIBLE INDIVIDUALS.—An individual who is a non-traditional Medicaid eligible individual (as defined in section 205(e)(4)(C)) in a State may be an Exchange-eligible individual if the individual was enrolled in a qualified health benefits plan, grandfathered health insurance coverage, or current group health plan during the 6 months before the individual became a non-traditional Medicaid eligible individual. During the period in which such an individual has chosen to enroll in an Exchange-participating health benefits plan, the individual is not also eligible for medical assistance under Medicaid.
(4) CONTINUING ELIGIBILITY PERMITTED.—
(A) IN GENERAL.—Except as provided in subparagraph (B), once an individual qualifies as an Exchange-eligible individual under this subsection (including as an employee or dependent of an employee of an Exchange-eligible employer) and enrolls under an Exchange-participating health benefits plan through the Health Insurance Exchange, the individual shall continue to be treated as an Exchange-eligible individual until the individual is no longer enrolled with an Exchange-participating health benefits plan.
(i) IN GENERAL.—Subparagraph (A) shall not apply to an individual once the individual becomes eligible for coverage—
(I) under part A of the Medicare program;
(II) under the Medicaid program as a Medicaid eligible individual, except as permitted under paragraph (3) or clause (ii); or
(III) in such other circumstances as the Commissioner may provide.
(ii) TRANSITION PERIOD.—In the case described in clause (i)(II), the Commissioner shall permit the individual to continue treatment under subparagraph (A) until such limited time as the Commissioner determines it is administratively feasible, consistent with minimizing disruption in the individual’s access to health care.
(1) SMALLEST EMPLOYER.—Subject to paragraph (4), smallest employers described in this paragraph are employers with 10 or fewer employees.
(2) SMALLER EMPLOYERS.—Subject to paragraph (4), smaller employers described in this paragraph are employers that are not smallest employers described in paragraph (1) and have 20 or fewer employees.
(A) IN GENERAL.—Beginning with Y3, the Commissioner may permit employers not described in paragraph (1) or (2) to be Exchange-eligible employers.
(B) PHASE-IN.—In applying subparagraph (A), the Commissioner may phase-in the application of such subparagraph based on the number of full-time employees of an employer and such other considerations as the Commissioner deems appropriate.
(4) CONTINUING ELIGIBILITY.—Once an employer is permitted to be an Exchange-eligible employer under this subsection and enrolls employees through the Health Insurance Exchange, the employer shall continue to be treated as an Exchange-eligible employer for each subsequent plan year regardless of the number of employees involved unless and until the employer meets the requirement of section 311(a) through paragraph (1) of such section by offering a group health plan and not through offering an Exchange-participating health benefits plan.
(5) EMPLOYER PARTICIPATION AND CONTRIBUTIONS.—
(A) SATISFACTION OF EMPLOYER RESPONSIBILITY.—For any year in which an employer is an Exchange-eligible employer, such employer may meet the requirements of section 312 with respect to employees of such employer by offering such employees the option of enrolling with Exchange-participating health benefits plans through the Health Insurance Exchange consistent with the provisions of subtitle B of title III.
(B) EMPLOYEE CHOICE.—Any employee offered Exchange-participating health benefits plans by the employer of such employee under subparagraph (A) may choose coverage under any such plan. That choice includes, with respect to family coverage, coverage of the dependents of such employee.
(6) AFFILIATED GROUPS.—Any employer which is part of a group of employers who are treated as a single employer under subsection (b), (c), (m), or (o) of section 414 of the Internal Revenue Code of 1986 shall be treated, for purposes of this subtitle, as a single employer.
(7) OTHER COUNTING RULES.—The Commissioner shall establish rules relating to how employees are counted for purposes of carrying out this subsection.
(f) Special situation authority.—The Commissioner shall have the authority to establish such rules as may be necessary to deal with special situations with regard to uninsured individuals and employers participating as Exchange-eligible individuals and employers, such as transition periods for individuals and employers who gain, or lose, Exchange-eligible participation status, and to establish grace periods for premium payment.
(g) Surveys of individuals and employers.—The Commissioner shall provide for periodic surveys of Exchange-eligible individuals and employers concerning satisfaction of such individuals and employers with the Health Insurance Exchange and Exchange-participating health benefits plans.
(1) IN GENERAL.—The Commissioner shall conduct a study of access to the Health Insurance Exchange for individuals and for employers, including individuals and employers who are not eligible and enrolled in Exchange-participating health benefits plans. The goal of the study is to determine if there are significant groups and types of individuals and employers who are not Exchange eligible individuals or employers, but who would have improved benefits and affordability if made eligible for coverage in the Exchange.
(2) ITEMS INCLUDED IN STUDY.—Such study also shall examine—
(A) the terms, conditions, and affordability of group health coverage offered by employers and QHBP offering entities outside of the Exchange compared to Exchange-participating health benefits plans; and
(B) the affordability-test standard for access of certain employed individuals to coverage in the Health Insurance Exchange.
(3) REPORT.—Not later than January 1 of Y3, in Y6, and thereafter, the Commissioner shall submit to Congress on the study conducted under this subsection and shall include in such report recommendations regarding changes in standards for Exchange eligibility for individuals and employers.
(a) In general.—The Commissioner shall specify the benefits to be made available under Exchange-participating health benefits plans during each plan year, consistent with subtitle C of title I and this section.
(b) Limitation on health benefits plans offered by offering entities.—The Commissioner may not enter into a contract with a QHBP offering entity under section 204(c) for the offering of an Exchange-participating health benefits plan in a service area unless the following requirements are met:
(1) REQUIRED OFFERING OF BASIC PLAN.—The entity offers only one basic plan for such service area.
(2) OPTIONAL OFFERING OF ENHANCED PLAN.—If and only if the entity offers a basic plan for such service area, the entity may offer one enhanced plan for such area.
(3) OPTIONAL OFFERING OF PREMIUM PLAN.—If and only if the entity offers an enhanced plan for such service area, the entity may offer one premium plan for such area.
(4) OPTIONAL OFFERING OF PREMIUM-PLUS PLANS.—If and only if the entity offers a premium plan for such service area, the entity may offer one or more premium-plus plans for such area.
All such plans may be offered under a single contract with the Commissioner.(c) Specification of benefit levels for plans.—
(1) IN GENERAL.—The Commissioner shall establish the following standards consistent with this subsection and title I:
(A) BASIC, ENHANCED, AND PREMIUM PLANS.—Standards for 3 levels of Exchange-participating health benefits plans: basic, enhanced, and premium (in this division referred to as a “basic plan”, “enhanced plan”, and “premium plan”, respectively).
(B) PREMIUM-PLUS PLAN BENEFITS.—Standards for additional benefits that may be offered, consistent with this subsection and subtitle C of title I, under a premium plan (such a plan with additional benefits referred to in this division as a “premium-plus plan”) .
(A) IN GENERAL.—A basic plan shall offer the essential benefits package required under title I for a qualified health benefits plan.
(B) TIERED COST-SHARING FOR AFFORDABLE CREDIT ELIGIBLE INDIVIDUALS.—In the case of an affordable credit eligible individual (as defined in section 242(a)(1)) enrolled in an Exchange-participating health benefits plan, the benefits under a basic plan are modified to provide for the reduced cost-sharing for the income tier applicable to the individual under section 244(c).
(3) ENHANCED PLAN.—An enhanced plan shall offer, in addition to the level of benefits under the basic plan, a lower level of cost-sharing as provided under title I consistent with section 123(b)(5)(A).
(4) PREMIUM PLAN.—A premium plan shall offer, in addition to the level of benefits under the basic plan, a lower level of cost-sharing as provided under title I consistent with section 123(b)(5)(B).
(5) PREMIUM-PLUS PLAN.—A premium-plus plan is a premium plan that also provides additional benefits, such as adult oral health and vision care, approved by the Commissioner. The portion of the premium that is attributable to such additional benefits shall be separately specified.
(6) RANGE OF PERMISSIBLE VARIATION IN COST-SHARING.—The Commissioner shall establish a permissible range of variation of cost-sharing for each basic, enhanced, and premium plan, except with respect to any benefit for which there is no cost-sharing permitted under the essential benefits package. Such variation shall permit a variation of not more than plus (or minus) 10 percent in cost-sharing with respect to each benefit category specified under section 122.
(d) Treatment of State benefit mandates.—Insofar as a State requires a health insurance issuer offering health insurance coverage to include benefits beyond the essential benefits package, such requirement shall continue to apply to an Exchange-participating health benefits plan, if the State has entered into an arrangement satisfactory to the Commissioner to reimburse the Commissioner for the amount of any net increase in affordability premium credits under subtitle C as a result of an increase in premium in basic plans as a result of application of such requirement.
(a) Contracting duties.—In carrying out section 201(b)(1) and consistent with this subtitle:
(1) OFFERING ENTITY AND PLAN STANDARDS.—The Commissioner shall—
(A) establish standards necessary to implement the requirements of this title and title I for—
(i) QHBP offering entities for the offering of an Exchange-participating health benefits plan; and
(ii) for Exchange-participating health benefits plans; and
(B) certify QHBP offering entities and qualified health benefits plans as meeting such standards and requirements of this title and title I for purposes of this subtitle.
(2) SOLICITING AND NEGOTIATING BIDS; CONTRACTS.—The Commissioner shall—
(A) solicit bids from QHBP offering entities for the offering of Exchange-participating health benefits plans;
(B) based upon a review of such bids, negotiate with such entities for the offering of such plans; and
(C) enter into contracts with such entities for the offering of such plans through the Health Insurance Exchange under terms (consistent with this title) negotiated between the Commissioner and such entities.
(3) FAR NOT APPLICABLE.—The provisions of the Federal Acquisition Regulation shall not apply to contracts between the Commissioner and QHBP offering entities for the offering of Exchange-participating health benefits plans under this title.
(b) Standards for QHBP offering entities to offer Exchange-participating health benefits plans.—The standards established under subsection (a)(1)(A) shall require that, in order for a QHBP offering entity to offer an Exchange-participating health benefits plan, the entity must meet the following requirements:
(1) LICENSED.—The entity shall be licensed to offer health insurance coverage under State law for each State in which it is offering such coverage.
(2) DATA REPORTING.—The entity shall provide for the reporting of such information as the Commissioner may specify, including information necessary to administer the risk pooling mechanism described in section 206(b) and information to address disparities in health and health care.
(3) IMPLEMENTING AFFORDABILITY CREDITS.—The entity shall provide for implementation of the affordability credits provided for enrollees under subtitle C, including the reduction in cost-sharing under section 244(c).
(4) ENROLLMENT.—The entity shall accept all enrollments under this subtitle, subject to such exceptions (such as capacity limitations) in accordance with the requirements under title I for a qualified health benefits plan. The entity shall notify the Commissioner if the entity projects or anticipates reaching such a capacity limitation that would result in a limitation in enrollment.
(5) RISK POOLING PARTICIPATION.—The entity shall participate in such risk pooling mechanism as the Commissioner establishes under section 206(b).
(6) ESSENTIAL COMMUNITY PROVIDERS.—With respect to the basic plan offered by the entity, the entity shall contract for outpatient services with covered entities (as defined in section 340B(a)(4) of the Public Health Service Act, as in effect as of July 1, 2009). The Commissioner shall specify the extent to which and manner in which the previous sentence shall apply in the case of a basic plan with respect to which the Commissioner determines provides substantially all benefits through a health maintenance organization, as defined in section 2791(b)(3) of the Public Health Service Act.
(7) CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES AND COMMUNICATIONS.—The entity shall provide for culturally and linguistically appropriate communication and health services.
(8) ADDITIONAL REQUIREMENTS.—The entity shall comply with other applicable requirements of this title, as specified by the Commissioner, which shall include standards regarding billing and collection practices for premiums and related grace periods and which may include standards to ensure that the entity does not use coercive practices to force providers not to contract with other entities offering coverage through the Health Insurance Exchange.
(1) BID APPLICATION.—To be eligible to enter into a contract under this section, a QHBP offering entity shall submit to the Commissioner a bid at such time, in such manner, and containing such information as the Commissioner may require.
(2) TERM.—Each contract with a QHBP offering entity under this section shall be for a term of not less than one year, but may be made automatically renewable from term to term in the absence of notice of termination by either party.
(3) ENFORCEMENT OF NETWORK ADEQUACY.—In the case of a health benefits plan of a QHBP offering entity that uses a provider network, the contract under this section with the entity shall provide that if—
(A) the Commissioner determines that such provider network does not meet such standards as the Commissioner shall establish under section 115; and
(B) an individual enrolled in such plan receives an item or service from a provider that is not within such network;
then any cost-sharing for such item or service shall be equal to the amount of such cost-sharing that would be imposed if such item or service was furnished by a provider within such network.
(4) OVERSIGHT AND ENFORCEMENT RESPONSIBILITIES.—The Commissioner shall establish processes, in coordination with State insurance regulators, to oversee, monitor, and enforce applicable requirements of this title with respect to QHBP offering entities offering Exchange-participating health benefits plans and such plans, including the marketing of such plans. Such processes shall include the following:
(A) GRIEVANCE AND COMPLAINT MECHANISMS.—The Commissioner shall establish, in coordination with State insurance regulators, a process under which Exchange-eligible individuals and employers may file complaints concerning violations of such standards.
(B) ENFORCEMENT.—In carrying out authorities under this division relating to the Health Insurance Exchange, the Commissioner may impose one or more of the intermediate sanctions described in section 142(c).
(i) IN GENERAL.—The Commissioner may terminate a contract with a QHBP offering entity under this section for the offering of an Exchange-participating health benefits plan if such entity fails to comply with the applicable requirements of this title. Any determination by the Commissioner to terminate a contract shall be made in accordance with formal investigation and compliance procedures established by the Commissioner under which—
(I) the Commissioner provides the entity with the reasonable opportunity to develop and implement a corrective action plan to correct the deficiencies that were the basis of the Commissioner’s determination; and
(II) the Commissioner provides the entity with reasonable notice and opportunity for hearing (including the right to appeal an initial decision) before terminating the contract.
(ii) EXCEPTION FOR IMMINENT AND SERIOUS RISK TO HEALTH.—Clause (i) shall not apply if the Commissioner determines that a delay in termination, resulting from compliance with the procedures specified in such clause prior to termination, would pose an imminent and serious risk to the health of individuals enrolled under the qualified health benefits plan of the QHBP offering entity.
(D) CONSTRUCTION.—Nothing in this subsection shall be construed as preventing the application of other sanctions under subtitle E of title I with respect to an entity for a violation of such a requirement.
(1) OUTREACH.—The Commissioner shall conduct outreach activities consistent with subsection (c), including through use of appropriate entities as described in paragraph (4) of such subsection, to inform and educate individuals and employers about the Health Insurance Exchange and Exchange-participating health benefits plan options. Such outreach shall include outreach specific to vulnerable populations, such as children, individuals with disabilities, individuals with mental illness, and individuals with other cognitive impairments.
(2) ELIGIBILITY.—The Commissioner shall make timely determinations of whether individuals and employers are Exchange-eligible individuals and employers (as defined in section 202).
(3) ENROLLMENT.—The Commissioner shall establish and carry out an enrollment process for Exchange-eligible individuals and employers, including at community locations, in accordance with subsection (b).
(1) IN GENERAL.—The Commissioner shall establish a process consistent with this title for enrollments in Exchange-participating health benefits plans. Such process shall provide for enrollment through means such as the mail, by telephone, electronically, and in person.
(A) OPEN ENROLLMENT PERIOD.—The Commissioner shall establish an annual open enrollment period during which an Exchange-eligible individual or employer may elect to enroll in an Exchange-participating health benefits plan for the following plan year and an enrollment period for affordability credits under subtitle C. Such periods shall be during September through November of each year, or such other time that would maximize timeliness of income verification for purposes of such subtitle. The open enrollment period shall not be less than 30 days.
(B) SPECIAL ENROLLMENT.—The Commissioner shall also provide for special enrollment periods to take into account special circumstances of individuals and employers, such as an individual who—
(i) loses acceptable coverage;
(ii) experiences a change in marital or other dependent status;
(iii) moves outside the service area of the Exchange-participating health benefits plan in which the individual is enrolled; or
(iv) experiences a significant change in income.
(C) ENROLLMENT INFORMATION.—The Commissioner shall provide for the broad dissemination of information to prospective enrollees on the enrollment process, including before each open enrollment period. In carrying out the previous sentence, the Commissioner may work with other appropriate entities to facilitate such provision of information.
(3) AUTOMATIC ENROLLMENT FOR NON-MEDICAID ELIGIBLE INDIVIDUALS.—
(A) IN GENERAL.—The Commissioner shall provide for a process under which individuals who are Exchange-eligible individuals described in subparagraph (B) are automatically enrolled under an appropriate Exchange-participating health benefits plan. Such process may involve a random assignment or some other form of assignment that takes into account the health care providers used by the individual involved or such other relevant factors as the Commissioner may specify.
(B) SUBSIDIZED INDIVIDUALS DESCRIBED.—An individual described in this subparagraph is an Exchange-eligible individual who is either of the following:
(i) AFFORDABILITY CREDIT ELIGIBLE INDIVIDUALS.—The individual—
(I) has applied for, and been determined eligible for, affordability credits under subtitle C;
(II) has not opted out from receiving such affordability credit; and
(III) does not otherwise enroll in another Exchange-participating health benefits plan.
(ii) INDIVIDUALS ENROLLED IN A TERMINATED PLAN.—The individual is enrolled in an Exchange-participating health benefits plan that is terminated (during or at the end of a plan year) and who does not otherwise enroll in another Exchange-participating health benefits plan.
(4) DIRECT PAYMENT OF PREMIUMS TO PLANS.—Under the enrollment process, individuals enrolled in an Exchange-participating health benefits plan shall pay such plans directly, and not through the Commissioner or the Health Insurance Exchange.
(c) Coverage information and assistance.—
(1) COVERAGE INFORMATION.—The Commissioner shall provide for the broad dissemination of information on Exchange-participating health benefits plans offered under this title. Such information shall be provided in a comparative manner, and shall include information on benefits, premiums, cost-sharing, quality, provider networks, and consumer satisfaction.
(2) CONSUMER ASSISTANCE WITH CHOICE.—To provide assistance to Exchange-eligible individuals and employers, the Commissioner shall—
(A) provide for the operation of a toll-free telephone hotline to respond to requests for assistance and maintain an Internet website through which individuals may obtain information on coverage under Exchange-participating health benefits plans and file complaints;
(B) develop and disseminate information to Exchange-eligible enrollees on their rights and responsibilities;
(C) assist Exchange-eligible individuals in selecting Exchange-participating health benefits plans and obtaining benefits through such plans; and
(D) ensure that the Internet website described in subparagraph (A) and the information described in subparagraph (B) is developed using plain language (as defined in section 133(a)(2)).
(3) USE OF OTHER ENTITIES.—In carrying out this subsection, the Commissioner may work with other appropriate entities to facilitate the dissemination of information under this subsection and to provide assistance as described in paragraph (2).
(d) Special duties related to Medicaid and CHIP.—
(1) COVERAGE FOR CERTAIN NEWBORNS.—
(A) IN GENERAL.—In the case of a child born in the United States who at the time of birth is not otherwise covered under acceptable coverage, for the period of time beginning on the date of birth and ending on the date the child otherwise is covered under acceptable coverage (or, if earlier, the end of the month in which the 60-day period, beginning on the date of birth, ends), the child shall be deemed—
(i) to be a non-traditional Medicaid eligible individual (as defined in subsection (e)(5)) for purposes of this division and Medicaid; and
(ii) to have elected to enroll in Medicaid through the application of paragraph (3).
(B) EXTENDED TREATMENT AS TRADITIONAL MEDICAID ELIGIBLE INDIVIDUAL.—In the case of a child described in subparagraph (A) who at the end of the period referred to in such subparagraph is not otherwise covered under acceptable coverage, the child shall be deemed (until such time as the child obtains such coverage or the State otherwise makes a determination of the child’s eligibility for medical assistance under its Medicaid plan pursuant to section 1943(c)(1) of the Social Security Act) to be a traditional Medicaid eligible individual described in section 1902(l)(1)(B) of such Act.
(2) CHIP TRANSITION.—A child who, as of the day before the first day of Y1, is eligible for child health assistance under title XXI of the Social Security Act (including a child receiving coverage under an arrangement described in section 2101(a)(2) of such Act) is deemed as of such first day to be an Exchange-eligible individual unless the individual is a traditional Medicaid eligible individual as of such day.
(3) AUTOMATIC ENROLLMENT OF MEDICAID ELIGIBLE INDIVIDUALS INTO MEDICAID.—The Commissioner shall provide for a process under which an individual who is described in section 202(d)(3) and has not elected to enroll in an Exchange-participating health benefits plan is automatically enrolled under Medicaid.
(4) NOTIFICATIONS.—The Commissioner shall notify each State in Y1 and for purposes of section 1902(gg)(1) of the Social Security Act (as added by section 1703(a)) whether the Health Insurance Exchange can support enrollment of children described in paragraph (2) in such State in such year.
(e) Medicaid coverage for Medicaid eligible individuals.—
(A) CHOICE FOR LIMITED EXCHANGE-ELIGIBLE INDIVIDUALS.—As part of the enrollment process under subsection (b), the Commissioner shall provide the option, in the case of an Exchange-eligible individual described in section 202(d)(3), for the individual to elect to enroll under Medicaid instead of under an Exchange-participating health benefits plan. Such an individual may change such election during an enrollment period under subsection (b)(2).
(B) MEDICAID ENROLLMENT OBLIGATION.—An Exchange eligible individual may apply, in the manner described in section 241(b)(1), for a determination of whether the individual is a Medicaid-eligible individual. If the individual is determined to be so eligible, the Commissioner, through the Medicaid memorandum of understanding, shall provide for the enrollment of the individual under the State Medicaid plan in accordance with the Medicaid memorandum of understanding under paragraph (4). In the case of such an enrollment, the State shall provide for the same periodic redetermination of eligibility under Medicaid as would otherwise apply if the individual had directly applied for medical assistance to the State Medicaid agency.
(2) NON-TRADITIONAL MEDICAID ELIGIBLE INDIVIDUALS.—In the case of a non-traditional Medicaid eligible individual described in section 202(d)(3) who elects to enroll under Medicaid under paragraph (1)(A), the Commissioner shall provide for the enrollment of the individual under the State Medicaid plan in accordance with the Medicaid memorandum of understanding under paragraph (4).
(3) COORDINATED ENROLLMENT WITH STATE THROUGH MEMORANDUM OF UNDERSTANDING.—The Commissioner, in consultation with the Secretary of Health and Human Services, shall enter into a memorandum of understanding with each State (each in this division referred to as a “Medicaid memorandum of understanding”) with respect to coordinating enrollment of individuals in Exchange-participating health benefits plans and under the State’s Medicaid program consistent with this section and to otherwise coordinate the implementation of the provisions of this division with respect to the Medicaid program. Such memorandum shall permit the exchange of information consistent with the limitations described in section 1902(a)(7) of the Social Security Act. Nothing in this section shall be construed as permitting such memorandum to modify or vitiate any requirement of a State Medicaid plan.
(4) MEDICAID ELIGIBLE INDIVIDUALS.—For purposes of this division:
(A) MEDICAID ELIGIBLE INDIVIDUAL.—The term “Medicaid eligible individual” means an individual who is eligible for medical assistance under Medicaid.
(B) TRADITIONAL MEDICAID ELIGIBLE INDIVIDUAL.—The term “traditional Medicaid eligible individual” means a Medicaid eligible individual other than an individual who is—
(i) a Medicaid eligible individual by reason of the application of subclause (VIII) of section 1902(a)(10)(A)(i) of the Social Security Act; or
(ii) a childless adult not described in section 1902(a)(10)(A) or (C) of such Act (as in effect as of the day before the date of the enactment of this Act).
(C) NON-TRADITIONAL MEDICAID ELIGIBLE INDIVIDUAL.—The term “non-traditional Medicaid eligible individual” means a Medicaid eligible individual who is not a traditional Medicaid eligible individual.
(f) Effective culturally and linguistically appropriate communication.—In carrying out this section, the Commissioner shall establish effective methods for communicating in plain language and a culturally and linguistically appropriate manner.
(a) Coordination of affordability credits.—The Commissioner shall coordinate the distribution of affordability premium and cost-sharing credits under subtitle C to QHBP offering entities offering Exchange-participating health benefits plans.
(b) Coordination of risk pooling.—The Commissioner shall establish a mechanism whereby there is an adjustment made of the premium amounts payable among QHBP offering entities offering Exchange-participating health benefits plans of premiums collected for such plans that takes into account (in a manner specified by the Commissioner) the differences in the risk characteristics of individuals and employers enrolled under the different Exchange-participating health benefits plans offered by such entities so as to minimize the impact of adverse selection of enrollees among the plans offered by such entities.
(c) Special Inspector General for the Health Insurance Exchange.—
(1) ESTABLISHMENT; APPOINTMENT.—There is hereby established the Office of the Special Inspector General for the Health Insurance Exchange, to be headed by a Special Inspector General for the Health Insurance Exchange (in this subsection referred to as the “Special Inspector General”) to be appointed by the President, by and with the advice and consent of the Senate. The nomination of an individual as Special Inspector General shall be made as soon as practicable after the establishment of the program under this subtitle.
(2) DUTIES.—The Special Inspector General shall—
(A) conduct, supervise, and coordinate audits, evaluations and investigations of the Health Insurance Exchange to protect the integrity of the Health Insurance Exchange, as well as the health and welfare of participants in the Exchange;
(B) report both to the Commissioner and to the Congress regarding program and management problems and recommendations to correct them;
(C) have other duties (described in paragraphs (2) and (3) of section 121 of division A of Public Law 110–343) in relation to the duties described in the previous subparagraphs; and
(D) have the authorities provided in section 6 of the Inspector General Act of 1978 in carrying out duties under this paragraph.
(3) APPLICATION OF OTHER SPECIAL INSPECTOR GENERAL PROVISIONS.—The provisions of subsections (b) (other than paragraphs (1) and (3)), (d) (other than paragraph (1)), and (e) of section 121 of division A of the Emergency Economic Stabilization Act of 2009 (Public Law 110–343) shall apply to the Special Inspector General under this subsection in the same manner as such provisions apply to the Special Inspector General under such section.
(4) REPORTS.—Not later than one year after the confirmation of the Special Inspector General, and annually thereafter, the Special Inspector General shall submit to the appropriate committees of Congress a report summarizing the activities of the Special Inspector General during the one year period ending on the date such report is submitted.
(5) TERMINATION.—The Office of the Special Inspector General shall terminate five years after the date of the enactment of this Act.
(a) Establishment of Health Insurance Exchange Trust Fund.—There is created within the Treasury of the United States a trust fund to be known as the “Health Insurance Exchange Trust Fund” (in this section referred to as the “Trust Fund”), consisting of such amounts as may be appropriated or credited to the Trust Fund under this section or any other provision of law.
(b) Payments from Trust Fund.—The Commissioner shall pay from time to time from the Trust Fund such amounts as the Commissioner determines are necessary to make payments to operate the Health Insurance Exchange, including payments under subtitle C (relating to affordability credits).
(1) DEDICATED PAYMENTS.—There is hereby appropriated to the Trust Fund amounts equivalent to the following:
(A) TAXES ON INDIVIDUALS NOT OBTAINING ACCEPTABLE COVERAGE.—The amounts received in the Treasury under section 59B of the Internal Revenue Code of 1986 (relating to requirement of health insurance coverage for individuals).
(B) EMPLOYMENT TAXES ON EMPLOYERS NOT PROVIDING ACCEPTABLE COVERAGE.—The amounts received in the Treasury under section 3111(c) of the Internal Revenue Code of 1986 (relating to employers electing to not provide health benefits).
(C) EXCISE TAX ON FAILURES TO MEET CERTAIN HEALTH COVERAGE REQUIREMENTS.—The amounts received in the Treasury under section 4980H(b) (relating to excise tax with respect to failure to meet health coverage participation requirements).
(2) APPROPRIATIONS TO COVER GOVERNMENT CONTRIBUTIONS.—There are hereby appropriated, out of any moneys in the Treasury not otherwise appropriated, to the Trust Fund, an amount equivalent to the amount of payments made from the Trust Fund under subsection (b) plus such amounts as are necessary reduced by the amounts deposited under paragraph (1).
(d) Application of certain rules.—Rules similar to the rules of subchapter B of chapter 98 of the Internal Revenue Code of 1986 shall apply with respect to the Trust Fund.
(1) a State (or group of States, subject to the approval of the Commissioner) applies to the Commissioner for approval of a State-based Health Insurance Exchange to operate in the State (or group of States); and
(2) the Commissioner approves such State-based Health Insurance Exchange,
then, subject to subsections (c) and (d), the State-based Health Insurance Exchange shall operate, instead of the Health Insurance Exchange, with respect to such State (or group of States). The Commissioner shall approve a State-based Health Insurance Exchange if it meets the requirements for approval under subsection (b).(b) Requirements for approval.—The Commissioner may not approve a State-based Health Insurance Exchange under this section unless the following requirements are met:
(1) The State-based Health Insurance Exchange must demonstrate the capacity to and provide assurances satisfactory to the Commissioner that the State-based Health Insurance Exchange will carry out the functions specified for the Health Insurance Exchange in the State (or States) involved, including—
(A) negotiating and contracting with QHBP offering entities for the offering of Exchange-participating health benefits plan, which satisfy the standards and requirements of this title and title I;
(B) enrolling Exchange-eligible individuals and employers in such State in such plans;
(C) the establishment of sufficient local offices to meet the needs of Exchange-eligible individuals and employers;
(D) administering affordability credits under subtitle B using the same methodologies (and at least the same income verification methods) as would otherwise apply under such subtitle and at a cost to the Federal Government which does exceed the cost to the Federal Government if this section did not apply; and
(E) enforcement activities consistent with federal requirements.
(2) There is no more than one Health Insurance Exchange operating with respect to any one State.
(3) The State provides assurances satisfactory to the Commissioner that approval of such an Exchange will not result in any net increase in expenditures to the Federal Government.
(4) The State provides for reporting of such information as the Commissioner determines and assurances satisfactory to the Commissioner that it will vigorously enforce violations of applicable requirements.
(5) Such other requirements as the Commissioner may specify.
(1) IN GENERAL.—A State-based Health Insurance Exchange may, at the option of each State involved, and only after providing timely and reasonable notice to the Commissioner, cease operation as such an Exchange, in which case the Health Insurance Exchange shall operate, instead of such State-based Health Insurance Exchange, with respect to such State (or States).
(2) TERMINATION; HEALTH INSURANCE EXCHANGE RESUMPTION OF FUNCTIONS.—The Commissioner may terminate the approval (for some or all functions) of a State-based Health Insurance Exchange under this section if the Commissioner determines that such Exchange no longer meets the requirements of subsection (b) or is no longer capable of carrying out such functions in accordance with the requirements of this subtitle. In lieu of terminating such approval, the Commissioner may temporarily assume some or all functions of the State-based Health Insurance Exchange until such time as the Commissioner determines the State-based Health Insurance Exchange meets such requirements of subsection (b) and is capable of carrying out such functions in accordance with the requirements of this subtitle.
(3) EFFECTIVENESS.—The ceasing or termination of a State-based Health Insurance Exchange under this subsection shall be effective in such time and manner as the Commissioner shall specify.
(1) AUTHORITY RETAINED.—Enforcement authorities of the Commissioner shall be retained by the Commissioner.
(2) DISCRETION TO RETAIN ADDITIONAL AUTHORITY.—The Commissioner may specify functions of the Health Insurance Exchange that—
(A) may not be performed by a State-based Health Insurance Exchange under this section; or
(B) may be performed by the Commissioner and by such a State-based Health Insurance Exchange.
(e) References.—In the case of a State-based Health Insurance Exchange, except as the Commissioner may otherwise specify under subsection (d), any references in this subtitle to the Health Insurance Exchange or to the Commissioner in the area in which the State-based Health Insurance Exchange operates shall be deemed a reference to the State-based Health Insurance Exchange and the head of such Exchange, respectively.
(f) Funding.—In the case of a State-based Health Insurance Exchange, there shall be assistance provided for the operation of such Exchange in the form of a matching grant with a State share of expenditures required.
(a) Establishment.—For years beginning with Y1, the Secretary of Health and Human Services (in this subtitle referred to as the “Secretary”) shall provide for the offering of an Exchange-participating health benefits plan (in this division referred to as the “public health insurance option”) that ensures choice, competition, and stability of affordable, high quality coverage throughout the United States in accordance with this subtitle. In designing the option, the Secretary’s primary responsibility is to create a low-cost plan without compromising quality or access to care.
(b) Offering as an Exchange-participating health benefits plan.—
(1) EXCLUSIVE TO THE EXCHANGE.—The public health insurance option shall only be made available through the Health Insurance Exchange.
(2) ENSURING A LEVEL PLAYING FIELD.—Consistent with this subtitle, the public health insurance option shall comply with requirements that are applicable under this title to an Exchange-participating health benefits plan, including requirements related to benefits, benefit levels, provider networks, notices, consumer protections, and cost sharing.
(3) PROVISION OF BENEFIT LEVELS.—The public health insurance option—
(A) shall offer basic, enhanced, and premium plans; and
(B) may offer premium-plus plans.
(c) Administrative contracting.—The Secretary may enter into contracts for the purpose of performing administrative functions (including functions described in subsection (a)(4) of section 1874A of the Social Security Act) with respect to the public health insurance option in the same manner as the Secretary may enter into contracts under subsection (a)(1) of such section. The Secretary has the same authority with respect to the public health insurance option as the Secretary has under subsections (a)(1) and (b) of section 1874A of the Social Security Act with respect to title XVIII of such Act. Contracts under this subsection shall not involve the transfer of insurance risk to such entity.
(d) Ombudsman.—The Secretary shall establish an office of the ombudsman for the public health insurance option which shall have duties with respect to the public health insurance option similar to the duties of the Medicare Beneficiary Ombudsman under section 1808(c)(2) of the Social Security Act.
(e) Data collection.—The Secretary shall collect such data as may be required to establish premiums and payment rates for the public health insurance option and for other purposes under this subtitle, including to improve quality and to reduce racial, ethnic, and other disparities in health and health care.
(f) Treatment of public health insurance option.—With respect to the public health insurance option, the Secretary shall be treated as a QHBP offering entity offering an Exchange-participating health benefits plan.
(g) Access to Federal courts.—The provisions of Medicare (and related provisions of title II of the Social Security Act) relating to access of Medicare beneficiaries to Federal courts for the enforcement of rights under Medicare, including with respect to amounts in controversy, shall apply to the public health insurance option and individuals enrolled under such option under this title in the same manner as such provisions apply to Medicare and Medicare beneficiaries.
(a) Establishment of premiums.—
(1) IN GENERAL.—The Secretary shall establish geographically-adjusted premium rates for the public health insurance option in a manner—
(A) that complies with the premium rules established by the Commissioner under section 113 for Exchange-participating health benefit plans; and
(B) at a level sufficient to fully finance the costs of—
(i) health benefits provided by the public health insurance option; and
(ii) administrative costs related to operating the public health insurance option.
(2) CONTINGENCY MARGIN.—In establishing premium rates under paragraph (1), the Secretary shall include an appropriate amount for a contingency margin.
(1) ESTABLISHMENT.—There is established in the Treasury of the United States an Account for the receipts and disbursements attributable to the operation of the public health insurance option, including the start-up funding under paragraph (2). Section 1854(g) of the Social Security Act shall apply to receipts described in the previous sentence in the same manner as such section applies to payments or premiums described in such section.
(A) IN GENERAL.—In order to provide for the establishment of the public health insurance option there is hereby appropriated to the Secretary, out of any funds in the Treasury not otherwise appropriated, $2,000,000,000. In order to provide for initial claims reserves before the collection of premiums, there is hereby appropriated to the Secretary, out of any funds in the Treasury not otherwise appropriated, such sums as necessary to cover 90 days worth of claims reserves based on projected enrollment.
(B) AMORTIZATION OF START-UP FUNDING.—The Secretary shall provide for the repayment of the startup funding provided under subparagraph (A) to the Treasury in an amortized manner over the 10-year period beginning with Y1.
(C) LIMITATION ON FUNDING.—Nothing in this section shall be construed as authorizing any additional appropriations to the Account, other than such amounts as are otherwise provided with respect to other Exchange-participating health benefits plans.
(a) Rates established by Secretary.—
(1) IN GENERAL.—The Secretary shall establish payment rates for the public health insurance option for services and health care providers consistent with this section and may change such payment rates in accordance with section 224.
(A) IN GENERAL.—Except as provided in subparagraph (B) and subsection (b)(1), during Y1, Y2, and Y3, the Secretary shall base the payment rates under this section for services and providers described in paragraph (1) on the payment rates for similar services and providers under parts A and B of Medicare.
(i) PRACTITIONERS’ SERVICES.—Payment rates for practitioners’ services otherwise established under the fee schedule under section 1848 of the Social Security Act shall be applied without regard to the provisions under subsection (f) of such section and the update under subsection (d)(4) under such section for a year as applied under this paragraph shall be not less than 1 percent.
(ii) ADJUSTMENTS.—The Secretary may determine the extent to which Medicare adjustments applicable to base payment rates under parts A and B of Medicare shall apply under this subtitle.
(3) FOR NEW SERVICES.—The Secretary shall modify payment rates described in paragraph (2) in order to accommodate payments for services, such as well-child visits, that are not otherwise covered under Medicare.
(4) PRESCRIPTION DRUGS.—Payment rates under this section for prescription drugs that are not paid for under part A or part B of Medicare shall be at rates negotiated by the Secretary.
(b) Incentives for participating providers.—
(1) INITIAL INCENTIVE PERIOD.—
(A) IN GENERAL.—The Secretary shall provide, in the case of services described in subparagraph (B) furnished during Y1, Y2, and Y3, for payment rates that are 5 percent greater than the rates established under subsection (a).
(B) SERVICES DESCRIBED.—The services described in this subparagraph are items and professional services, under the public health insurance option by a physician or other health care practitioner who participates in both Medicare and the public health insurance option.
(C) SPECIAL RULES.—A pediatrician and any other health care practitioner who is a type of practitioner that does not typically participate in Medicare (as determined by the Secretary) shall also be eligible for the increased payment rates under subparagraph (A).
(2) SUBSEQUENT PERIODS.—Beginning with Y4 and for subsequent years, the Secretary shall continue to use an administrative process to set such rates in order to promote payment accuracy, to ensure adequate beneficiary access to providers, and to promote affordability and the efficient delivery of medical care consistent with section 221(a). Such rates shall not be set at levels expected to increase overall medical costs under the option beyond what would be expected if the process under subsection (a)(2) and paragraph (1) of this subsection were continued.
(3) ESTABLISHMENT OF A PROVIDER NETWORK.—Health care providers participating under Medicare are participating providers in the public health insurance option unless they opt out in a process established by the Secretary.
(c) Administrative process for setting rates.—Chapter 5 of title 5, United States Code shall apply to the process for the initial establishment of payment rates under this section but not to the specific methodology for establishing such rates or the calculation of such rates.
(d) Construction.—Nothing in this subtitle shall be construed as limiting the Secretary’s authority to correct for payments that are excessive or deficient, taking into account the provisions of section 221(a) and the amounts paid for similar health care providers and services under other Exchange-participating health benefits plans.
(e) Construction.—Nothing in this subtitle shall be construed as affecting the authority of the Secretary to establish payment rates, including payments to provide for the more efficient delivery of services, such as the initiatives provided for under section 224.
(f) Limitations on review.—There shall be no administrative or judicial review of a payment rate or methodology established under this section or under section 224.
(a) In general.—For plan years beginning with Y1, the Secretary may utilize innovative payment mechanisms and policies to determine payments for items and services under the public health insurance option. The payment mechanisms and policies under this section may include patient-centered medical home and other care management payments, accountable care organizations, value-based purchasing, bundling of services, differential payment rates, performance or utilization based payments, partial capitation, and direct contracting with providers.
(b) Requirements for innovative payments.—The Secretary shall design and implement the payment mechanisms and policies under this section in a manner that—
(A) improve health outcomes;
(B) reduce health disparities (including racial, ethnic, and other disparities);
(C) provide efficient and affordable care;
(D) address geographic variation in the provision of health services; or
(E) prevent or manage chronic illness; and
(2) promotes care that is integrated, patient-centered, quality, and efficient.
(c) Encouraging the use of high value services.—To the extent allowed by the benefit standards applied to all Exchange-participating health benefits plans, the public health insurance option may modify cost sharing and payment rates to encourage the use of services that promote health and value.
(d) Non-uniformity permitted.—Nothing in this subtitle shall prevent the Secretary from varying payments based on different payment structure models (such as accountable care organizations and medical homes) under the public health insurance option for different geographic areas.
(a) In general.—The Secretary shall establish conditions of participation for health care providers under the public health insurance option.
(b) Licensure or certification.—The Secretary shall not allow a health care provider to participate in the public health insurance option unless such provider is appropriately licensed or certified under State law.
(c) Payment terms for providers.—
(1) PHYSICIANS.—The Secretary shall provide for the annual participation of physicians under the public health insurance option, for which payment may be made for services furnished during the year, in one of 2 classes:
(A) PREFERRED PHYSICIANS.—Those physicians who agree to accept the payment rate established under section 223 (without regard to cost-sharing) as the payment in full.
(B) PARTICIPATING, NON-PREFERRED PHYSICIANS.—Those physicians who agree not to impose charges (in relation to the payment rate described in section 223 for such physicians) that exceed the ratio permitted under section 1848(g)(2)(C) of the Social Security Act.
(2) OTHER PROVIDERS.—The Secretary shall provide for the participation (on an annual or other basis specified by the Secretary) of health care providers (other than physicians) under the public health insurance option under which payment shall only be available if the provider agrees to accept the payment rate established under section 223 (without regard to cost-sharing) as the payment in full.
(d) Exclusion of certain providers.—The Secretary shall exclude from participation under the public health insurance option a health care provider that is excluded from participation in a Federal health care program (as defined in section 1128B(f) of the Social Security Act).
Provisions of law (other than criminal law provisions) identified by the Secretary by regulation, in consultation with the Inspector General of the Department of Health and Human Services, that impose sanctions with respect to waste, fraud, and abuse under Medicare, such as the False Claims Act (31 U.S.C. 3729 et seq.), shall also apply to the public health insurance option.
(a) In general.—Subject to the succeeding provisions of this subtitle, in the case of an affordable credit eligible individual enrolled in an Exchange-participating health benefits plan—
(1) the individual shall be eligible for, in accordance with this subtitle, affordability credits consisting of—
(A) an affordability premium credit under section 243 to be applied against the premium for the Exchange-participating health benefits plan in which the individual is enrolled; and
(B) an affordability cost-sharing credit under section 244 to be applied as a reduction of the cost-sharing otherwise applicable to such plan; and
(2) the Commissioner shall pay the QHBP offering entity that offers such plan from the Health Insurance Exchange Trust Fund the aggregate amount of affordability credits for all affordable credit eligible individuals enrolled in such plan.
(1) IN GENERAL.—An Exchange eligible individual may apply to the Commissioner through the Health Insurance Exchange or through another entity under an arrangement made with the Commissioner, in a form and manner specified by the Commissioner. The Commissioner through the Health Insurance Exchange or through another public entity under an arrangement made with the Commissioner shall make a determination as to eligibility of an individual for affordability credits under this subtitle. The Commissioner shall establish a process whereby, on the basis of information otherwise available, individuals may be deemed to be affordable credit eligible individuals. In carrying this subtitle, the Commissioner shall establish effective methods that ensure that individuals with limited English proficiency are able to apply for affordability credits.
(2) USE OF STATE MEDICAID AGENCIES.—If the Commissioner determines that a State Medicaid agency has the capacity to make a determination of eligibility for affordability credits under this subtitle and under the same standards as used by the Commissioner, under the Medicaid memorandum of understanding (as defined in section 205(c)(4))—
(A) the State Medicaid agency is authorized to conduct such determinations for any Exchange-eligible individual who requests such a determination; and
(B) the Commissioner shall reimburse the State Medicaid agency for the costs of conducting such determinations.
(3) MEDICAID SCREEN AND ENROLL OBLIGATION.—In the case of an application made under paragraph (1), there shall be a determination of whether the individual is a Medicaid-eligible individual. If the individual is determined to be so eligible, the Commissioner, through the Medicaid memorandum of understanding, shall provide for the enrollment of the individual under the State Medicaid plan in accordance with the Medicaid memorandum of understanding. In the case of such an enrollment, the State shall provide for the same periodic redetermination of eligibility under Medicaid as would otherwise apply if the individual had directly applied for medical assistance to the State Medicaid agency.
(c) Use of affordability credits.—
(1) IN GENERAL.—In Y1 and Y2 an affordable credit eligible individual may use an affordability credit only with respect to a basic plan.
(2) FLEXIBILITY IN PLAN ENROLLMENT AUTHORIZED.—Beginning with Y3, the Commissioner shall establish a process to allow an affordability credit to be used for enrollees in enhanced or premium plans. In the case of an affordable credit eligible individual who enrolls in an enhanced or premium plan, the individual shall be responsible for any difference between the premium for such plan and the affordability credit amount otherwise applicable if the individual had enrolled in a basic plan.
(d) Access to data.—In carrying out this subtitle, the Commissioner shall request from the Secretary of the Treasury consistent with section 6103 of the Internal Revenue Code of 1986 such information as may be required to carry out this subtitle.
(e) No cash rebates.—In no case shall an affordable credit eligible individual receive any cash payment as a result of the application of this subtitle.
(1) IN GENERAL.—For purposes of this division, the term “affordable credit eligible individual” means, subject to subsection (b), an individual who is lawfully present in a State in the United States (other than as a nonimmigrant described in a subparagraph (excluding subparagraphs (K), (T), (U), and (V)) of section 101(a)(15) of the Immigration and Nationality Act)—
(A) who is enrolled under an Exchange-participating health benefits plan and is not enrolled under such plan as an employee (or dependent of an employee) through an employer qualified health benefits plan that meets the requirements of section 312;
(B) with family income below 400 percent of the Federal poverty level for a family of the size involved; and
(C) who is not a Medicaid eligible individual, other than an individual described in section 202(d)(3) or an individual during a transition period under section 202(d)(4)(B)(ii).
(2) TREATMENT OF FAMILY.—Except as the Commissioner may otherwise provide, members of the same family who are affordable credit eligible individuals shall be treated as a single affordable credit individual eligible for the applicable credit for such a family under this subtitle.
(b) Limitations on employee and dependent disqualification.—
(1) IN GENERAL.—Subject to paragraph (2), the term “affordable credit eligible individual” does not include a full-time employee of an employer if the employer offers the employee coverage (for the employee and dependents) as a full-time employee under a group health plan if the coverage and employer contribution under the plan meet the requirements of section 312.
(A) FOR CERTAIN FAMILY CIRCUMSTANCES.—The Commissioner shall establish such exceptions and special rules in the case described in paragraph (1) as may be appropriate in the case of a divorced or separated individual or such a dependent of an employee who would otherwise be an affordable credit eligible individual.
(B) FOR UNAFFORDABLE EMPLOYER COVERAGE.—Beginning in Y2, in the case of full-time employees for which the cost of the employee premium for coverage under a group health plan would exceed 11 percent of current family income (determined by the Commissioner on the basis of verifiable documentation and without regard to section 245), paragraph (1) shall not apply.
(1) IN GENERAL.—In this title, the term “income” means modified adjusted gross income (as defined in section 59B of the Internal Revenue Code of 1986).
(2) STUDY OF INCOME DISREGARDS.—The Commissioner shall conduct a study that examines the application of income disregards for purposes of this subtitle. Not later than the first day of Y2, the Commissioner shall submit to Congress a report on such study and shall include such recommendations as the Commissioner determines appropriate.
(d) Clarification of treatment of affordability credits.—Affordability credits under this subtitle shall not be treated, for purposes of title IV of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, to be a benefit provided under section 403 of such title.
(a) In general.—The affordability premium credit under this section for an affordable credit eligible individual enrolled in an Exchange-participating health benefits plan is in an amount equal to the amount (if any) by which the premium for the plan (or, if less, the reference premium amount specified in subsection (c)), exceeds the affordable premium amount specified in subsection (b) for the individual.
(b) Affordable premium amount.—
(1) IN GENERAL.—The affordable premium amount specified in this subsection for an individual for monthly premium in a plan year shall be equal to 1⁄12 of the product of—
(A) the premium percentage limit specified in paragraph (2) for the individual based upon the individual’s family income for the plan year; and
(B) the individual’s family income for such plan year.
(2) PREMIUM PERCENTAGE LIMITS BASED ON TABLE.—The Commissioner shall establish premium percentage limits so that for individuals whose family income is within an income tier specified in the table in subsection (d) such percentage limits shall increase, on a sliding scale in a linear manner, from the initial premium percentage to the final premium percentage specified in such table for such income tier.
(c) Reference premium amount.—The reference premium amount specified in this subsection for a plan year for an individual in a premium rating area is equal to the average premium for the 3 basic plans in the area for the plan year with the lowest premium levels. In computing such amount the Commissioner may exclude plans with extremely limited enrollments.
(d) Table of premium percentage limits and actuarial value percentages based on income tier.—
(1) IN GENERAL.—For purposes of this subtitle, the table specified in this subsection is as follows:
| In the case of family income (expressed as a percent of FPL) within the following income tier: | The initial premium percentage is— | The final premium percentage is— | The actuarial value percentage is— |
| 133% through 150% | 1.5% | 3% | 97% |
| 150% through 200% | 3% | 5% | 93% |
| 200% through 250% | 5% | 7% | 85% |
| 250% through 300% | 7% | 9% | 78% |
| 300% through 350% | 9% | 10% | 72% |
| 350% through 400% | 10% | 11% | 70% |
(2) SPECIAL RULES.—For purposes of applying the table under paragraph (1)—
(A) FOR LOWEST LEVEL OF INCOME.—In the case of an individual with income that does not exceed 133 percent of FPL, the individual shall be considered to have income that is 133% of FPL.
(B) APPLICATION OF HIGHER ACTUARIAL VALUE PERCENTAGE AT TIER TRANSITION POINTS.—If two actuarial value percentages may be determined with respect to an individual, the actuarial value percentage shall be the higher of such percentages.
(a) In general.—The affordability cost-sharing credit under this section for an affordable credit eligible individual enrolled in an Exchange-participating health benefits plan is in the form of the cost-sharing reduction described in subsection (b) provided under this section for the income tier in which the individual is classified based on the individual’s family income.
(b) Cost-sharing reductions.—The Commissioner shall specify a reduction in cost-sharing amounts and the annual limitation on cost-sharing specified in section 122(c)(2)(B) under a basic plan for each income tier specified in the table under section 243(d), with respect to a year, in a manner so that, as estimated by the Commissioner, the actuarial value of the coverage with such reduced cost-sharing amounts (and the reduced annual cost-sharing limit) is equal to the actuarial value percentage (specified in the table under section 243(d) for the income tier involved) of the full actuarial value if there were no cost-sharing imposed under the plan.
(c) Determination and payment of cost-sharing affordability credit.—In the case of an affordable credit eligible individual in a tier enrolled in an Exchange-participating health benefits plan offered by a QHBP offering entity, the Commissioner shall provide for payment to the offering entity of an amount equivalent to the increased actuarial value of the benefits under the plan provided under section 203(c)(2)(B) resulting from the reduction in cost-sharing described in subsection (b).
(a) In general.—In applying this subtitle for an affordability credit for an individual for a plan year, the individual’s income shall be the income (as defined in section 242(c)) for the individual for the most recent taxable year (as determined in accordance with rules of the Commissioner). The Federal poverty level applied shall be such level in effect as of the date of the application.
(b) Program integrity; Income verification procedures.—
(1) PROGRAM INTEGRITY.—The Commissioner shall take such steps as may be appropriate to ensure the accuracy of determinations and redeterminations under this subtitle.
(A) IN GENERAL.—Upon an initial application of an individual for an affordability credit under this subtitle (or in applying section 242(b)) or upon an application for a change in the affordability credit based upon a significant change in family income described in subparagraph (A)—
(i) the Commissioner shall request from the Secretary of the Treasury the disclosure to the Commissioner of such information as may be permitted to verify the information contained in such application; and
(ii) the Commissioner shall use the information so disclosed to verify such information.
(B) ALTERNATIVE PROCEDURES.—The Commissioner shall establish procedures for the verification of income for purposes of this subtitle if no income tax return is available for the most recent completed tax year.
(1) CHANGES IN INCOME AS A PERCENT OF FPL.—In the case that an individual’s income (expressed as a percentage of the Federal poverty level for a family of the size involved) for a plan year is expected (in a manner specified by the Commissioner) to be significantly different from the income (as so expressed) used under subsection (a), the Commissioner shall establish rules requiring an individual to report, consistent with the mechanism established under paragraph (2), significant changes in such income (including a significant change in family composition) to the Commissioner and requiring the substitution of such income for the income otherwise applicable.
(2) REPORTING OF SIGNIFICANT CHANGES IN INCOME.—The Commissioner shall establish rules under which an individual determined to be an affordable credit eligible individual would be required to inform the Commissioner when there is a significant change in the family income of the individual (expressed as a percentage of the FPL for a family of the size involved) and of the information regarding such change. Such mechanism shall provide for guidelines that specify the circumstances that qualify as a significant change, the verifiable information required to document such a change, and the process for submission of such information. If the Commissioner receives new information from an individual regarding the family income of the individual, the Commissioner shall provide for a redetermination of the individual’s eligibility to be an affordable credit eligible individual.
(3) TRANSITION FOR CHIP.—In the case of a child described in section 202(d)(2), the Commissioner shall establish rules under which the family income of the child is deemed to be no greater than the family income of the child as most recently determined before Y1 by the State under title XXI of the Social Security Act.
(4) STUDY OF GEOGRAPHIC VARIATION IN APPLICATION OF FPL.—The Commissioner shall examine the feasibility and implication of adjusting the application of the Federal poverty level under this subtitle for different geographic areas so as to reflect the variations in cost-of-living among different areas within the United States. If the Commissioner determines that an adjustment is feasible, the study should include a methodology to make such an adjustment. Not later than the first day of Y2, the Commissioner shall submit to Congress a report on such study and shall include such recommendations as the Commissioner determines appropriate.
(d) Penalties for misrepresentation.—In the case of an individual intentionally misrepresents family income or the individual fails (without regard to intent) to disclose to the Commissioner a significant change in family income under subsection (c) in a manner that results in the individual becoming an affordable credit eligible individual when the individual is not or in the amount of the affordability credit exceeding the correct amount—
(1) the individual is liable for repayment of the amount of the improper affordability credit; ;and
(2) in the case of such an intentional misrepresentation or other egregious circumstances specified by the Commissioner, the Commissioner may impose an additional penalty.
Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.
For an individual’s responsibility to obtain acceptable coverage, see section 59B of the Internal Revenue Code of 1986 (as added by section 401 of this Act).
An employer meets the requirements of this section if such employer does all of the following:
(1) OFFER OF COVERAGE.—The employer offers each employee individual and family coverage under a qualified health benefits plan (or under a current employment-based health plan (within the meaning of section 102(b))) in accordance with section 312.
(2) CONTRIBUTION TOWARDS COVERAGE.—If an employee accepts such offer of coverage, the employer makes timely contributions towards such coverage in accordance with section 312.
(3) CONTRIBUTION IN LIEU OF COVERAGE.—Beginning with Y2, if an employee declines such offer but otherwise obtains coverage in an Exchange-participating health benefits plan (other than by reason of being covered by family coverage as a spouse or dependent of the primary insured), the employer shall make a timely contribution to the Health Insurance Exchange with respect to each such employee in accordance with section 313.
(a) In general.—An employer meets the requirements of this section with respect to an employee if the following requirements are met:
(1) OFFERING OF COVERAGE.—The employer offers the coverage described in section 311(1) either through an Exchange-participating health benefits plan or other than through such a plan.
(2) EMPLOYER REQUIRED CONTRIBUTION.—The employer timely pays to the issuer of such coverage an amount not less than the employer required contribution specified in subsection (b) for such coverage.
(3) PROVISION OF INFORMATION.—The employer provides the Health Choices Commissioner, the Secretary of Labor, the Secretary of Health and Human Services, and the Secretary of the Treasury, as applicable, with such information as the Commissioner may require to ascertain compliance with the requirements of this section.
(4) AUTOENROLLMENT OF EMPLOYEES.—The employer provides for autoenrollment of the employee in accordance with subsection (c).
(b) Reduction of employee premiums through minimum employer contribution.—
(1) FULL-TIME EMPLOYEES.—The minimum employer contribution described in this subsection for coverage of a full-time employee (and, if any, the employee’s spouse and qualifying children (as defined in section 152(c) of the Internal Revenue Code of 1986) under a qualified health benefits plan (or current employment-based health plan) is equal to—
(A) in case of individual coverage, not less than 72.5 percent of the applicable premium (as defined in section 4980B(f)(4) of such Code, subject to paragraph (2)) of the lowest cost plan offered by the employer that is a qualified health benefits plan (or is such current employment-based health plan); and
(B) in the case of family coverage which includes coverage of such spouse and children, not less 65 percent of such applicable premium of such lowest cost plan.
(2) APPLICABLE PREMIUM FOR EXCHANGE COVERAGE.—In this subtitle, the amount of the applicable premium of the lowest cost plan with respect to coverage of an employee under an Exchange-participating health benefits plan is the reference premium amount under section 243(c) for individual coverage (or, if elected, family coverage) for the premium rating area in which the individual or family resides.
(3) MINIMUM EMPLOYER CONTRIBUTION FOR EMPLOYEES OTHER THAN FULL-TIME EMPLOYEES.—In the case of coverage for an employee who is not a full-time employee, the amount of the minimum employer contribution under this subsection shall be a proportion (as determined in accordance with rules of the Health Choices Commissioner, the Secretary of Labor, the Secretary of Health and Human Services, and the Secretary of the Treasury, as applicable) of the minimum employer contribution under this subsection with respect to a full-time employee that reflects the proportion of—
(A) the average weekly hours of employment of the employee by the employer, to
(B) the minimum weekly hours specified by the Commissioner for an employee to be a full-time employee.
(4) SALARY REDUCTIONS NOT TREATED AS EMPLOYER CONTRIBUTIONS.—For purposes of this section, any contribution on behalf of an employee with respect to which there is a corresponding reduction in the compensation of the employee shall not be treated as an amount paid by the employer.
(c) Automatic enrollment for employer sponsored health benefits.—
(1) IN GENERAL.—The requirement of this subsection with respect to an employer and an employee is that the employer automatically enroll such employee into the employment-based health benefits plan for individual coverage under the plan option with the lowest applicable employee premium.
(2) OPT-OUT.—In no case may an employer automatically enroll an employee in a plan under paragraph (1) if such employee makes an affirmative election to opt out of such plan or to elect coverage under an employment-based health benefits plan offered by such employer. An employer shall provide an employee with a 30-day period to make such an affirmative election before the employer may automatically enroll the employee in such a plan.
(A) IN GENERAL.—Each employer described in paragraph (1) who automatically enrolls an employee into a plan as described in such paragraph shall provide the employees, within a reasonable period before the beginning of each plan year (or, in the case of new employees, within a reasonable period before the end of the enrollment period for such a new employee), written notice of the employees’ rights and obligations relating to the automatic enrollment requirement under such paragraph. Such notice must be comprehensive and understood by the average employee to whom the automatic enrollment requirement applies.
(B) INCLUSION OF SPECIFIC INFORMATION.—The written notice under subparagraph (A) must explain an employee’s right to opt out of being automatically enrolled in a plan and in the case that more than one level of benefits or employee premium level is offered by the employer involved, the notice must explain which level of benefits and employee premium level the employee will be automatically enrolled in the absence of an affirmative election by the employee.
(a) In general.—A contribution is made in accordance with this section with respect to an employee if such contribution is equal to an amount equal to 8 percent of the average wages paid by the employer during the period of enrollment (determined by taking into account all employees of the employer and in such manner as the Commissioner provides, including rules providing for the appropriate aggregation of related employers). Any such contribution—
(1) shall be paid to the Health Choices Commissioner for deposit into the Health Insurance Exchange Trust Fund, and
(2) shall not be applied against the premium of the employee under the Exchange-participating health benefits plan in which the employee is enrolled.
(b) Special rules for small employers.—
(1) IN GENERAL.—In the case of any employer who is a small employer for any calendar year, subsection (a) shall be applied by substituting the applicable percentage determined in accordance with the following table for “8 percent”:
| If the annual payroll of such employer for the preceding calendar year: | The applicable percentage is: |
| Does not exceed $250,000 | 0 percent |
| Exceeds $250,000, but does not exceed $300,000 | 2 percent |
| Exceeds $300,000, but does not exceed $350,000 | 4 percent |
| Exceeds $350,000, but does not exceed $400,000 | 6 percent |
(2) SMALL EMPLOYER.—For purposes of this subsection, the term “small employer” means any employer for any calendar year if the annual payroll of such employer for the preceding calendar year does not exceed $400,000.
(3) ANNUAL PAYROLL.—For purposes of this paragraph, the term “annual payroll” means, with respect to any employer for any calendar year, the aggregate wages paid by the employer during such calendar year.
(4) AGGREGATION RULES.—Related employers and predecessors shall be treated as a single employer for purposes of this subsection.
The Health Choices Commissioner (in coordination with the Secretary of Labor, the Secretary of Health and Human Services, and the Secretary of the Treasury) shall have authority to set standards for determining whether employers or insurers are undertaking any actions to affect the risk pool within the Health Insurance Exchange by inducing individuals to decline coverage under a qualified health benefits plan (or current employment-based health plan (within the meaning of section 102(b)) offered by the employer and instead to enroll in an Exchange-participating health benefits plan. An employer violating such standards shall be treated as not meeting the requirements of this section.
(a) In general.—Subtitle B of title I of the Employee Retirement Income Security Act of 1974 is amended by adding at the end the following new part:
“(a) In general.—An employer may make an election with the Secretary to be subject to the health coverage participation requirements.
“(b) Time and manner.—An election under subsection (a) may be made at such time and in such form and manner as the Secretary may prescribe.
“(a) In general.—If an employer makes an election to the Secretary under section 801—
“(1) such election shall be treated as the establishment and maintenance of a group health plan (as defined in section 733(a)) for purposes of this title, subject to section 151 of the America’s Affordable Health Choices Act of 2009, and
“(2) the health coverage participation requirements shall be deemed to be included as terms and conditions of such plan.
“(b) Periodic investigations to discover noncompliance.—The Secretary shall regularly audit a representative sampling of employers and group health plans and conduct investigations and other activities under section 504 with respect to such sampling of plans so as to discover noncompliance with the health coverage participation requirements in connection with such plans. The Secretary shall communicate findings of noncompliance made by the Secretary under this subsection to the Secretary of the Treasury and the Health Choices Commissioner. The Secretary shall take such timely enforcement action as appropriate to achieve compliance.
“For purposes of this part, the term ‘health coverage participation requirements’ means the requirements of part 1 of subtitle B of title III of division A of America’s Affordable Health Choices Act of 2009 (as in effect on the date of the enactment of such Act).
“(a) Affiliated groups.—In the case of any employer which is part of a group of employers who are treated as a single employer under subsection (b), (c), (m), or (o) of section 414 of the Internal Revenue Code of 1986, the election under section 801 shall be made by such employer as the Secretary may provide. Any such election, once made, shall apply to all members of such group.
“(b) Separate elections.—Under regulations prescribed by the Secretary, separate elections may be made under section 801 with respect to—
“(1) separate lines of business, and
“(2) full-time employees and employees who are not full-time employees.
“The Secretary may terminate the election of any employer under section 801 if the Secretary (in coordination with the Health Choices Commissioner) determines that such employer is in substantial noncompliance with the health coverage participation requirements and shall refer any such determination to the Secretary of the Treasury as appropriate.
“The Secretary may promulgate such regulations as may be necessary or appropriate to carry out the provisions of this part, in accordance with section 324(a) of the America’s Affordable Health Choices Act of 2009. The Secretary may promulgate any interim final rules as the Secretary determines are appropriate to carry out this part.”.
(b) Enforcement of health coverage participation requirements.—Section 502 of such Act (29 U.S.C. 1132) is amended—
(1) in subsection (a)(6), by striking “paragraph” and all that follows through “subsection (c)” and inserting “paragraph (2), (4), (5), (6), (7), (8), (9), (10), or (11) of subsection (c)”; and
(2) in subsection (c), by redesignating the second paragraph (10) as paragraph (12) and by inserting after the first paragraph (10) the following new paragraph:
“(11) Health coverage participation requirements.—
“(A) CIVIL PENALTIES.—In the case of any employer who fails (during any period with respect to which an election under section 801(a) is in effect) to satisfy the health coverage participation requirements with respect to any employee, the Secretary may assess a civil penalty against the employer of $100 for each day in the period beginning on the date such failure first occurs and ending on the date such failure is corrected.
“(B) HEALTH COVERAGE PARTICIPATION REQUIREMENTS.—For purposes of this paragraph, the term ‘health coverage participation requirements’ has the meaning provided in section 803.
“(C) LIMITATIONS ON AMOUNT OF PENALTY.—
“(i) PENALTY NOT TO APPLY WHERE FAILURE NOT DISCOVERED EXERCISING REASONABLE DILIGENCE.—No penalty shall be assessed under subparagraph (A) with respect to any failure during any period for which it is established to the satisfaction of the Secretary that the employer did not know, or exercising reasonable diligence would not have known, that such failure existed.
“(ii) PENALTY NOT TO APPLY TO FAILURES CORRECTED WITHIN 30 DAYS.—No penalty shall be assessed under subparagraph (A) with respect to any failure if—
“(I) such failure was due to reasonable cause and not to willful neglect, and
“(II) such failure is corrected during the 30-day period beginning on the 1st date that the employer knew, or exercising reasonable diligence would have known, that such failure existed.
“(iii) OVERALL LIMITATION FOR UNINTENTIONAL FAILURES.—In the case of failures which are due to reasonable cause and not to willful neglect, the penalty assessed under subparagraph (A) for failures during any 1-year period shall not exceed the amount equal to the lesser of—
“(I) 10 percent of the aggregate amount paid or incurred by the employer (or predecessor employer) during the preceding 1-year period for group health plans, or
“(II) $500,000.
“(D) ADVANCE NOTIFICATION OF FAILURE PRIOR TO ASSESSMENT.—Before a reasonable time prior to the assessment of any penalty under this paragraph with respect to any failure by an employer, the Secretary shall inform the employer in writing of such failure and shall provide the employer information regarding efforts and procedures which may be undertaken by the employer to correct such failure.
“(E) COORDINATION WITH EXCISE TAX.—Under regulations prescribed in accordance with section 324 of the America’s Affordable Health Choices Act of 2009, the Secretary and the Secretary of the Treasury shall coordinate the assessment of penalties under this section in connection with failures to satisfy health coverage participation requirements with the imposition of excise taxes on such failures under section 4980H(b) of the Internal Revenue Code of 1986 so as to avoid duplication of penalties with respect to such failures.
“(F) DEPOSIT OF PENALTY COLLECTED.—Any amount of penalty collected under this paragraph shall be deposited as miscellaneous receipts in the Treasury of the United States.”.
(c) Clerical amendments.—The table of contents in section 1 of such Act is amended by inserting after the item relating to section 734 the following new items:
(d) Effective date.—The amendments made by this section shall apply to periods beginning after December 31, 2012.
(a) Failure to elect, or substantially comply with, health coverage participation requirements.—For employment tax on employers who fail to elect, or substantially comply with, the health coverage participation requirements described in part 1, see section 3111(c) of the Internal Revenue Code of 1986 (as added by section 412 of this Act).
(b) Other failures.—For excise tax on other failures of electing employers to comply with such requirements, see section 4980H of the Internal Revenue Code of 1986 (as added by section 411 of this Act).
(a) In general.—Part C of title XXVII of the Public Health Service Act is amended by adding at the end the following new section:
“(a) Election of employer to be subject to national health coverage participation requirements.—
“(1) In general.—An employer may make an election with the Secretary to be subject to the health coverage participation requirements.
“(2) Time and manner.—An election under paragraph (1) may be made at such time and in such form and manner as the Secretary may prescribe.
“(b) Treatment of coverage resulting from election.—
“(1) In general.—If an employer makes an election to the Secretary under subsection (a)—
“(A) such election shall be treated as the establishment and maintenance of a group health plan for purposes of this title, subject to section 151 of the America’s Affordable Health Choices Act of 2009, and
“(B) the health coverage participation requirements shall be deemed to be included as terms and conditions of such plan.
“(2) Periodic investigations to determine compliance with health coverage participation requirements.—The Secretary shall regularly audit a representative sampling of employers and conduct investigations and other activities with respect to such sampling of employers so as to discover noncompliance with the health coverage participation requirements in connection with such employers (during any period with respect to which an election under subsection (a) is in effect). The Secretary shall communicate findings of noncompliance made by the Secretary under this subsection to the Secretary of the Treasury and the Health Choices Commissioner. The Secretary shall take such timely enforcement action as appropriate to achieve compliance.
“(c) Health coverage participation requirements.—For purposes of this section, the term ‘health coverage participation requirements’ means the requirements of part 1 of subtitle B of title III of division A of the America’s Affordable Health Choices Act of 2009 (as in effect on the date of the enactment of this section).
“(d) Separate elections.—Under regulations prescribed by the Secretary, separate elections may be made under subsection (a) with respect to full-time employees and employees who are not full-time employees.
“(e) Termination of election in cases of substantial noncompliance.—The Secretary may terminate the election of any employer under subsection (a) if the Secretary (in coordination with the Health Choices Commissioner) determines that such employer is in substantial noncompliance with the health coverage participation requirements and shall refer any such determination to the Secretary of the Treasury as appropriate.
“(f) Enforcement of health coverage participation requirements.—
“(1) Civil penalties.—In the case of any employer who fails (during any period with respect to which the election under subsection (a) is in effect) to satisfy the health coverage participation requirements with respect to any employee, the Secretary may assess a civil penalty against the employer of $100 for each day in the period beginning on the date such failure first occurs and ending on the date such failure is corrected.
“(2) Limitations on amount of penalty.—
“(A) PENALTY NOT TO APPLY WHERE FAILURE NOT DISCOVERED EXERCISING REASONABLE DILIGENCE.—No penalty shall be assessed under paragraph (1) with respect to any failure during any period for which it is established to the satisfaction of the Secretary that the employer did not know, or exercising reasonable diligence would not have known, that such failure existed.
“(B) PENALTY NOT TO APPLY TO FAILURES CORRECTED WITHIN 30 DAYS.—No penalty shall be assessed under paragraph (1) with respect to any failure if—
“(i) such failure was due to reasonable cause and not to willful neglect, and
“(ii) such failure is corrected during the 30-day period beginning on the 1st date that the employer knew, or exercising reasonable diligence would have known, that such failure existed.
“(C) OVERALL LIMITATION FOR UNINTENTIONAL FAILURES.—In the case of failures which are due to reasonable cause and not to willful neglect, the penalty assessed under paragraph (1) for failures during any 1-year period shall not exceed the amount equal to the lesser of—
“(i) 10 percent of the aggregate amount paid or incurred by the employer (or predecessor employer) during the preceding taxable year for group health plans, or
“(ii) $500,000.
“(3) Advance notification of failure prior to assessment.—Before a reasonable time prior to the assessment of any penalty under paragraph (1) with respect to any failure by an employer, the Secretary shall inform the employer in writing of such failure and shall provide the employer information regarding efforts and procedures which may be undertaken by the employer to correct such failure.
“(4) Actions to enforce assessments.—The Secretary may bring a civil action in any District Court of the United States to collect any civil penalty under this subsection.
“(5) Coordination with excise tax.—Under regulations prescribed in accordance with section 324 of the America’s Affordable Health Choices Act of 2009, the Secretary and the Secretary of the Treasury shall coordinate the assessment of penalties under paragraph (1) in connection with failures to satisfy health coverage participation requirements with the imposition of excise taxes on such failures under section 4980H(b) of the Internal Revenue Code of 1986 so as to avoid duplication of penalties with respect to such failures.
“(6) Deposit of penalty collected.—Any amount of penalty collected under this subsection shall be deposited as miscellaneous receipts in the Treasury of the United States.
“(g) Regulations.—The Secretary may promulgate such regulations as may be necessary or appropriate to carry out the provisions of this section, in accordance with section 324(a) of the America’s Affordable Health Choices Act of 2009. The Secretary may promulgate any interim final rules as the Secretary determines are appropriate to carry out this section.”.
(b) Effective date.—The amendments made by subsection (a) shall apply to periods beginning after December 31, 2012.
(a) Assuring coordination.—The officers consisting of the Secretary of Labor, the Secretary of the Treasury, the Secretary of Health and Human Services, and the Health Choices Commissioner shall ensure, through the execution of an interagency memorandum of understanding among such officers, that—
(1) regulations, rulings, and interpretations issued by such officers relating to the same matter over which two or more of such officers have responsibility under subpart B of part 6 of subtitle B of title I of the Employee Retirement Income Security Act of 1974, section 4980H of the Internal Revenue Code of 1986, and section 2793 of the Public Health Service Act are administered so as to have the same effect at all times; and
(2) coordination of policies relating to enforcing the same requirements through such officers in order to have a coordinated enforcement strategy that avoids duplication of enforcement efforts and assigns priorities in enforcement.
(b) Multiemployer plans.—In the case of a group health plan that is a multiemployer plan (as defined in section 3(37) of the Employee Retirement Income Security Act of 1974), the regulations prescribed in accordance with subsection (a) by the officers referred to in subsection (a) shall provide for the application of the health coverage participation requirements to the plan sponsor and contributing sponsors of such plan.
(a) In general.—Subchapter A of chapter 1 of the Internal Revenue Code of 1986 is amended by adding at the end the following new part:
“(a) Tax imposed.—In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of—
“(1) the taxpayer’s modified adjusted gross income for the taxable year, over
“(2) the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer.
“(1) Tax limited to average premium.—
“(A) IN GENERAL.—The tax imposed under subsection (a) with respect to any taxpayer for any taxable year shall not exceed the applicable national average premium for such taxable year.
“(B) APPLICABLE NATIONAL AVERAGE PREMIUM.—
“(i) IN GENERAL.—For purposes of subparagraph (A), the ‘applicable national average premium’ means, with respect to any taxable year, the average premium (as determined by the Secretary, in coordination with the Health Choices Commissioner) for self-only coverage under a basic plan which is offered in a Health Insurance Exchange for the calendar year in which such taxable year begins.
“(ii) FAILURE TO PROVIDE COVERAGE FOR MORE THAN ONE INDIVIDUAL.—In the case of any taxpayer who fails to meet the requirements of subsection (e) with respect to more than one individual during the taxable year, clause (i) shall be applied by substituting ‘family coverage’ for ‘self-only coverage’.
“(2) Proration for part year failures.—The tax imposed under subsection (a) with respect to any taxpayer for any taxable year shall not exceed the amount which bears the same ratio to the amount of tax so imposed (determined without regard to this paragraph and after application of paragraph (1)) as—
“(A) the aggregate periods during such taxable year for which such individual failed to meet the requirements of subsection (d), bears to
“(B) the entire taxable year.
“(1) Dependents.—Subsection (a) shall not apply to any individual for any taxable year if a deduction is allowable under section 151 with respect to such individual to another taxpayer for any taxable year beginning in the same calendar year as such taxable year.
“(2) Nonresident aliens.—Subsection (a) shall not apply to any individual who is a nonresident alien.
“(3) Individuals residing outside United States.—Any qualified individual (as defined in section 911(d)) (and any qualifying child residing with such individual) shall be treated for purposes of this section as covered by acceptable coverage during the period described in subparagraph (A) or (B) of section 911(d)(1), whichever is applicable.
“(4) Individuals residing in possessions of the United States.—Any individual who is a bona fide resident of any possession of the United States (as determined under section 937(a)) for any taxable year (and any qualifying child residing with such individual) shall be treated for purposes of this section as covered by acceptable coverage during such taxable year.
“(5) Religious conscience exemption.—
“(A) IN GENERAL.—Subsection (a) shall not apply to any individual (and any qualifying child residing with such individual) for any period if such individual has in effect an exemption which certifies that such individual is a member of a recognized religious sect or division thereof described in section 1402(g)(1) and an adherent of established tenets or teachings of such sect or division as described in such section.
“(B) EXEMPTION.—An application for the exemption described in subparagraph (A) shall be filed with the Secretary at such time and in such form and manner as the Secretary may prescribe. Any such exemption granted by the Secretary shall be effective for such period as the Secretary determines appropriate.
“(d) Acceptable coverage requirement.—
“(1) In general.—The requirements of this subsection are met with respect to any individual for any period if such individual (and each qualifying child of such individual) is covered by acceptable coverage at all times during such period.
“(2) Acceptable coverage.—For purposes of this section, the term ‘acceptable coverage’ means any of the following:
“(A) QUALIFIED HEALTH BENEFITS PLAN COVERAGE.—Coverage under a qualified health benefits plan (as defined in section 100(c) of the America’s Affordable Health Choices Act of 2009).
“(B) GRANDFATHERED HEALTH INSURANCE COVERAGE; COVERAGE UNDER GRANDFATHERED EMPLOYMENT-BASED HEALTH PLAN.—Coverage under a grandfathered health insurance coverage (as defined in subsection (a) of section 102 of the America’s Affordable Health Choices Act of 2009) or under a current employment-based health plan (within the meaning of subsection (b) of such section).
“(C) MEDICARE.—Coverage under part A of title XVIII of the Social Security Act.
“(D) MEDICAID.—Coverage for medical assistance under title XIX of the Social Security Act.
“(E) MEMBERS OF THE ARMED FORCES AND DEPENDENTS (INCLUDING TRICARE).—Coverage under chapter 55 of title 10, United States Code, including similar coverage furnished under section 1781 of title 38 of such Code.
“(F) VA.—Coverage under the veteran’s health care program under chapter 17 of title 38, United States Code, but only if the coverage for the individual involved is determined by the Secretary in coordination with the Health Choices Commissioner to be not less than the level specified by the Secretary of the Treasury, in coordination with the Secretary of Veteran’s Affairs and the Health Choices Commissioner, based on the individual’s priority for services as provided under section 1705(a) of such title.
“(G) OTHER COVERAGE.—Such other health benefits coverage as the Secretary, in coordination with the Health Choices Commissioner, recognizes for purposes of this subsection.
“(e) Other definitions and special rules.—
“(1) Qualifying child.—For purposes of this section, the term ‘qualifying child’ has the meaning given such term by section 152(c). With respect to any period during which health coverage for a child must be provided by an individual pursuant to a child support order, such child shall be treated as a qualifying child of such individual (and not as a qualifying child of any other individual).
“(2) Basic plan.—For purposes of this section, the term ‘basic plan’ has the meaning given such term under section 100(c) of the America’s Affordable Health Choices Act of 2009.
“(3) Health Insurance Exchange.—For purposes of this section, the term ‘Health Insurance Exchange’ has the meaning given such term under section 100(c) of the America’s Affordable Health Choices Act of 2009, including any State-based health insurance exchange approved for operation under section 208 of such Act.
“(4) Family coverage.—For purposes of this section, the term ‘family coverage’ means any coverage other than self-only coverage.
“(5) Modified adjusted gross income.—For purposes of this section, the term ‘modified adjusted gross income’ means adjusted gross income—
“(A) determined without regard to section 911, and
“(B) increased by the amount of interest received or accrued by the taxpayer during the taxable year which is exempt from tax.
“(6) Not treated as tax imposed by this chapter for certain purposes.—The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes of section 55.
“(f) Regulations.—The Secretary shall prescribe such regulations or other guidance as may be necessary or appropriate to carry out the purposes of this section, including regulations or other guidance (developed in coordination with the Health Choices Commissioner) which provide—
“(1) exemption from the tax imposed under subsection (a) in cases of de minimis lapses of acceptable coverage, and
“(2) a process for applying for a waiver of the application of subsection (a) in cases of hardship.”.
(1) IN GENERAL.—Subpart B of part III of subchapter A of chapter 61 of such Code is amended by inserting after section 6050W the following new section:
“(a) Requirement of reporting.—Every person who provides acceptable coverage (as defined in section 59B(d)) to any individual during any calendar year shall, at such time as the Secretary may prescribe, make the return described in subsection (b) with respect to such individual.
“(b) Form and manner of returns.—A return is described in this subsection if such return—
“(1) is in such form as the Secretary may prescribe, and
“(A) the name, address, and TIN of the primary insured and the name of each other individual obtaining coverage under the policy,
“(B) the period for which each such individual was provided with the coverage referred to in subsection (a), and
“(C) such other information as the Secretary may require.
“(c) Statements to be furnished to individuals with respect to whom information is required.—Every person required to make a return under subsection (a) shall furnish to each primary insured whose name is required to be set forth in such return a written statement showing—
“(1) the name and address of the person required to make such return and the phone number of the information contact for such person, and
“(2) the information required to be shown on the return with respect to such individual.
The written statement required under the preceding sentence shall be furnished on or before January 31 of the year following the calendar year for which the return under subsection (a) is required to be made.“(d) Coverage provided by governmental units.—In the case of coverage provided by any governmental unit or any agency or instrumentality thereof, the officer or employee who enters into the agreement to provide such coverage (or the person appropriately designated for purposes of this section) shall make the returns and statements required by this section.”.
(2) PENALTY FOR FAILURE TO FILE.—
(A) RETURN.—Subparagraph (B) of section 6724(d)(1) of such Code is amended by striking “or” at the end of clause (xxii), by striking “and” at the end of clause (xxiii) and inserting “or”, and by adding at the end the following new clause:
“(xxiv) section 6050X (relating to returns relating to health insurance coverage), and”.
(B) STATEMENT.—Paragraph (2) of section 6724(d) of such Code is amended by striking “or” at the end of subparagraph (EE), by striking the period at the end of subparagraph (FF) and inserting “, or”, and by inserting after subparagraph (FF) the following new subparagraph:
“(GG) section 6050X (relating to returns relating to health insurance coverage).”.
(c) Return requirement.—Subsection (a) of section 6012 of such Code is amended by inserting after paragraph (9) the following new paragraph:
“(10) Every individual to whom section 59B(a) applies and who fails to meet the requirements of section 59B(d) with respect to such individual or any qualifying child (as defined in section 152(c)) of such individual.”.
(1) The table of parts for subchapter A of chapter 1 of the Internal Revenue Code of 1986 is amended by adding at the end the following new item:
(2) The table of sections for subpart B of part III of subchapter A of chapter 61 is amended by adding at the end the following new item:
(e) Section 15 not to apply.—The amendment made by subsection (a) shall not be treated as a change in a rate of tax for purposes of section 15 of the Internal Revenue Code of 1986.
(1) IN GENERAL.—The amendments made by this section shall apply to taxable years beginning after December 31, 2012.
(2) RETURNS.—The amendments made by subsection (b) shall apply to calendar years beginning after December 31, 2012.
(a) In general.—Chapter 43 of the Internal Revenue Code of 1986 is amended by adding at the end the following new section:
“(a) Election of employer responsibility to provide health coverage.—
“(1) In general.—Subsection (b) shall apply to any employer with respect to whom an election under paragraph (2) is in effect.
“(2) Time and manner.—An employer may make an election under this paragraph at such time and in such form and manner as the Secretary may prescribe.
“(3) Affiliated groups.—In the case of any employer which is part of a group of employers who are treated as a single employer under subsection (b), (c), (m), or (o) of section 414, the election under paragraph (2) shall be made by such person as the Secretary may provide. Any such election, once made, shall apply to all members of such group.
“(4) Separate elections.—Under regulations prescribed by the Secretary, separate elections may be made under paragraph (2) with respect to—
“(A) separate lines of business, and
“(B) full-time employees and employees who are not full-time employees.
“(5) Termination of election in cases of substantial noncompliance.—The Secretary may terminate the election of any employer under paragraph (2) if the Secretary (in coordination with the Health Choices Commissioner) determines that such employer is in substantial noncompliance with the health coverage participation requirements.
“(b) Excise tax with respect to failure to meet health coverage participation requirements.—
“(1) In general.—In the case of any employer who fails (during any period with respect to which the election under subsection (a) is in effect) to satisfy the health coverage participation requirements with respect to any employee to whom such election applies, there is hereby imposed on each such failure with respect to each such employee a tax of $100 for each day in the period beginning on the date such failure first occurs and ending on the date such failure is corrected.
“(2) Limitations on amount of tax.—
“(A) TAX NOT TO APPLY WHERE FAILURE NOT DISCOVERED EXERCISING REASONABLE DILIGENCE.—No tax shall be imposed by paragraph (1) on any failure during any period for which it is established to the satisfaction of the Secretary that the employer neither knew, nor exercising reasonable diligence would have known, that such failure existed.
“(B) TAX NOT TO APPLY TO FAILURES CORRECTED WITHIN 30 DAYS.—No tax shall be imposed by paragraph (1) on any failure if—
“(i) such failure was due to reasonable cause and not to willful neglect, and
“(ii) such failure is corrected during the 30-day period beginning on the 1st date that the employer knew, or exercising reasonable diligence would have known, that such failure existed.
“(C) OVERALL LIMITATION FOR UNINTENTIONAL FAILURES.—In the case of failures which are due to reasonable cause and not to willful neglect, the tax imposed by subsection (a) for failures during the taxable year of the employer shall not exceed the amount equal to the lesser of—
“(i) 10 percent of the aggregate amount paid or incurred by the employer (or predecessor employer) during the preceding taxable year for employment-based health plans, or
“(ii) $500,000.
“(D) COORDINATION WITH OTHER ENFORCEMENT PROVISIONS.—The tax imposed under paragraph (1) with respect to any failure shall be reduced (but not below zero) by the amount of any civil penalty collected under section 502(c)(11) of the Employee Retirement Income Security Act of 1974 or section 2793(g) of the Public Health Service Act with respect to such failure.
“(c) Health coverage participation requirements.—For purposes of this section, the term ‘health coverage participation requirements’ means the requirements of part I of subtitle B of title III of the America’s Affordable Health Choices Act of 2009 (as in effect on the date of the enactment of this section).”.
(b) Clerical amendment.—The table of sections for chapter 43 of such Code is amended by adding at the end the following new item:
(c) Effective date.—The amendments made by this section shall apply to periods beginning after December 31, 2012.
(a) In general.—Section 3111 of the Internal Revenue Code of 1986 is amended by redesignating subsection (c) as subsection (d) and by inserting after subsection (b) the following new subsection:
“(c) Employers electing to not provide health benefits.—
“(1) In general.—In addition to other taxes, there is hereby imposed on every nonelecting employer an excise tax, with respect to having individuals in his employ, equal to 8 percent of the wages (as defined in section 3121(a)) paid by him with respect to employment (as defined in section 3121(b)).
“(2) Special rules for small employers.—
“(A) IN GENERAL.—In the case of any employer who is small employer for any calendar year, paragraph (1) shall be applied by substituting the applicable percentage determined in accordance with the following table for ‘8 percent’:
| “If the annual payroll of such employer for the preceding calendar year: | The applicable percentage is: |
| Does not exceed $250,000 | 0 percent |
| Exceeds $250,000, but does not exceed $300,000 | 2 percent |
| Exceeds $300,000, but does not exceed $350,000 | 4 percent |
| Exceeds $350,000, but does not exceed $400,000 | 6 percent |
“(B) SMALL EMPLOYER.—For purposes of this paragraph, the term ‘small employer’ means any employer for any calendar year if the annual payroll of such employer for the preceding calendar year does not exceed $400,000.
“(C) ANNUAL PAYROLL.—For purposes of this paragraph, the term ‘annual payroll’ means, with respect to any employer for any calendar year, the aggregate wages (as defined in section 3121(a)) paid by him with respect to employment (as defined in section 3121(b)) during such calendar year.
“(3) Nonelecting employer.—For purposes of paragraph (1), the term ‘nonelecting employer’ means any employer for any period with respect to which such employer does not have an election under section 4980H(a) in effect.
“(4) Special rule for separate elections.—In the case of an employer who makes a separate election described in section 4980H(a)(4) for any period, paragraph (1) shall be applied for such period by taking into account only the wages paid to employees who are not subject to such election.
“(5) Aggregation; predecessors.—For purposes of this subsection—
“(A) all persons treated as a single employer under subsection (b), (c), (m), or (o) of section 414 shall be treated as 1 employer, and
“(B) any reference to any person shall be treated as including a reference to any predecessor of such person.”.
(b) Definitions.—Section 3121 of such Code is amended by adding at the end the following new subsection:
“(aa) Special rules for tax on employers electing not to provide health benefits.—For purposes of section 3111(c)—
“(1) Paragraphs (1), (5), and (19) of subsection (b) shall not apply.
“(2) Paragraph (7) of subsection (b) shall apply by treating all services as not covered by the retirement systems referred to in subparagraphs (C) and (F) thereof.
“(3) Subsection (e) shall not apply and the term ‘State’ shall include the District of Columbia.”.
(c) Conforming amendment.—Subsection (d) of section 3111 of such Code, as redesignated by this section, is amended by striking “this section” and inserting “subsections (a) and (b)”.
(d) Application to railroads.—
(1) IN GENERAL.—Section 3221 of such Code is amended by redesignating subsection (c) as subsection (d) and by inserting after subsection (b) the following new subsection: “(c) Employers electing to not provide health benefits.— “(1) In general.—In addition to other taxes, there is hereby imposed on every nonelecting employer an excise tax, with respect to having individuals in his employ, equal to 8 percent of the compensation paid during any calendar year by such employer for services rendered to such employer. “(2) Exception for small employers.—Rules similar to the rules of section 3111(c)(2) shall apply for purposes of this subsection. “(3) Nonelecting employer.—For purposes of paragraph (1), the term ‘nonelecting employer’ means any employer for any period with respect to which such employer does not have an election under section 4980H(a) in effect. “(4) Special rule for separate elections.—In the case of an employer who makes a separate election described in section 4980H(a)(4) for any period, subsection (a) shall be applied for such period by taking into account only the wages paid to employees who are not subject to such election.”.
(2) DEFINITIONS.—Subsection (e) of section 3231 of such Code is amended by adding at the end the following new paragraph:
“(13) Special rules for tax on employers electing not to provide health benefits.—For purposes of section 3221(c)—
“(A) Paragraph (1) shall be applied without regard to the third sentence thereof.
“(B) Paragraph (2) shall not apply.”.
(3) CONFORMING AMENDMENT.—Subsection (d) of section 3221 of such Code, as redesignated by this section, is amended by striking “subsections (a) and (b), see section 3231(e)(2)” and inserting “this section, see paragraphs (2) and (13)(B) of section 3231(e)”.
(e) Effective date.—The amendments made by this section shall apply to periods beginning after December 31, 2012.
(a) In general.—Subpart D of part IV of subchapter A of chapter 1 of the Internal Revenue Code of 1986 (relating to business-related credits) is amended by adding at the end the following new section:
“(a) In general.—For purposes of section 38, in the case of a qualified small employer, the small business employee health coverage credit determined under this section for the taxable year is an amount equal to the applicable percentage of the qualified employee health coverage expenses of such employer for such taxable year.
“(1) In general.—For purposes of this section, the applicable percentage is 50 percent.
“(2) Phaseout based on average compensation of employees.—In the case of an employer whose average annual employee compensation for the taxable year exceeds $20,000, the percentage specified in paragraph (1) shall be reduced by a number of percentage points which bears the same ratio to 50 as such excess bears to $20,000.
“(1) Phaseout based on employer size.—In the case of an employer who employs more than 10 qualified employees during the taxable year, the credit determined under subsection (a) shall be reduced by an amount which bears the same ratio to the amount of such credit (determined without regard to this paragraph and after the application of the other provisions of this section) as—
“(i) the number of qualified employees employed by the employer during the taxable year, over
“(ii) 10, bears to
“(B) 15.
“(2) Credit not allowed with respect to certain highly compensated employees.—No credit shall be allowed under subsection (a) with respect to qualified employee health coverage expenses paid or incurred with respect to any employee for any taxable year if the aggregate compensation paid by the employer to such employee during such taxable year exceeds $80,000.
“(d) Qualified employee health coverage expenses.—For purposes of this section—
“(1) In general.—The term ‘qualified employee health coverage expenses’ means, with respect to any employer for any taxable year, the aggregate amount paid or incurred by such employer during such taxable year for coverage of any qualified employee of the employer (including any family coverage which covers such employee) under qualified health coverage.
“(2) Qualified health coverage.—The term ‘qualified health coverage’ means acceptable coverage (as defined in section 59B(d)) which—
“(A) is provided pursuant to an election under section 4980H(a), and
“(B) satisfies the requirements referred to in section 4980H(c).
“(e) Other definitions.—For purposes of this section—
“(1) Qualified small employer.—For purposes of this section, the term ‘qualified small employer’ means any employer for any taxable year if—
“(A) the number of qualified employees employed by such employer during the taxable year does not exceed 25, and
“(B) the average annual employee compensation of such employer for such taxable year does not exceed the sum of the dollar amounts in effect under subsection (b)(2).
“(2) Qualified employee.—The term ‘qualified employee’ means any employee of an employer for any taxable year of the employer if such employee received at least $5,000 of compensation from such employer for services performed in the trade or business of such employer during such taxable year.
“(3) Average annual employee compensation.—The term ‘average annual employee compensation’ means, with respect to any employer for any taxable year, the average amount of compensation paid by such employer to qualified employees of such employer during such taxable year.
“(4) Compensation.—The term ‘compensation’ has the meaning given such term in section 408(p)(6)(A).
“(5) Family coverage.—The term ‘family coverage’ means any coverage other than self-only coverage.
“(f) Special rules.—For purposes of this section—
“(1) Special rule for partnerships and self-employed.—In the case of a partnership (or a trade or business carried on by an individual) which has one or more qualified employees (determined without regard to this paragraph) with respect to whom the election under 4980H(a) applies, each partner (or, in the case of a trade or business carried on by an individual, such individual) shall be treated as an employee.
“(2) Aggregation rule.—All persons treated as a single employer under subsection (b), (c), (m), or (o) of section 414 shall be treated as 1 employer.
“(3) Denial of double benefit.—Any deduction otherwise allowable with respect to amounts paid or incurred for health insurance coverage to which subsection (a) applies shall be reduced by the amount of the credit determined under this section.
“(4) Inflation adjustment.—In the case of any taxable year beginning after 2013, each of the dollar amounts in subsections (b)(2), (c)(2), and (e)(2) shall be increased by an amount equal to—
“(A) such dollar amount, multiplied by
“(B) the cost of living adjustment determined under section 1(f)(3) for the calendar year in which the taxable year begins determined by substituting ‘calendar year 2012’ for ‘calendar year 1992’ in subparagraph (B) thereof.
If any increase determined under this paragraph is not a multiple of $50, such increase shall be rounded to the next lowest multiple of $50.”.
(b) Credit to be part of general business credit.—Subsection (b) of section 38 of such Code (relating to general business credit) is amended by striking “plus” at the end of paragraph (34), by striking the period at the end of paragraph (35) and inserting “, plus” , and by adding at the end the following new paragraph:
“(36) in the case of a qualified small employer (as defined in section 45R(e)), the small business employee health coverage credit determined under section 45R(a).”.
(c) Clerical amendment.—The table of sections for subpart D of part IV of subchapter A of chapter 1 of such Code is amended by inserting after the item relating to section 45Q the following new item:
(d) Effective date.—The amendments made by this section shall apply to taxable years beginning after December 31, 2012.
(a) In general.—Subsection (l) of section 6103 of the Internal Revenue Code of 1986 is amended by adding at the end the following new paragraph:
“(21) Disclosure of return information to carry out health insurance exchange subsidies.—
“(A) IN GENERAL.—The Secretary, upon written request from the Health Choices Commissioner or the head of a State-based health insurance exchange approved for operation under section 208 of the America’s Affordable Health Choices Act of 2009, shall disclose to officers and employees of the Health Choices Administration or such State-based health insurance exchange, as the case may be, return information of any taxpayer whose income is relevant in determining any affordability credit described in subtitle C of title II of the America’s Affordable Health Choices Act of 2009. Such return information shall be limited to—
“(i) taxpayer identity information with respect to such taxpayer,
“(ii) the filing status of such taxpayer,
“(iii) the modified adjusted gross income of such taxpayer (as defined in section 59B(e)(5)),
“(iv) the number of dependents of the taxpayer,
“(v) such other information as is prescribed by the Secretary by regulation as might indicate whether the taxpayer is eligible for such affordability credits (and the amount thereof), and
“(vi) the taxable year with respect to which the preceding information relates or, if applicable, the fact that such information is not available.
“(B) RESTRICTION ON USE OF DISCLOSED INFORMATION.—Return information disclosed under subparagraph (A) may be used by officers and employees of the Health Choices Administration or such State-based health insurance exchange, as the case may be, only for the purposes of, and to the extent necessary in, establishing and verifying the appropriate amount of any affordability credit described in subtitle C of title II of the America’s Affordable Health Choices Act of 2009 and providing for the repayment of any such credit which was in excess of such appropriate amount.”.
(b) Procedures and recordkeeping related to disclosures.—Paragraph (4) of section 6103(p) of such Code is amended—
(1) by inserting “, or any entity described in subsection (l)(21),” after “or (20)” in the matter preceding subparagraph (A),
(2) by inserting “or any entity described in subsection (l)(21),” after “or (o)(1)(A),” in subparagraph (F)(ii), and
(3) by inserting “or any entity described in subsection (l)(21),” after “or (20),” both places it appears in the matter after subparagraph (F).
(c) Unauthorized disclosure or inspection.—Paragraph (2) of section 7213(a) of such Code is amended by striking “or (20)” and inserting “(20), or (21)”.
(a) In general.—Part VIII of subchapter A of chapter 1 of the Internal Revenue Code of 1986, as added by this title, is amended by adding at the end the following new subpart:
“(a) General rule.—In the case of a taxpayer other than a corporation, there is hereby imposed (in addition to any other tax imposed by this subtitle) a tax equal to—
“(1) 1 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $350,000 but does not exceed $500,000,
“(2) 1.5 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $500,000 but does not exceed $1,000,000, and
“(3) 5.4 percent of so much of the modified adjusted gross income of the taxpayer as exceeds $1,000,000.
“(b) Taxpayers not making a joint return.—In the case of any taxpayer other than a taxpayer making a joint return under section 6013 or a surviving spouse (as defined in section 2(a)), subsection (a) shall be applied by substituting for each of the dollar amounts therein (after any increase determined under subsection (e)) a dollar amount equal to—
“(1) 50 percent of the dollar amount so in effect in the case of a married individual filing a separate return, and
“(2) 80 percent of the dollar amount so in effect in any other case.
“(c) Adjustments based on Federal health reform savings.—
“(1) In general.—Except as provided in paragraph (2), in the case of any taxable year beginning after December 31, 2012, subsection (a) shall be applied—
“(A) by substituting ‘2 percent’ for ‘1 percent’, and
“(B) by substituting ‘3 percent’ for ‘1.5 percent’.
“(2) Adjustments based on excess Federal health reform savings.—
“(A) EXCEPTION IF FEDERAL HEALTH REFORM SAVINGS SIGNIFICANTLY EXCEEDS BASE AMOUNT.—If the excess Federal health reform savings is more than $150,000,000,000 but not more than $175,000,000,000, paragraph (1) shall not apply.
“(B) FURTHER ADJUSTMENT FOR ADDITIONAL FEDERAL HEALTH REFORM SAVINGS.—If the excess Federal health reform savings is more than $175,000,000,000, paragraphs (1) and (2) of subsection (a) (and paragraph (1) of this subsection) shall not apply to any taxable year beginning after December 31, 2012.
“(C) EXCESS FEDERAL HEALTH REFORM SAVINGS.—For purposes of this subsection, the term ‘excess Federal health reform savings’ means the excess of—
“(i) the Federal health reform savings, over
“(ii) $525,000,000,000.
“(D) FEDERAL HEALTH REFORM SAVINGS.—The term ‘Federal health reform savings’ means the sum of the amounts described in subparagraphs (A) and (B) of paragraph (3).
“(3) Determination of Federal health reform savings.—Not later than December 1, 2012, the Director of the Office of Management and Budget shall—
“(A) determine, on the basis of the study conducted under paragraph (4), the aggregate reductions in Federal expenditures which have been achieved as a result of the provisions of, and amendments made by, division B of the America’s Affordable Health Choices Act of 2009 during the period beginning on October 1, 2009, and ending with the latest date with respect to which the Director has sufficient data to make such determination, and
“(B) estimate, on the basis of such study and the determination under subparagraph (A), the aggregate reductions in Federal expenditures which will be achieved as a result of such provisions and amendments during so much of the period beginning with fiscal year 2010 and ending with fiscal year 2019 as is not taken into account under subparagraph (A).
“(4) Study of Federal health reform savings.—The Director of the Office of Management and Budget shall conduct a study of the reductions in Federal expenditures during fiscal years 2010 through 2019 which are attributable to the provisions of, and amendments made by, division B of the America’s Affordable Health Choices Act of 2009. The Director shall complete such study not later than December 1, 2012.
“(5) Reductions in Federal expenditures determined without regard to program investments.—For purposes of paragraphs (3) and (4), reductions in Federal expenditures shall be determined without regard to section 1121 of the America’s Affordable Health Choices Act of 2009 and other program investments under division B thereof.
“(d) Modified adjusted gross income.—For purposes of this section, the term ‘modified adjusted gross income’ means adjusted gross income reduced by any deduction (not taken into account in determining adjusted gross income) allowed for investment interest (as defined in section 163(d)). In the case of an estate or trust, adjusted gross income shall be determined as provided in section 67(e).
“(1) In general.—In the case of taxable years beginning after 2011, the dollar amounts in subsection (a) shall be increased by an amount equal to—
“(A) such dollar amount, multiplied by
“(B) the cost-of-living adjustment determined under section 1(f)(3) for the calendar year in which the taxable year begins, by substituting ‘calendar year 2010’ for ‘calendar year 1992’ in subparagraph (B) thereof.
“(2) Rounding.—If any amount as adjusted under paragraph (1) is not a multiple of $5,000, such amount shall be rounded to the next lowest multiple of $5,000.
“(1) Nonresident alien.—In the case of a nonresident alien individual, only amounts taken into account in connection with the tax imposed under section 871(b) shall be taken into account under this section.
“(2) Citizens and residents living abroad.—The dollar amounts in effect under subsection (a) (after the application of subsections (b) and (e)) shall be decreased by the excess of—
“(A) the amounts excluded from the taxpayer’s gross income under section 911, over
“(B) the amounts of any deductions or exclusions disallowed under section 911(d)(6) with respect to the amounts described in subparagraph (A).
“(3) Charitable trusts.—Subsection (a) shall not apply to a trust all the unexpired interests in which are devoted to one or more of the purposes described in section 170(c)(2)(B).
“(4) Not treated as tax imposed by this chapter for certain purposes.—The tax imposed under this section shall not be treated as tax imposed by this chapter for purposes of determining the amount of any credit under this chapter or for purposes of section 55.”.
(b) Clerical amendment.—The table of subparts for part VIII of subchapter A of chapter 1 of such Code, as added by this title, is amended by inserting after the item relating to subpart A the following new item:
(c) Section 15 not to apply.—The amendment made by subsection (a) shall not be treated as a change in a rate of tax for purposes of section 15 of the Internal Revenue Code of 1986.
(d) Effective date.—The amendments made by this section shall apply to taxable years beginning after December 31, 2010.
(a) HSAs.—Subparagraph (A) of section 223(d)(2) of the Internal Revenue Code of 1986 is amended by adding at the end the following: “Such term shall include an amount paid for medicine or a drug only if such medicine or drug is a prescribed drug or is insulin.”.
(b) Archer MSAs.—Subparagraph (A) of section 220(d)(2) of such Code is amended by adding at the end the following: “Such term shall include an amount paid for medicine or a drug only if such medicine or drug is a prescribed drug or is insulin.”.
(c) Health flexible spending arrangements and health reimbursement arrangements.—Section 106 of such Code is amended by adding at the end the following new subsection:
“(f) Reimbursements for medicine restricted to prescribed drugs and insulin.—For purposes of this section and section 105, reimbursement for expenses incurred for a medicine or a drug shall be treated as a reimbursement for medical expenses only if such medicine or drug is a prescribed drug or is insulin.”.
(d) Effective dates.—The amendment made by this section shall apply to expenses incurred after December 31, 2009.
(a) In general.—Paragraphs (5)(D) and (6) of section 864(f) of the Internal Revenue Code of 1986 are each amended by striking “December 31, 2010” and inserting “December 31, 2019”.
(b) Transition.—Subsection (f) of section 864 of such Code is amended by striking paragraph (7).
(a) In general.—Section 894 of the Internal Revenue Code of 1986 (relating to income affected by treaty) is amended by adding at the end the following new subsection:
“(d) Limitation on treaty benefits for certain deductible payments.—
“(1) In general.—In the case of any deductible related-party payment, any withholding tax imposed under chapter 3 (and any tax imposed under subpart A or B of this part) with respect to such payment may not be reduced under any treaty of the United States unless any such withholding tax would be reduced under a treaty of the United States if such payment were made directly to the foreign parent corporation.
“(2) Deductible related-party payment.—For purposes of this subsection, the term ‘deductible related-party payment’ means any payment made, directly or indirectly, by any person to any other person if the payment is allowable as a deduction under this chapter and both persons are members of the same foreign controlled group of entities.
“(3) Foreign controlled group of entities.—For purposes of this subsection—
“(A) IN GENERAL.—The term ‘foreign controlled group of entities’ means a controlled group of entities the common parent of which is a foreign corporation.
“(B) CONTROLLED GROUP OF ENTITIES.—The term ‘controlled group of entities’ means a controlled group of corporations as defined in section 1563(a)(1), except that—
“(i) ‘more than 50 percent’ shall be substituted for ‘at least 80 percent’ each place it appears therein, and
“(ii) the determination shall be made without regard to subsections (a)(4) and (b)(2) of section 1563.
A partnership or any other entity (other than a corporation) shall be treated as a member of a controlled group of entities if such entity is controlled (within the meaning of section 954(d)(3)) by members of such group (including any entity treated as a member of such group by reason of this sentence).
“(4) Foreign parent corporation.—For purposes of this subsection, the term ‘foreign parent corporation’ means, with respect to any deductible related-party payment, the common parent of the foreign controlled group of entities referred to in paragraph (3)(A).
“(5) Regulations.—The Secretary may prescribe such regulations or other guidance as are necessary or appropriate to carry out the purposes of this subsection, including regulations or other guidance which provide for—
“(A) the treatment of two or more persons as members of a foreign controlled group of entities if such persons would be the common parent of such group if treated as one corporation, and
“(B) the treatment of any member of a foreign controlled group of entities as the common parent of such group if such treatment is appropriate taking into account the economic relationships among such entities.”.
(b) Effective date.—The amendment made by this section shall apply to payments made after the date of the enactment of this Act.
(a) In general.—Section 7701 of the Internal Revenue Code of 1986 is amended by redesignating subsection (o) as subsection (p) and by inserting after subsection (n) the following new subsection:
“(o) Clarification of economic substance doctrine.—
“(1) Application of doctrine.—In the case of any transaction to which the economic substance doctrine is relevant, such transaction shall be treated as having economic substance only if—
“(A) the transaction changes in a meaningful way (apart from Federal income tax effects) the taxpayer’s economic position, and
“(B) the taxpayer has a substantial purpose (apart from Federal income tax effects) for entering into such transaction.
“(2) Special rule where taxpayer relies on profit potential.—
“(A) IN GENERAL.—The potential for profit of a transaction shall be taken into account in determining whether the requirements of subparagraphs (A) and (B) of paragraph (1) are met with respect to the transaction only if the present value of the reasonably expected pre-tax profit from the transaction is substantial in relation to the present value of the expected net tax benefits that would be allowed if the transaction were respected.
“(B) TREATMENT OF FEES AND FOREIGN TAXES.—Fees and other transaction expenses and foreign taxes shall be taken into account as expenses in determining pre-tax profit under subparagraph (A).
“(3) State and local tax benefits.—For purposes of paragraph (1), any State or local income tax effect which is related to a Federal income tax effect shall be treated in the same manner as a Federal income tax effect.
“(4) Financial accounting benefits.—For purposes of paragraph (1)(B), achieving a financial accounting benefit shall not be taken into account as a purpose for entering into a transaction if the origin of such financial accounting benefit is a reduction of Federal income tax.
“(5) Definitions and special rules.—For purposes of this subsection—
“(A) ECONOMIC SUBSTANCE DOCTRINE.—The term ‘economic substance doctrine’ means the common law doctrine under which tax benefits under subtitle A with respect to a transaction are not allowable if the transaction does not have economic substance or lacks a business purpose.
“(B) EXCEPTION FOR PERSONAL TRANSACTIONS OF INDIVIDUALS.—In the case of an individual, paragraph (1) shall apply only to transactions entered into in connection with a trade or business or an activity engaged in for the production of income.
“(C) OTHER COMMON LAW DOCTRINES NOT AFFECTED.—Except as specifically provided in this subsection, the provisions of this subsection shall not be construed as altering or supplanting any other rule of law, and the requirements of this subsection shall be construed as being in addition to any such other rule of law.
“(D) DETERMINATION OF APPLICATION OF DOCTRINE NOT AFFECTED.—The determination of whether the economic substance doctrine is relevant to a transaction (or series of transactions) shall be made in the same manner as if this subsection had never been enacted.
“(6) Regulations.—The Secretary shall prescribe such regulations as may be necessary or appropriate to carry out the purposes of this subsection.”.
(b) Effective Date.—The amendments made by this section shall apply to transactions entered into after the date of the enactment of this Act.
(a) Penalty for underpayments attributable to transactions lacking economic substance.—
(1) IN GENERAL.—Subsection (b) of section 6662 of the Internal Revenue Code of 1986 is amended by inserting after paragraph (5) the following new paragraph:
“(6) Any disallowance of claimed tax benefits by reason of a transaction lacking economic substance (within the meaning of section 7701(o)) or failing to meet the requirements of any similar rule of law.”.
(2) INCREASED PENALTY FOR NONDISCLOSED TRANSACTIONS.—Section 6662 of such Code is amended by adding at the end the following new subsection: “(i) Increase in penalty in case of nondisclosed noneconomic substance transactions.— “(1) In general.—In the case of any portion of an underpayment which is attributable to one or more nondisclosed noneconomic substance transactions, subsection (a) shall be applied with respect to such portion by substituting ‘40 percent’ for ‘20 percent’. “(2) Nondisclosed noneconomic substance transactions.—For purposes of this subsection, the term ‘nondisclosed noneconomic substance transaction’ means any portion of a transaction described in subsection (b)(6) with respect to which the relevant facts affecting the tax treatment are not adequately disclosed in the return nor in a statement attached to the return. “(3) Special rule for amended returns.—Except as provided in regulations, in no event shall any amendment or supplement to a return of tax be taken into account for purposes of this subsection if the amendment or supplement is filed after the earlier of the date the taxpayer is first contacted by the Secretary regarding the examination of the return or such other date as is specified by the Secretary.”.
(3) CONFORMING AMENDMENT.—Subparagraph (B) of section 6662A(e)(2) of such Code is amended—
(A) by striking “section 6662(h)” and inserting “subsections (h) or (i) of section 6662”, and
(B) by striking “gross valuation misstatement penalty” in the heading and inserting “certain increased underpayment penalties”.
(b) Reasonable cause exception not applicable to noneconomic substance transactions, tax shelters, and certain large or publicly traded persons.—Subsection (c) of section 6664 of such Code is amended—
(1) by redesignating paragraphs (2) and (3) as paragraphs (3) and (4), respectively,
(2) by striking “paragraph (2)” in paragraph (4)(A), as so redesignated, and inserting “paragraph (3)”, and
(3) by inserting after paragraph (1) the following new paragraph:
“(2) Exception.—Paragraph (1) shall not apply to—
“(A) to any portion of an underpayment which is attributable to one or more tax shelters (as defined in section 6662(d)(2)(C)) or transactions described in section 6662(b)(6), and
“(B) to any taxpayer if such taxpayer is a specified person (as defined in section 6662(d)(2)(D)(ii)).”.
(c) Application of penalty for erroneous claim for refund or credit to noneconomic substance transactions.—Section 6676 of such Code is amended by redesignating subsection (c) as subsection (d) and inserting after subsection (b) the following new subsection:
“(c) Noneconomic substance transactions treated as lacking reasonable basis.—For purposes of this section, any excessive amount which is attributable to any transaction described in section 6662(b)(6) shall not be treated as having a reasonable basis.”.
(d) Special understatement reduction rule for certain large or publicly traded persons.—
(1) IN GENERAL.—Paragraph (2) of section 6662(d) of such Code is amended by adding at the end the following new subparagraph:
“(D) SPECIAL REDUCTION RULE FOR CERTAIN LARGE OR PUBLICLY TRADED PERSONS.—
“(i) IN GENERAL.—In the case of any specified person—
“(I) subparagraph (B) shall not apply, and
“(II) the amount of the understatement under subparagraph (A) shall be reduced by that portion of the understatement which is attributable to any item with respect to which the taxpayer has a reasonable belief that the tax treatment of such item by the taxpayer is more likely than not the proper tax treatment of such item.
“(ii) SPECIFIED PERSON.—For purposes of this subparagraph, the term ‘specified person’ means—
“(I) any person required to file periodic or other reports under section 13 of the Securities Exchange Act of 1934, and
“(II) any corporation with gross receipts in excess of $100,000,000 for the taxable year involved.
All persons treated as a single employer under section 52(a) shall be treated as one person for purposes of subclause (II).”.
(2) CONFORMING AMENDMENT.—Subparagraph (C) of section 6662(d)(2) of such Code is amended by striking “Subparagraph (B)” and inserting “Subparagraphs (B) and (D)(i)(II)”.
(e) Effective Date.—The amendments made by this section shall apply to transactions entered into after the date of the enactment of this Act.
(a) Application of accident and health plans to eligible beneficiaries.—
(1) EXCLUSION OF CONTRIBUTIONS.—Section 106 of the Internal Revenue Code of 1986, as amended by section 442, (relating to contributions by employer to accident and health plans) is amended by adding at the end the following new subsection: “(g) Coverage provided for eligible beneficiaries of employees.— “(1) In general.—Subsection (a) shall apply with respect to any eligible beneficiary of the employee. “(2) Eligible beneficiary.—For purposes of this subsection, the term ‘eligible beneficiary’ means any individual who is eligible to receive benefits or coverage under an accident or health plan.”.
(2) EXCLUSION OF AMOUNTS EXPENDED FOR MEDICAL CARE.—The first sentence of section 105(b) of such Code (relating to amounts expended for medical care) is amended—
(A) by striking “and his dependents” and inserting “his dependents”, and
(B) by inserting before the period the following: “and any eligible beneficiary (within the meaning of section 106(f)) with respect to the taxpayer”.
(A) Section 3121(a)(2) of such Code is amended—
(i) by striking “or any of his dependents” in the matter preceding subparagraph (A) and inserting “, any of his dependents, or any eligible beneficiary (within the meaning of section 106(g)) with respect to the employee”,
(ii) by striking “or any of his dependents,” in subparagraph (A) and inserting “, any of his dependents, or any eligible beneficiary (within the meaning of section 106(g)) with respect to the employee,”, and
(iii) by striking “and their dependents” both places it appears and inserting “and such employees’ dependents and eligible beneficiaries (within the meaning of section 106(g))”.
(B) Section 3231(e)(1) of such Code is amended—
(i) by striking “or any of his dependents” and inserting “, any of his dependents, or any eligible beneficiary (within the meaning of section 106(g)) with respect to the employee,”, and
(ii) by striking “and their dependents” both places it appears and inserting “and such employees’ dependents and eligible beneficiaries (within the meaning of section 106(g))”.
(C) Section 3306(b)(2) of such Code is amended—
(i) by striking “or any of his dependents” in the matter preceding subparagraph (A) and inserting “, any of his dependents, or any eligible beneficiary (within the meaning of section 106(g)) with respect to the employee,”,
(ii) by striking “or any of his dependents” in subparagraph (A) and inserting “, any of his dependents, or any eligible beneficiary (within the meaning of section 106(g)) with respect to the employee”, and
(iii) by striking “and their dependents” both places it appears and inserting “and such employees’ dependents and eligible beneficiaries (within the meaning of section 106(g))”.
(D) Section 3401(a) of such Code is amended by striking “or” at the end of paragraph (22), by striking the period at the end of paragraph (23) and inserting “; or”, and by inserting after paragraph (23) the following new paragraph:
“(24) for any payment made to or for the benefit of an employee or any eligible beneficiary (within the meaning of section 106(g)) if at the time of such payment it is reasonable to believe that the employee will be able to exclude such payment from income under section 106 or under section 105 by reference in section 105(b) to section 106(g).”.
(b) Expansion of dependency for purposes of deduction for health insurance costs of self-employed individuals.—
(1) IN GENERAL.—Paragraph (1) of section 162(l) of the Internal Revenue Code of 1986 (relating to special rules for health insurance costs of self-employed individuals) is amended to read as follows:
“(1) Allowance of deduction.—In the case of a taxpayer who is an employee within the meaning of section 401(c)(1), there shall be allowed as a deduction under this section an amount equal to the amount paid during the taxable year for insurance which constitutes medical care for—
“(A) the taxpayer,
“(B) the taxpayer’s spouse,
“(C) the taxpayer’s dependents, and
“(i) satisfies the age requirements of section 152(c)(3)(A),
“(ii) bears a relationship to the taxpayer described in section 152(d)(2)(H), and
“(iii) meets the requirements of section 152(d)(1)(C), and
“(i) does not satisfy the age requirements of section 152(c)(3)(A),
“(ii) bears a relationship to the taxpayer described in section 152(d)(2)(H),
“(iii) meets the requirements of section 152(d)(1)(D), and
“(iv) is not the spouse of the taxpayer and does not bear any relationship to the taxpayer described in subparagraphs (A) through (G) of section 152(d)(2).”.
(2) CONFORMING AMENDMENT.—Subparagraph (B) of section 162(l)(2) of such Code is amended by inserting “, any dependent, or individual described in subparagraph (D) or (E) of paragraph (1) with respect to” after “spouse”.
(c) Extension to eligible beneficiaries of sick and accident benefits provided to members of a voluntary employees’ beneficiary association and their dependents.—Section 501(c)(9) of the Internal Revenue Code of 1986 (relating to list of exempt organizations) is amended by adding at the end the following new sentence: “For purposes of providing for the payment of sick and accident benefits to members of such an association and their dependents, the term ‘dependents’ shall include any individual who is an eligible beneficiary (within the meaning of section 106(f)), as determined under the terms of a medical benefit, health insurance, or other program under which members and their dependents are entitled to sick and accident benefits.”.
(d) Flexible spending arrangements and health reimbursement arrangements.—The Secretary of Treasury shall issue guidance of general applicability providing that medical expenses that otherwise qualify—
(1) for reimbursement from a flexible spending arrangement under regulations in effect on the date of the enactment of this Act may be reimbursed from an employee’s flexible spending arrangement, notwithstanding the fact that such expenses are attributable to any individual who is not the employee’s spouse or dependent (within the meaning of section 105(b) of the Internal Revenue Code of 1986) but is an eligible beneficiary (within the meaning of section 106(f) of such Code) under the flexible spending arrangement with respect to the employee, and
(2) for reimbursement from a health reimbursement arrangement under regulations in effect on the date of the enactment of this Act may be reimbursed from an employee’s health reimbursement arrangement, notwithstanding the fact that such expenses are attributable to an individual who is not a spouse or dependent (within the meaning of section 105(b) of such Code) but is an eligible beneficiary (within the meaning of section 106(f) of such Code) under the health reimbursement arrangement with respect to the employee.
(e) Effective date.—The amendments made by this section shall apply to taxable years beginning after December 31, 2009.
1st Session |
To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.
Mr. Dingell (for himself, Mr. Rangel, Mr. Waxman, Mr. George Miller of California, Mr. Stark, Mr. Pallone, and Mr. Andrews) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Labor, Oversight and Government Reform, and the Budget, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
(1) IN GENERAL.—The purpose of this division is to provide affordable, quality health care for all Americans and reduce the growth in health care spending.
(2) BUILDING ON CURRENT SYSTEM.—This division achieves this purpose by building on what works in today’s health care system, while repairing the aspects that are broken.
(3) INSURANCE REFORMS.—This division—
(A) enacts strong insurance market reforms;
(B) creates a new Health Insurance Exchange, with a public health insurance option alongside private plans;
(C) includes sliding scale affordability credits; and
(D) initiates shared responsibility among workers, employers, and the government;
so that all Americans have coverage of essential health benefits.
(4) HEALTH DELIVERY REFORM.—This division institutes health delivery system reforms both to increase quality and to reduce growth in health spending so that health care becomes more affordable for businesses, families, and government.
(b) Table of contents of division.—The table of contents of this division is as follows:
(c) General definitions.—Except as otherwise provided, in this division:
(1) ACCEPTABLE COVERAGE.—The term “acceptable coverage” has the meaning given such term in section 202(d)(2).
(2) BASIC PLAN.—The term “basic plan” has the meaning given such term in section 203(c).
(3) COMMISSIONER.—The term “Commissioner” means the Health Choices Commissioner established under section 141.
(4) COST-SHARING.—The term “cost-sharing” includes deductibles, coinsurance, copayments, and similar charges but does not include premiums or any network payment differential for covered services or spending for non-covered services.
(5) DEPENDENT.—The term “dependent” has the meaning given such term by the Commissioner and includes a spouse.
(6) EMPLOYMENT-BASED HEALTH PLAN.—The term “employment-based health plan”—
(A) means a group health plan (as defined in section 733(a)(1) of the Employee Retirement Income Security Act of 1974);
(B) includes such a plan that is the following:
(i) FEDERAL, STATE, AND TRIBAL GOVERNMENTAL PLANS.—A governmental plan (as defined in section 3(32) of the Employee Retirement Income Security Act of 1974), including a health benefits plan offered under chapter 89 of title 5, United States Code; or
(ii) CHURCH PLANS.—A church plan (as defined in section 3(33) of the Employee Retirement Income Security Act of 1974); and
(C) excludes coverage described in section 202(d)(2)(E) (relating to TRICARE).
(7) ENHANCED PLAN.—The term “enhanced plan” has the meaning given such term in section 203(c).
(8) ESSENTIAL BENEFITS PACKAGE.—The term “essential benefits package” is defined in section 122(a).
(9) FAMILY.—The term “family” means an individual and includes the individual’s dependents.
(10) FEDERAL POVERTY LEVEL; FPL.—The terms “Federal poverty level” and “FPL” have the meaning given the term “poverty line” in section 673(2) of the Community Services Block Grant Act (42 U.S.C. 9902(2)), including any revision required by such section.
(11) HEALTH BENEFITS PLAN.—The terms “health benefits plan” means health insurance coverage and an employment-based health plan and includes the public health insurance option.
(12) HEALTH INSURANCE COVERAGE; HEALTH INSURANCE ISSUER.—The terms “health insurance coverage” and “health insurance issuer” have the meanings given such terms in section 2791 of the Public Health Service Act.
(13) HEALTH INSURANCE EXCHANGE.—The term “Health Insurance Exchange” means the Health Insurance Exchange established under section 201.
(14) MEDICAID.—The term “Medicaid” means a State plan under title XIX of the Social Security Act (whether or not the plan is operating under a waiver under section 1115 of such Act).
(15) MEDICARE.—The term “Medicare” means the health insurance programs under title XVIII of the Social Security Act.
(16) PLAN SPONSOR.—The term “plan sponsor” has the meaning given such term in section 3(16)(B) of the Employee Retirement Income Security Act of 1974.
(17) PLAN YEAR.—The term “plan year” means—
(A) with respect to an employment-based health plan, a plan year as specified under such plan; or
(B) with respect to a health benefits plan other than an employment-based health plan, a 12-month period as specified by the Commissioner.
(18) PREMIUM PLAN; PREMIUM-PLUS PLAN.—The terms “premium plan” and “premium-plus plan” have the meanings given such terms in section 203(c).
(19) QHBP OFFERING ENTITY.—The terms “QHBP offering entity” means, with respect to a health benefits plan that is—
(A) a group health plan (as defined, subject to subsection (d), in section 733(a)(1) of the Employee Retirement Income Security Act of 1974), the plan sponsor in relation to such group health plan, except that, in the case of a plan maintained jointly by 1 or more employers and 1 or more employee organizations and with respect to which an employer is the primary source of financing, such term means such employer;
(B) health insurance coverage, the health insurance issuer offering the coverage;
(C) the public health insurance option, the Secretary of Health and Human Services;
(D) a non-Federal governmental plan (as defined in section 2791(d) of the Public Health Service Act), the State or political subdivision of a State (or agency or instrumentality of such State or subdivision) which establishes or maintains such plan; or
(E) a Federal governmental plan (as defined in section 2791(d) of the Public Health Service Act), the appropriate Federal official.
(20) QUALIFIED HEALTH BENEFITS PLAN.—The term “qualified health benefits plan” means a health benefits plan that meets the requirements for such a plan under title I and includes the public health insurance option.
(21) PUBLIC HEALTH INSURANCE OPTION.—The term “public health insurance option” means the public health insurance option as provided under subtitle B of title II.
(22) SERVICE AREA; PREMIUM RATING AREA.—The terms “service area” and “premium rating area” mean with respect to health insurance coverage—
(A) offered other than through the Health Insurance Exchange, such an area as established by the QHBP offering entity of such coverage in accordance with applicable State law; and
(B) offered through the Health Insurance Exchange, such an area as established by such entity in accordance with applicable State law and applicable rules of the Commissioner for Exchange-participating health benefits plans.
(23) STATE.—The term “State” means the 50 States and the District of Columbia.
(24) STATE MEDICAID AGENCY.—The term “State Medicaid agency” means, with respect to a Medicaid plan, the single State agency responsible for administering such plan under title XIX of the Social Security Act.
(25) Y1, Y2, ETC..—The terms “Y1” , “Y2”, “Y3”, “Y4”, “Y5”, and similar subsequently numbered terms, mean 2013 and subsequent years, respectively.
(26) EMPLOYEE PREMIUM.—The term “employee premium” does not include a collectively bargained premium in the case of a group health plan (as defined in section 733(a)(1) of the Employee Retirement Income Security Act of 1974) that is a multiemployer plan (as defined in section 3(37) of such Act).
(a) Purpose.—The purpose of this title is to establish standards to ensure that new health insurance coverage and employment-based health plans that are offered meet standards guaranteeing access to affordable coverage, essential benefits, and other consumer protections.
(b) Requirements for qualified health benefits plans.—On or after the first day of Y1, a health benefits plan shall not be a qualified health benefits plan under this division unless the plan meets the applicable requirements of the following subtitles for the type of plan and plan year involved:
(1) Subtitle B (relating to affordable coverage).
(2) Subtitle C (relating to essential benefits).
(3) Subtitle D (relating to consumer protection).
(c) Terminology.—In this division:
(1) ENROLLMENT IN EMPLOYMENT-BASED HEALTH PLANS.—An individual shall be treated as being “enrolled” in an employment-based health plan if the individual is a participant or beneficiary (as such terms are defined in section 3(7) and 3(8), respectively, of the Employee Retirement Income Security Act of 1974) in such plan.
(2) INDIVIDUAL AND GROUP HEALTH INSURANCE COVERAGE.—The terms “individual health insurance coverage” and “group health insurance coverage” mean health insurance coverage offered in the individual market or large or small group market, respectively, as defined in section 2791 of the Public Health Service Act.
(d) Sense of Congress on health care needs of United States territories.—It is the sense of the Congress that the reforms made by H.R. 3200, as introduced, must be strengthened to meaningfully address the health care needs of residents of American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, Puerto Rico, and the United States Virgin Islands and Congress is committed to working with the representatives of these territories to ensure that residents of these territories have access to high-quality and affordable health care in such a way that best serves their unique needs.
(a) Grandfathered health insurance coverage defined.—Subject to the succeeding provisions of this section, for purposes of establishing acceptable coverage under this division, the term “grandfathered health insurance coverage” means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met:
(1) LIMITATION ON NEW ENROLLMENT.—
(A) IN GENERAL.—Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1.
(B) DEPENDENT COVERAGE PERMITTED.—Subparagraph (A) shall not affect the subsequent enrollment of a dependent of an individual who is covered as of such first day.
(2) LIMITATION ON CHANGES IN TERMS OR CONDITIONS.—Subject to paragraph (3) and except as required by law, the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day before the first day of Y1.
(3) RESTRICTIONS ON PREMIUM INCREASES.—The issuer cannot vary the percentage increase in the premium for a risk group of enrollees in specific grandfathered health insurance coverage without changing the premium for all enrollees in the same risk group at the same rate, as specified by the Commissioner.
(b) Grace period for current employment-based health plans.—
(A) IN GENERAL.—The Commissioner shall establish a grace period whereby, for plan years beginning after the end of the 5-year period beginning with Y1, an employment-based health plan in operation as of the day before the first day of Y1 must meet the same requirements as apply to a qualified health benefits plan under section 101, including the essential benefit package requirement under section 121.
(B) EXCEPTION FOR LIMITED BENEFITS PLANS.—Subparagraph (A) shall not apply to an employment-based health plan in which the coverage consists only of one or more of the following:
(i) Any coverage described in section 3001(a)(1)(B)(ii)(IV) of division B of the American Recovery and Reinvestment Act of 2009 (PL 111–5).
(ii) Excepted benefits (as defined in section 733(c) of the Employee Retirement Income Security Act of 1974), including coverage under a specified disease or illness policy described in paragraph (3)(A) of such section.
(iii) Such other limited benefits as the Commissioner may specify.
In no case shall an employment-based health plan in which the coverage consists only of one or more of the coverage or benefits described in clauses (i) through (iii) be treated as acceptable coverage under this division
(2) TRANSITIONAL TREATMENT AS ACCEPTABLE COVERAGE.—During the grace period specified in paragraph (1)(A), an employment-based health plan that is described in such paragraph shall be treated as acceptable coverage under this division.
(3) EXCEPTION FOR CONSUMER-DIRECTED HEALTH PLANS AND ARRANGEMENTS.—In the case of a group health plan which consists of a consumer-directed health plan or arrangement (including a high deductible health plan, within the meaning of section 223(c)(2) of the Internal Revenue Code of 1986), such group health plan shall be treated as acceptable coverage under a current group health plan for purposes of this division.
(c) Limitation on individual health insurance coverage.—
(1) IN GENERAL.—Individual health insurance coverage that is not grandfathered health insurance coverage under subsection (a) may only be offered on or after the first day of Y1 as an Exchange-participating health benefits plan.
(2) SEPARATE, EXCEPTED COVERAGE PERMITTED.—Excepted benefits (as defined in section 2791(c) of the Public Health Service Act) are not included within the definition of health insurance coverage. Nothing in paragraph (1) shall prevent the offering, other than through the Health Insurance Exchange, of excepted benefits so long as it is offered and priced separately from health insurance coverage.
A qualified health benefits plan may not impose any pre-existing condition exclusion (as defined in section 2701(b)(1)(A) of the Public Health Service Act) or otherwise impose any limit or condition on the coverage under the plan with respect to an individual or dependent based on any health status-related factors (as defined in section 2791(d)(9) of the Public Health Service Act) in relation to the individual or dependent.
The requirements of sections 2711 (other than subsections (c) and (e)) and 2712 (other than paragraphs (3), and (6) of subsection (b) and subsection (e)) of the Public Health Service Act, relating to guaranteed availability and renewability of health insurance coverage, shall apply to individuals and employers in all individual and group health insurance coverage, whether offered to individuals or employers through the Health Insurance Exchange, through any employment-based health plan, or otherwise, in the same manner as such sections apply to employers and health insurance coverage offered in the small group market, except that such section 2712(b)(1) shall apply only if, before nonrenewal or discontinuation of coverage, the issuer has provided the enrollee with notice of non-payment of premiums and there is a grace period during which the enrollees has an opportunity to correct such nonpayment. Rescissions of such coverage shall be prohibited except in cases of fraud as defined in sections 2712(b)(2) of such Act.
(a) In general.—The premium rate charged for an insured qualified health benefits plan may not vary except as follows:
(1) LIMITED AGE VARIATION PERMITTED.—By age (within such age categories as the Commissioner shall specify) so long as the ratio of the highest such premium to the lowest such premium does not exceed the ratio of 2 to 1.
(2) BY AREA.—By premium rating area (as permitted by State insurance regulators or, in the case of Exchange-participating health benefits plans, as specified by the Commissioner in consultation with such regulators).
(3) BY FAMILY ENROLLMENT.—By family enrollment (such as variations within categories and compositions of families) so long as the ratio of the premium for family enrollment (or enrollments) to the premium for individual enrollment is uniform, as specified under State law and consistent with rules of the Commissioner.
(1) STUDY.—The Commissioner, in coordination with the Secretary of Health and Human Services and the Secretary of Labor, shall conduct a study of the large group insured and self-insured employer health care markets. Such study shall examine the following:
(A) The types of employers by key characteristics, including size, that purchase insured products versus those that self-insure.
(B) The similarities and differences between typical insured and self-insured health plans.
(C) The financial solvency and capital reserve levels of employers that self-insure by employer size.
(D) The risk of self-insured employers not being able to pay obligations or otherwise becoming financially insolvent.
(E) The extent to which rating rules are likely to cause adverse selection in the large group market or to encourage small and mid size employers to self-insure
(2) REPORTS.—Not later than 18 months after the date of the enactment of this Act, the Commissioner shall submit to Congress and the applicable agencies a report on the study conducted under paragraph (1). Such report shall include any recommendations the Commissioner deems appropriate to ensure that the law does not provide incentives for small and mid-size employers to self-insure or create adverse selection in the risk pools of large group insurers and self-insured employers. Not later than 18 months after the first day of Y1, the Commissioner shall submit to Congress and the applicable agencies an updated report on such study, including updates on such recommendations.
(a) Nondiscrimination in benefits.—A qualified health benefits plan shall comply with standards established by the Commissioner to prohibit discrimination in health benefits or benefit structures for qualified health benefits plans, building from sections 702 of Employee Retirement Income Security Act of 1974, 2702 of the Public Health Service Act, and section 9802 of the Internal Revenue Code of 1986.
(b) Parity in mental health and substance abuse disorder benefits.—To the extent such provisions are not superceded by or inconsistent with subtitle C, the provisions of section 2705 (other than subsections (a)(1), (a)(2), and (c)) of section 2705 of the Public Health Service Act shall apply to a qualified health benefits plan, regardless of whether it is offered in the individual or group market, in the same manner as such provisions apply to health insurance coverage offered in the large group market.
(a) In general.—A qualified health benefits plan that uses a provider network for items and services shall meet such standards respecting provider networks as the Commissioner may establish to assure the adequacy of such networks in ensuring enrollee access to such items and services and transparency in the cost-sharing differentials between in-network coverage and out-of-network coverage.
(b) Internet access to information.—A qualified health benefits plan that uses a provider network shall provide a current listing of all providers in its network on its website and such data shall be available on the Health Insurance Exchange website as a ‘click through’ from the basic information on that plan. The Commissioner shall also establish an on-line system whereby an individual may select by name any medical provider (as defined by the Commissioner) and be informed of the plan or plans with which that provider is contracting.
(c) Provider network defined.—In this division, the term “provider network” means the providers with respect to which covered benefits, treatments, and services are available under a health benefits plan.
The QHBP offering entity shall provide that for any plan year in which a qualified health benefits plan that the entity offers has a medical loss ratio (expressed as a percentage) that is less than a percentage (not less than 85 percent) specified by the Commissioner, the QHBP offering entity offering such plan shall provide for rebates to enrollees of payment sufficient to meet such loss ratio. The Commissioner shall establish a uniform definition of medical loss ratio and methodology for determining how to calculate the medical loss ratio. Such methodology shall be designed to take into account the special circumstances of smaller and newer plans.
In the case of health insurance coverage offered under a qualified health benefits plan, the coverage and cost of coverage may not be changed during the course of a plan year except to increase coverage to the enrollee or to lower costs to the enrollee.
(a) In general.—A qualified health benefits plan shall provide coverage that at least meets the benefit standards adopted under section 124 for the essential benefits package described in section 122 for the plan year involved.
(1) NON-EXCHANGE-PARTICIPATING HEALTH BENEFITS PLANS.—In the case of a qualified health benefits plan that is not an Exchange-participating health benefits plan, such plan may offer such coverage in addition to the essential benefits package as the QHBP offering entity may specify.
(2) EXCHANGE-PARTICIPATING HEALTH BENEFITS PLANS.—In the case of an Exchange-participating health benefits plan, such plan is required under section 203 to provide specified levels of benefits and, in the case of a plan offering a premium-plus level of benefits, provide additional benefits.
(3) CONTINUATION OF OFFERING OF SEPARATE EXCEPTED BENEFITS COVERAGE.—Nothing in this division shall be construed as affecting the offering of health benefits in the form of excepted benefits (described in section 102(b)(1)(B)(ii)) if such benefits are offered under a separate policy, contract, or certificate of insurance.
(c) No restrictions on coverage unrelated to clinical appropriateness.—A qualified health benefits plan may not impose any restriction (other than cost-sharing) unrelated to clinical appropriateness on the coverage of the health care items and services.
(a) In general.—In this division, the term “essential benefits package” means health benefits coverage, consistent with standards adopted under section 124 to ensure the provision of quality health care and financial security, that—
(1) provides payment for the items and services described in subsection (b) in accordance with generally accepted standards of medical or other appropriate clinical or professional practice;
(2) limits cost-sharing for such covered health care items and services in accordance with such benefit standards, consistent with subsection (c);
(3) does not impose any annual or lifetime limit on the coverage of covered health care items and services;
(4) complies with section 115(a) (relating to network adequacy); and
(5) is equivalent, as certified by Office of the Actuary of the Centers for Medicare & Medicaid Services, to the average prevailing employer-sponsored coverage.
(b) Minimum services to be covered.—The items and services described in this subsection are the following:
(1) Hospitalization.
(2) Outpatient hospital and outpatient clinic services, including emergency department services.
(3) Professional services of physicians and other health professionals.
(4) Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care in institutional settings, physician offices, patients’ homes or place of residence, or other settings, as appropriate.
(5) Prescription drugs.
(6) Rehabilitative and habilitative services.
(7) Mental health and substance use disorder services.
(8) Preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services and including mental health and substance abuse services recommended by the Task Force on Clinical Preventive Services and those mental health and substance abuse services with compelling research or evidence, including Screening, Brief Intervention and Referral to Treatment (SBIRT), and those vaccines recommended for use by the Director of the Centers for Disease Control and Prevention.
(9) Maternity care.
(10) Well baby and well child care and early and periodic screening, diagnostic, and treatment services (as defined in section 1905(r) of the Social Security Act) at least for children under 21 years of age.
(11) Durable medical equipment, prosthetics, orthotics and related supplies.
(c) Requirements relating to cost-sharing and minimum actuarial value.—
(1) NO COST-SHARING FOR PREVENTIVE SERVICES.—There shall be no cost-sharing under the essential benefits package for preventive items and services (as specified under the benefit standards), including well baby and well child care.
(A) ANNUAL LIMITATION.—The cost-sharing incurred under the essential benefits package with respect to an individual (or family) for a year does not exceed the applicable level specified in subparagraph (B).
(B) APPLICABLE LEVEL.—The applicable level specified in this subparagraph for Y1 is $5,000 for an individual and $10,000 for a family. Such levels shall be increased (rounded to the nearest $100) for each subsequent year by the annual percentage increase in the Consumer Price Index (United States city average) applicable to such year.
(C) USE OF COPAYMENTS.—In establishing cost-sharing levels for basic, enhanced, and premium plans under this subsection, the Secretary shall, to the maximum extent possible, use only copayments and not coinsurance.
(A) IN GENERAL.—The cost-sharing under the essential benefits package shall be designed to provide a level of coverage that is designed to provide benefits that are actuarially equivalent to approximately 70 percent of the full actuarial value of the benefits provided under the reference benefits package described in subparagraph (B).
(B) REFERENCE BENEFITS PACKAGE DESCRIBED.—The reference benefits package described in this subparagraph is the essential benefits package if there were no cost-sharing imposed.
(1) IN GENERAL.—There is established a private-public advisory committee which shall be a panel of medical and other experts to be known as the Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans.
(2) CHAIR.—The Surgeon General shall be a member and the chair of the Health Benefits Advisory Committee.
(3) MEMBERSHIP.—The Health Benefits Advisory Committee shall be composed of the following members, in addition to the Surgeon General:
(A) 9 members who are not Federal employees or officers and who are appointed by the President.
(B) 9 members who are not Federal employees or officers and who are appointed by the Comptroller General of the United States in a manner similar to the manner in which the Comptroller General appoints members to the Medicare Payment Advisory Commission under section 1805(c) of the Social Security Act.
(C) Such even number of members (not to exceed 8) who are Federal employees and officers, as the President may appoint.
The membership of the Committee shall include one or more experts in scientific evidence and clinical practice of integrative health care services. Such initial appointments shall be made not later than 60 days after the date of the enactment of this Act.
(4) TERMS.—Each member of the Health Benefits Advisory Committee shall serve a 3-year term on the Committee, except that the terms of the initial members shall be adjusted in order to provide for a staggered term of appointment for all such members.
(5) PARTICIPATION.—The membership of the Health Benefits Advisory Committee shall at least reflect providers, employers, labor, health insurance issuers, experts in health care financing and delivery, experts in racial and ethnic disparities, experts in care for those with disabilities, representatives of relevant governmental agencies. and at least one practicing physician or other health professional and an expert on children’s health and shall represent a balance among various sectors of the health care system so that no single sector unduly influences the recommendations of such Committee. The membership of the Committee shall also include educated patients, consumer advocates, or both, who shall include persons who represent individuals affected by a specific disease or medical condition, are knowledgeable about the health care system, and have received training regarding health, medical, and scientific matters.
(1) RECOMMENDATIONS ON BENEFIT STANDARDS.—The Health Benefits Advisory Committee shall recommend to the Secretary of Health and Human Services (in this subtitle referred to as the “Secretary”) benefit standards (as defined in paragraph (4)), and periodic updates to such standards. In developing such recommendations, the Committee shall—
(A) take into account innovation in health care,
(B) consider how such standards could reduce health disparities,
(C) take into account integrative health care services, and
(D) take into account typical multiemployer plan benefit structures and the impact of the essential benefit package on such plans.
(2) DEADLINE.—The Health Benefits Advisory Committee shall recommend initial benefit standards to the Secretary not later than 1 year after the date of the enactment of this Act.
(3) STATE INPUT.—The Health Benefits Advisory Committee shall examine the health coverage laws and benefits of each State in developing recommendations under this subsection and may incorporate such coverage and benefits as the Committee determines to be appropriate and consistent with this Act. The Health Benefits Advisory Committee shall also seek input from the States and consider recommendations on how to ensure that the quality of health coverage does not decline in any State.
(4) PUBLIC INPUT.—The Health Benefits Advisory Committee shall allow for public input as a part of developing recommendations under this subsection.
(5) BENEFIT STANDARDS DEFINED.—In this subtitle, the term “benefit standards” means standards respecting—
(A) the essential benefits package described in section 122, including categories of covered treatments, items and services within benefit classes, and cost-sharing; and
(B) the cost-sharing levels for enhanced plans and premium plans (as provided under section 203(c)) consistent with paragraph (5).
(6) LEVELS OF COST-SHARING FOR ENHANCED AND PREMIUM PLANS.—
(A) ENHANCED PLAN.—The level of cost-sharing for enhanced plans shall be designed so that such plans have benefits that are actuarially equivalent to approximately 85 percent of the actuarial value of the benefits provided under the reference benefits package described in section 122(c)(3)(B).
(B) PREMIUM PLAN.—The level of cost-sharing for premium plans shall be designed so that such plans have benefits that are actuarially equivalent to approximately 95 percent of the actuarial value of the benefits provided under the reference benefits package described in section 122(c)(3)(B).
(7) RECOMMENDATIONS OF INTEGRATIVE HEALTH CARE SERVICES TASK FORCE.—
(A) INCLUSION IN COMMITTEE’S RECOMMENDATIONS.—The Health Benefits Advisory Committee shall include in its recommendations under paragraph (1) the recommendations made by the Integrative Health Care Services Task Force established under subparagraph (B).
(B) ESTABLISHMENT OF TASK FORCE.—The Health Benefits Advisory Committee shall establish an Integrative Health Care Services Task Force. Such Task Force shall consist of 5 experts with expertise in research in, and practice of, integrative health care. Such experts shall be appointed by the Committee from among experts nominated by the Secretary, in consultation with the National Center for Complementary and Alternative Medicine at the National Institutes of Health. The duty of the Task Force shall be to make recommendations to the Committee on evidence-based, clinically effective, and safe integrative care services.
(1) PER DIEM PAY.—Each member of the Health Benefits Advisory Committee shall receive travel expenses, including per diem in accordance with applicable provisions under subchapter I of chapter 57 of title 5, United States Code, and shall otherwise serve without additional pay.
(2) MEMBERS NOT TREATED AS FEDERAL EMPLOYEES.—Members of the Health Benefits Advisory Committee shall not be considered employees of the Federal government solely by reason of any service on the Committee.
(3) APPLICATION OF FACA.—The Federal Advisory Committee Act (5 U.S.C. App.), other than section 14, shall apply to the Health Benefits Advisory Committee.
(d) Publication.—The Secretary shall provide for publication in the Federal Register and the posting on the Internet website of the Department of Health and Human Services of all recommendations made by the Health Benefits Advisory Committee under this section.
(a) Process for Adoption of Recommendations.—
(1) REVIEW OF RECOMMENDED STANDARDS.—Not later than 45 days after the date of receipt of benefit standards recommended under section 123 (including such standards as modified under paragraph (2)(B)), the Secretary shall review such standards and shall determine whether to propose adoption of such standards as a package.
(2) DETERMINATION TO ADOPT STANDARDS.—If the Secretary determines—
(A) to propose adoption of benefit standards so recommended as a package, the Secretary shall, by regulation under section 553 of title 5, United States Code, propose adoption such standards; or
(B) not to propose adoption of such standards as a package, the Secretary shall notify the Health Benefits Advisory Committee in writing of such determination and the reasons for not proposing the adoption of such recommendation and provide the Committee with a further opportunity to modify its previous recommendations and submit new recommendations to the Secretary on a timely basis.
(3) CONTINGENCY.—If, because of the application of paragraph (2)(B), the Secretary would otherwise be unable to propose initial adoption of such recommended standards by the deadline specified in subsection (b)(1), the Secretary shall, by regulation under section 553 of title 5, United States Code, propose adoption of initial benefit standards by such deadline.
(4) PUBLICATION.—The Secretary shall provide for publication in the Federal Register of all determinations made by the Secretary under this subsection.
(1) INITIAL STANDARDS.—Not later than 18 months after the date of the enactment of this Act, the Secretary shall, through the rulemaking process consistent with subsection (a), adopt an initial set of benefit standards.
(2) PERIODIC UPDATING STANDARDS.—Under subsection (a), the Secretary shall provide for the periodic updating of the benefit standards previously adopted under this section.
(3) REQUIREMENT.—The Secretary may not adopt any benefit standards for an essential benefits package or for level of cost-sharing that are inconsistent with the requirements for such a package or level under sections 122 and 123(b)(5).
Neither the Commissioner nor any health insurance issuer offering health insurance coverage through the Exchange shall discriminate in approving or covering a health care service on the basis of its religious or spiritual content if expenditures for such a health care service are allowable as a deduction under 213(d) of the Internal Revenue Code of 1986, as in effect on January 1, 2009.
The Commissioner shall establish uniform marketing standards that all insured QHBP offering entities shall meet.
(a) In general.—A QHBP offering entity shall provide for timely grievance and appeals mechanisms that the Commissioner shall establish.
(b) Internal claims and appeals process.—Under a qualified health benefits plan the QHBP offering entity shall provide an internal claims and appeals process that initially incorporates the claims and appeals procedures (including urgent claims) set forth at section 2560.503–1 of title 29, Code of Federal Regulations, as published on November 21, 2000 (65 Fed. Reg. 70246) and shall update such process in accordance with any standards that the Commissioner may establish.
(1) IN GENERAL.—The Commissioner shall establish an external review process (including procedures for expedited reviews of urgent claims) that provides for an impartial, independent, and de novo review of denied claims under this division.
(2) REQUIRING FAIR GRIEVANCE AND APPEALS MECHANISMS.—A determination made, with respect to a qualified health benefits plan offered by a QHBP offering entity, under the external review process established under this subsection shall be binding on the plan and the entity.
(d) Construction.—Nothing in this section shall be construed as affecting the availability of judicial review under State law for adverse decisions under subsection (b) or (c), subject to section 151.
(a) Accurate and timely disclosure.—
(1) IN GENERAL.—A qualified health benefits plan shall comply with standards established by the Commissioner for the accurate and timely disclosure of plan documents, plan terms and conditions, claims payment policies and practices, periodic financial disclosure, data on enrollment, data on disenrollment, data on the number of claims denials, data on rating practices, information on cost-sharing and payments with respect to any out-of-network coverage, and other information as determined appropriate by the Commissioner. The Commissioner shall require that such disclosure be provided in plain language.
(2) PLAIN LANGUAGE.—In this subsection, the term “plain language” means language that the intended audience, including individuals with limited English proficiency, can readily understand and use because that language is clean, concise, well-organized, and follows other best practices of plain language writing.
(3) GUIDANCE.—The Commissioner shall develop and issue guidance on best practices of plain language writing.
(b) Contracting reimbursement.—A qualified health benefits plan shall comply with standards established by the Commissioner to ensure transparency to each health care provider relating to reimbursement arrangements between such plan and such provider.
(c) Advance notice of plan changes.—A change in a qualified health benefits plan shall not be made without such reasonable and timely advance notice to enrollees of such change.
(d) Identification of providers trained and accredited in integrative medicine.—A qualified health benefit plan shall include in the disclosure required under subsection (a) identification to enrollees of any providers of services under the plan that are trained and accredited in integrative health medicine.
The requirements of the previous provisions of this subtitle shall apply to qualified health benefits plans that are not being offered through the Health Insurance Exchange only to the extent specified by the Commissioner.
A QHBP offering entity shall comply with the requirements of section 1857(f) of the Social Security Act with respect to a qualified health benefits plan it offers in the same manner an Medicare Advantage organization is required to comply with such requirements with respect to a Medicare Advantage plan it offers under part C of Medicare.
The Commissioner shall establish standards for the coordination and subrogation of benefits and reimbursement of payments in cases involving individuals and multiple plan coverage.
A QHBP offering entity is required to comply with standards for electronic financial and administrative transactions under section 1173A of the Social Security Act, added by section 163(a).
(a) In general.—A qualified health benefits plan shall ensure that its records relative to prescription information containing patient identifiable and prescriber-identifiable data are maintained in accordance with this section.”
(1) IN GENERAL.—Records described in subsection (a) may not be licensed, transferred, used, or sold by any pharmacy benefits manager, insurance company, electronic transmission intermediary, retail, mail order, or Internet pharmacy or other similar entity, for any commercial purpose, except for the limited purposes of—
(A) pharmacy reimbursement;
(B) formulary compliance;
(C) care management;
(D) utilization review by a health care provider, the patient's insurance provider or the agent of either;
(E) health care research; or
(F) as otherwise provided by law.
(2) COMMERCIAL PURPOSE.—For purposes of paragraph (1), the term “commercial purpose” includes, but is not limited to, advertising, marketing, promotion, or any activity that could be used to influence sales or market share of a pharmaceutical product, influence or evaluate the prescribing behavior of an individual health care professional, or evaluate the effectiveness of a professional pharmaceutical detailing sales force.
(1) PERMITTED PRACTICES.—Nothing in this section shall prohibit—
(A) the dispensing of prescription medications to a patient or to the patient's authorized representative;
(B) the transmission of prescription information between an authorized prescriber and a licensed pharmacy;
(C) the transfer of prescription information between licensed pharmacies;
(D) the transfer of prescription records that may occur in the event a pharmacy ownership is changed or transferred;
(E) care management educational communications provided to a patient about the patient's health condition, adherence to a prescribed course of therapy, or other information about the drug being dispensed, treatment options, or clinical trials.
(2) DE-IDENTIFIED DATA.—Nothing in this section shall prohibit the collection, use, transfer, or sale of patient and prescriber de-identified data by zip code, geographic region, or medical specialty for commercial purposes.
(a) In general.—There is hereby established, as an independent agency in the executive branch of the Government, a Health Choices Administration (in this division referred to as the “Administration”).
(1) IN GENERAL.—The Administration shall be headed by a Health Choices Commissioner (in this division referred to as the “Commissioner”) who shall be appointed by the President, by and with the advice and consent of the Senate.
(2) COMPENSATION; ETC.—The provisions of paragraphs (2), (5) and (7) of subsection (a) (relating to compensation, terms, general powers, rulemaking, and delegation) of section 702 of the Social Security Act (42 U.S.C. 902) shall apply to the Commissioner and the Administration in the same manner as such provisions apply to the Commissioner of Social Security and the Social Security Administration.
(a) Duties.—The Commissioner is responsible for carrying out the following functions under this division:
(1) QUALIFIED PLAN STANDARDS.—The establishment of qualified health benefits plan standards under this title, including the enforcement of such standards in coordination with State insurance regulators and the Secretaries of Labor and the Treasury.
(2) HEALTH INSURANCE EXCHANGE.—The establishment and operation of a Health Insurance Exchange under subtitle A of title II.
(3) INDIVIDUAL AFFORDABILITY CREDITS.—The administration of individual affordability credits under subtitle C of title II, including determination of eligibility for such credits.
(4) ADDITIONAL FUNCTIONS.—Such additional functions as may be specified in this division.
(b) Promoting accountability.—
(1) IN GENERAL.—The Commissioner shall undertake activities in accordance with this subtitle to promote accountability of QHBP offering entities in meeting Federal health insurance requirements, regardless of whether such accountability is with respect to qualified health benefits plans offered through the Health Insurance Exchange or outside of such Exchange.
(2) COMPLIANCE EXAMINATION AND AUDITS.—
(A) IN GENERAL.—The commissioner shall, in coordination with States, conduct audits of qualified health benefits plan compliance with Federal requirements. Such audits may include random compliance audits and targeted audits in response to complaints or other suspected non-compliance.
(B) RECOUPMENT OF COSTS IN CONNECTION WITH EXAMINATION AND AUDITS.—The Commissioner is authorized to recoup from qualified health benefits plans reimbursement for the costs of such examinations and audit of such QHBP offering entities.
(c) Data collection.—The Commissioner shall collect data for purposes of carrying out the Commissioner’s duties, including for purposes of promoting quality and value, protecting consumers, and addressing disparities in health and health care and may share such data with the Secretary of Health and Human Services.
(1) IN GENERAL.—In the case that the Commissioner determines that a QHBP offering entity violates a requirement of this title, the Commissioner may, in coordination with State insurance regulators and the Secretary of Labor, provide, in addition to any other remedies authorized by law, for any of the remedies described in paragraph (2).
(2) REMEDIES.—The remedies described in this paragraph, with respect to a qualified health benefits plan offered by a QHBP offering entity, are—
(A) civil money penalties of not more than the amount that would be applicable under similar circumstances for similar violations under section 1857(g) of the Social Security Act;
(B) suspension of enrollment of individuals under such plan after the date the Commissioner notifies the entity of a determination under paragraph (1) and until the Commissioner is satisfied that the basis for such determination has been corrected and is not likely to recur;
(C) in the case of an Exchange-participating health benefits plan, suspension of payment to the entity under the Health Insurance Exchange for individuals enrolled in such plan after the date the Commissioner notifies the entity of a determination under paragraph (1) and until the Secretary is satisfied that the basis for such determination has been corrected and is not likely to recur; or
(D) working with State insurance regulators to terminate plans for repeated failure by the offering entity to meet the requirements of this title.
(e) Standard definitions of insurance and medical terms.—The Commissioner shall provide for the development of standards for the definitions of terms used in health insurance coverage, including insurance-related terms.
(f) Efficiency in administration.—The Commissioner shall issue regulations for the effective and efficient administration of the Health Insurance Exchange and affordability credits under subtitle C, including, with respect to the determination of eligibility for affordability credits, the use of personnel who are employed in accordance with the requirements of title 5, United States Code, to carry out the duties of the Commissioner or, in the case of sections 208 and 241(b)(2), the use of State personnel who are employed in accordance with standards prescribed by the Office of Personnel Management pursuant to section 208 of the Intergovernmental Personnel Act of 1970 (42 U.S.C. 4728).
(a) Consultation.—In carrying out the Commissioner’s duties under this division, the Commissioner, as appropriate, shall consult with at least with the following:
(1) The National Association of Insurance Commissioners, State attorneys general, and State insurance regulators, including concerning the standards for insured qualified health benefits plans under this title and enforcement of such standards.
(2) Appropriate State agencies, specifically concerning the administration of individual affordability credits under subtitle C of title II and the offering of Exchange-participating health benefits plans, to Medicaid eligible individuals under subtitle A of such title.
(3) Other appropriate Federal agencies.
(4) Indian tribes and tribal organizations.
(5) The National Association of Insurance Commissioners for purposes of using model guidelines established by such association for purposes of subtitles B and D.
(1) IN GENERAL.—In carrying out the functions of the Commissioner, including with respect to the enforcement of the provisions of this division, the Commissioner shall work in coordination with existing Federal and State entities to the maximum extent feasible consistent with this division and in a manner that prevents conflicts of interest in duties and ensures effective enforcement.
(2) UNIFORM STANDARDS.—The Commissioner, in coordination with such entities, shall seek to achieve uniform standards that adequately protect consumers in a manner that does not unreasonably affect employers and insurers.
(a) In general.—The Commissioner shall appoint within the Health Choices Administration a Qualified Health Benefits Plan Ombudsman who shall have expertise and experience in the fields of health care and education of (and assistance to) individuals.
(b) Duties.—The Qualified Health Benefits Plan Ombudsman shall, in a linguistically appropriate manner—
(1) receive complaints, grievances, and requests for information submitted by individuals;
(2) provide assistance with respect to complaints, grievances, and requests referred to in paragraph (1), including—
(A) helping individuals determine the relevant information needed to seek an appeal of a decision or determination;
(B) assistance to such individuals with any problems arising from disenrollment from such a plan;
(C) assistance to such individuals in choosing a qualified health benefits plan in which to enroll; and
(D) assistance to such individuals in presenting information under subtitle C (relating to affordability credits);
(3) consult with educated patients and consumer advocates (described in section 123(a)(5)); and
(4) submit annual reports to Congress and the Commissioner that describe the activities of the Ombudsman and that include such recommendations for improvement in the administration of this division as the Ombudsman determines appropriate. The Ombudsman shall not serve as an advocate for any increases in payments or new coverage of services, but may identify issues and problems in payment or coverage policies.
(a) Coverage not offered through Exchange.—
(1) IN GENERAL.—In the case of health insurance coverage not offered through the Health Insurance Exchange (whether or not offered in connection with an employment-based health plan), and in the case of employment-based health plans, the requirements of this title do not supercede any requirements applicable under titles XXII and XXVII of the Public Health Service Act, parts 6 and 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974, or State law, except insofar as such requirements prevent the application of a requirement of this division, as determined by the Commissioner.
(2) CONSTRUCTION.—Nothing in paragraph (1) shall be construed as affecting the application of section 514 of the Employee Retirement Income Security Act of 1974.
(b) Coverage offered through Exchange.—
(1) IN GENERAL.—In the case of health insurance coverage offered through the Health Insurance Exchange—
(A) the requirements of this title do not supercede any requirements (including requirements relating to genetic information nondiscrimination and mental health) applicable under title XXVII of the Public Health Service Act or under State law, except insofar as such requirements prevent the application of a requirement of this division, as determined by the Commissioner; and
(B) individual rights and remedies under State laws shall apply.
(2) CONSTRUCTION.—In the case of coverage described in paragraph (1), nothing in such paragraph shall be construed as preventing the application of rights and remedies under State laws with respect to any requirement referred to in paragraph (1)(A).
(a) In general.—Except as otherwise explicitly permitted by this Act and by subsequent regulations consistent with this Act, all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services.
(b) Implementation.—To implement the requirement set forth in subsection (a), the Secretary of Health and Human Services shall, not later than 18 months after the date of the enactment of this Act, promulgate such regulations as are necessary or appropriate to insure that all health care and related services (including insurance coverage and public health activities) covered by this Act are provided (whether directly or through contractual, licensing, or other arrangements) without regard to personal characteristics extraneous to the provision of high quality health care or related services.
(a) Retaliation prohibited.—No employer may discharge any employee or otherwise discriminate against any employee with respect to his compensation, terms, conditions, or other privileges of employment because the employee (or any person acting pursuant to a request of the employee)—
(1) provided, caused to be provided, or is about to provide or cause to be provided to the employer, the Federal Government, or the attorney general of a State information relating to any violation of, or any act or omission the employee reasonably believes to be a violation of any provision of this Act or any order, rule, or regulation promulgated under this Act;
(2) testified or is about to testify in a proceeding concerning such violation;
(3) assisted or participated or is about to assist or participate in such a proceeding; or
(4) objected to, or refused to participate in, any activity, policy, practice, or assigned task that the employee (or other such person) reasonably believed to be in violation of any provision of this Act or any order, rule, or regulation promulgated under this Act.
(b) Enforcement action.—An employee covered by this section who alleges discrimination by an employer in violation of subsection (a) may bring an action governed by the rules, procedures, legal burdens of proof, and remedies set forth in section 40(b) of the Consumer Product Safety Act (15 U.S.C. 2087(b)).
(c) Employer defined.—As used in this section, the term “employer” means any person (including one or more individuals, partnerships, associations, corporations, trusts, professional membership organization including a certification, disciplinary, or other professional body, unincorporated organizations, nongovernmental organizations, or trustees) engaged in profit or nonprofit business or industry whose activities are governed by this Act, and any agent, contractor, subcontractor, grantee, or consultant of such person.
(d) Rule of construction.—The rule of construction set forth in section 20109(h) of title 49, United States Code, shall also apply to this section.
Nothing in this division shall be construed to alter or supercede any statutory or other obligation to engage in collective bargaining over the terms and conditions of employment related to health care.
If any provision of this Act, or any application of such provision to any person or circumstance, is held to be unconstitutional, the remainder of the provisions of this Act and the application of the provision to any other person or circumstance shall not be affected.
(a) In general.—Subject to this section—
(1) nothing in this division (or an amendment made by this division) shall be construed to modify or limit the application of the exemption for the Hawaii Prepaid Health Care Act (Haw. Rev. Stat. §§ 393-1 et seq.) as provided for under section 514(b)(5) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1144(b)(5)), and such exemption shall also apply with respect to the provisions of this division, and
(2) for purposes of this division (and the amendments made by this division), coverage provided pursuant to the Hawaii Prepaid Health Care Act shall be treated as a qualified health benefits plan providing acceptable coverage so long as the Secretary of Labor determines that such coverage for employees (taking into account the benefits and the cost to employees for such benefits) is substantially equivalent to or greater than the coverage provided for employees pursuant to the essential benefits package.
(b) Coordination with State law of Hawaii.—The Commissioner shall, based on ongoing consultation with the appropriate officials of the State of Hawaii, make adjustments to rules and regulations of the Commissioner under this division as may be necessary, as determined by the Commissioner, to most effectively coordinate the provisions of this division with the provisions of the Hawaii Prepaid Health Care Act, taking into account any changes made from time to time to the Hawaii Prepaid Health Care Act and related laws of such State.
(a) Study.—The Commissioner shall conduct a study on methods that QHBP offering entities can use to encourage increased meaningful use of electronic health records by health care providers, including—
(1) qualified health benefits plans offering higher reimbursement rates for such meaningful use; and
(2) promoting the use by health care providers of low-cost available electronic health record software packages, such as software made available to health care providers by the Veterans Administration.
(b) Report.—Not later than 2 years after the date of the enactment of this Act, the Commissioner shall submit to the Congress a report containing—
(1) the results of the study under subsection (a); and
(2) recommendations concerning whether qualified health benefits plans should increase reimbursement rates to health care providers to increase meaningful use of electronic health records by such providers.
(1) IN GENERAL.—Not later than one year after the date the report is submitted to the Congress under subsection (b), if, under subsection (b)(2), the Commissioner recommends increased reimbursement rates, the Commissioner shall require that qualified health benefits plans increase reimbursement rates for health care providers that show meaningful use of electronic health records.
(2) COST LIMITATION.—An increase in rates under paragraph (1) shall not result in any increase in affordability premium or cost-sharing credits under subtitle C of title II of this division.
Nothing in this Act shall be construed to preclude any participant or beneficiary in a group health plan from entering into any contract or arrangement for health care with any health care provider.
(1) IN GENERAL.—Not later than 90 days after the date of the enactment of this Act, the Secretary of Health and Human Services shall establish a temporary reinsurance program (in this section referred to as the “reinsurance program”) to provide reimbursement to assist participating employment-based plans with the cost of providing health benefits to retirees and to eligible spouses, surviving spouses and dependents of such retirees.
(2) DEFINITIONS.—For purposes of this section:
(A) The term “eligible employment-based plan” means a group health benefits plan that—
(i) is maintained by one or more employers, former employers or employee associations, or a voluntary employees’ beneficiary association, or a committee or board of individuals appointed to administer such plan, and
(ii) provides health benefits to retirees.
(B) The term “health benefits” means medical, surgical, hospital, prescription drug, and such other benefits as shall be determined by the Secretary, whether self-funded or delivered through the purchase of insurance or otherwise.
(C) The term “participating employment-based plan” means an eligible employment-based plan that is participating in the reinsurance program.
(D) The term “retiree” means, with respect to a participating employment-benefit plan, an individual who—
(i) is 55 years of age or older;
(ii) is not eligible for coverage under title XVIII of the Social Security Act; and
(iii) is not an active employee of an employer maintaining the plan or of any employer that makes or has made substantial contributions to fund such plan.
(E) The term “Secretary” means Secretary of Health and Human Services.
(b) Participation.—To be eligible to participate in the reinsurance program, an eligible employment-based plan shall submit to the Secretary an application for participation in the program, at such time, in such manner, and containing such information as the Secretary shall require.
(A) IN GENERAL.—Under the reinsurance program, a participating employment-based plan shall submit claims for reimbursement to the Secretary which shall contain documentation of the actual costs of the items and services for which each claim is being submitted.
(B) BASIS FOR CLAIMS.—Each claim submitted under subparagraph (A) shall be based on the actual amount expended by the participating employment-based plan involved within the plan year for the appropriate employment based health benefits provided to a retiree or to the spouse, surviving spouse, or dependent of a retiree. In determining the amount of any claim for purposes of this subsection, the participating employment-based plan shall take into account any negotiated price concessions (such as discounts, direct or indirect subsidies, rebates, and direct or indirect remunerations) obtained by such plan with respect to such health benefits. For purposes of calculating the amount of any claim, the costs paid by the retiree or by the spouse, surviving spouse, or dependent of the retiree in the form of deductibles, co-payments, and co-insurance shall be included along with the amounts paid by the participating employment-based plan.
(2) PROGRAM PAYMENTS AND LIMIT.—If the Secretary determines that a participating employment-based plan has submitted a valid claim under paragraph (1), the Secretary shall reimburse such plan for 80 percent of that portion of the costs attributable to such claim that exceeds $15,000, but is less than $90,000. Such amounts shall be adjusted each year based on the percentage increase in the medical care component of the Consumer Price Index (rounded to the nearest multiple of $1,000) for the year involved.
(3) USE OF PAYMENTS.—Amounts paid to a participating employment-based plan under this subsection shall be used to lower the costs borne directly by the participants and beneficiaries for health benefits provided under such plan in the form of premiums, co-payments, deductibles, co-insurance, or other out-of-pocket costs. Such payments shall not be used to reduce the costs of an employer maintaining the participating employment-based plan. The Secretary shall develop a mechanism to monitor the appropriate use of such payments by such plans.
(4) APPEALS AND PROGRAM PROTECTIONS.—The Secretary shall establish—
(A) an appeals process to permit participating employment-based plans to appeal a determination of the Secretary with respect to claims submitted under this section; and
(B) procedures to protect against fraud, waste, and abuse under the program.
(5) AUDITS.—The Secretary shall conduct annual audits of claims data submitted by participating employment-based plans under this section to ensure that they are in compliance with the requirements of this section.
(d) Retiree Reserve Trust Fund.—
(A) IN GENERAL.—There is established in the Treasury of the United States a trust fund to be known as the “Retiree Reserve Trust Fund” (referred to in this section as the “Trust Fund”), that shall consist of such amounts as may be appropriated or credited to the Trust Fund as provided for in this subsection to enable the Secretary to carry out the reinsurance program. Such amounts shall remain available until expended.
(B) FUNDING.—There are hereby appropriated to the Trust Fund, out of any moneys in the Treasury not otherwise appropriated, an amount requested by the Secretary as necessary to carry out this section, except that the total of all such amounts requested shall not exceed $10,000,000,000.
(C) APPROPRIATIONS FROM THE TRUST FUND.—
(i) IN GENERAL.—Amounts in the Trust Fund are appropriated to provide funding to carry out the reinsurance program and shall be used to carry out such program.
(ii) BUDGETARY IMPLICATIONS.—Amounts appropriated under clause (i), and outlays flowing from such appropriations, shall not be taken into account for purposes of any budget enforcement procedures including allocations under section 302(a) and (b) of the Balanced Budget and Emergency Deficit Control Act and budget resolutions for fiscal years during which appropriations are made from the Trust Fund.
(iii) LIMITATION TO AVAILABLE FUNDS.—The Secretary has the authority to stop taking applications for participation in the program or take such other steps in reducing expenditures under the reinsurance program in order to ensure that expenditures under the reinsurance program do not exceed the funds available under this subsection.
(a) In general.—Part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 is amended by inserting after section 714 the following new section:
“(a) In general.—Every group health plan shall contain a provision which expressly bars the plan, or any fiduciary of the plan, from reducing the benefits provided under the plan to a retired participant, or beneficiary of such participant, if such reduction affects the benefits provided to the participant or beneficiary as of the date the participant retired for purposes of the plan and such reduction occurs after the participant's retirement unless such reduction is also made with respect to active participants.
“(b) No reduction.—Notwithstanding that a group health plan described in subsection (a) may contain a provision reserving the general power to amend or terminate the plan or a provision specifically authorizing the plan to make post-retirement reductions in retiree health benefits, it shall be prohibited for any group health plan, whether through amendment or otherwise, to reduce the benefits provided to a retired participant or his or her beneficiary under the terms of the plan if such reduction of benefits occurs after the date the participant retired for purposes of the plan and reduces benefits that were provided to the participant, or his or her beneficiary, as of the date the participant retired unless such reduction is also made with respect to active participants.”.
(b) Conforming amendment.—The table of contents in section 1 of such Act is amended by inserting after the item relating to section 714 the following new item:
(c) Effective date.—The amendments made by this section shall take effect on the date of the enactment of this Act.
(a) Amendments to the Employee Retirement Income Security Act of 1974.—
(1) REDUCTION IN LOOK-BACK PERIOD.—Section 701(a)(1) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1181(a)(1)) is amended by striking “6-month period” and inserting “30-day period”.
(2) REDUCTION IN PERMITTED PREEXISTING CONDITION LIMITATION PERIOD.—Section 701(a)(2) of such Act (29 U.S.C. 1181(a)(2)) is amended by striking “12 months” and inserting “3 months”, and by striking “18 months” and inserting “9 months”.
(3) INAPPLICABILITY OF INTERIM LIMITATIONS UPON APPLICABILITY OF TOTAL PROHIBITION OF EXCLUSION.—Section 701 of such Act shall cease to be effective in the case of any group health plan as of the date on which such plan becomes subject to the requirements of section 111 of this Act (relating to prohibiting preexisting condition exclusions).
(1) IN GENERAL.—Except as provided in subparagraph (B), the amendments made by paragraphs (1) and (2) of subsection (a) shall apply with respect to group health plans for plan years beginning after the end of the 6th calendar month following the date of the enactment of this Act.
(2) SPECIAL RULE FOR COLLECTIVE BARGAINING AGREEMENTS.—In the case of a group health plan maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers ratified before the date of the enactment of this Act, the amendments made by paragraphs (1) and (2) of subsection (a) shall not apply to plan years beginning before the earlier of—
(A) the date on which the last of the collective bargaining agreements relating to the plan terminates (determined without regard to any extension thereof agreed to after the date of the enactment of this Act), or
(B) 3 years after the date of the enactment of this Act.
For purposes of subparagraph (A), any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement added by the amendments made by paragraphs (1) and (2) of subsection (a) shall not be treated as a termination of such collective bargaining agreement.
(a) Extension of current periods of continuation coverage.—
(1) IN GENERAL.—In the case of any individual who is, under a COBRA continuation coverage provision, covered under COBRA continuation coverage on or after the date of the enactment of this Act, the required period of any such coverage which has not subsequently terminated under the terms of such provision for any reason other than the expiration of a period of a specified number of months shall, notwithstanding such provision and subject to subsection (b), extend to the earlier of the date on which such individual becomes eligible for coverage under an employment-based health plan or the date on which such individual becomes eligible for health insurance coverage through the Health Insurance Exchange (or a State-based Health Insurance Exchange operating in a State or group of States).
(2) NOTICE.—As soon as practicable after the date of the enactment of this Act, the Secretary of Labor, in consultation with the Secretary of the Treasury and the Secretary of Health and Human Services, shall, in consultation with administrators of the group health plans (or other entities) that provide or administer the COBRA continuation coverage involved, provide rules setting forth the form and manner in which prompt notice to individuals of the continued availability of COBRA continuation coverage to such individuals under paragraph (1).
(b) Continued effect of other terminating events.—Notwithstanding subsection (a), any required period of COBRA continuation coverage which is extended under such subsection shall terminate upon the occurrence, prior to the date of termination otherwise provided in such subsection, of any terminating event specified in the applicable continuation coverage provision other than the expiration of a period of a specified number of months.
(c) Access to State health benefits risk pools.—This section shall supersede any provision of the law of a State or political subdivision thereof to the extent that such provision has the effect of limiting or precluding access by a qualified beneficiary whose COBRA continuation coverage has been extended under this section to a State health benefits risk pool recognized by the Commissioner for purposes of this section solely by reason of the extension of such coverage beyond the date on which such coverage otherwise would have expired.
(d) Definitions.—For purposes of this section—
(1) COBRA CONTINUATION COVERAGE.—The term “COBRA continuation coverage” means continuation coverage provided pursuant to part 6 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (other than under section 609), title XXII of the Public Health Service Act, section 4980B of the Internal Revenue Code of 1986 (other than subsection (f)(1) of such section insofar as it relates to pediatric vaccines), or section 905a of title 5, United States Code, or under a State program that provides comparable continuation coverage. Such term does not include coverage under a health flexible spending arrangement under a cafeteria plan within the meaning of section 125 of the Internal Revenue Code of 1986.
(2) COBRA CONTINUATION PROVISION.—The term “COBRA continuation provision” means the provisions of law described in paragraph (1).
(a) Establishment.—There is established within the Health Choices Administration and under the direction of the Commissioner a Health Insurance Exchange in order to facilitate access of individuals and employers, through a transparent process, to a variety of choices of affordable, quality health insurance coverage, including a public health insurance option.
(b) Outline of duties of Commissioner.—In accordance with this subtitle and in coordination with appropriate Federal and State officials as provided under section 143(b), the Commissioner shall—
(1) under section 204 establish standards for, accept bids from, and negotiate and enter into contracts with, QHBP offering entities for the offering of health benefits plans through the Health Insurance Exchange, with different levels of benefits required under section 203, and including with respect to oversight and enforcement;
(2) under section 205 facilitate outreach and enrollment in such plans of Exchange-eligible individuals and employers described in section 202; and
(3) conduct such activities related to the Health Insurance Exchange as required, including establishment of a risk pooling mechanism under section 206 and consumer protections under subtitle D of title I.
(c) Exchange-participating health benefits plan defined.—In this division, the term “Exchange-participating health benefits plan” means a qualified health benefits plan that is offered through the Health Insurance Exchange.
(a) Access to coverage.—In accordance with this section, all individuals are eligible to obtain coverage through enrollment in an Exchange-participating health benefits plan offered through the Health Insurance Exchange unless such individuals are enrolled in another qualified health benefits plan or other acceptable coverage.
(b) Definitions.—In this division:
(1) EXCHANGE-ELIGIBLE INDIVIDUAL.—The term “Exchange-eligible individual” means an individual who is eligible under this section to be enrolled through the Health Insurance Exchange in an Exchange-participating health benefits plan and, with respect to family coverage, includes dependents of such individual.
(2) EXCHANGE-ELIGIBLE EMPLOYER.—The term “Exchange-eligible employer” means an employer that is eligible under this section to enroll through the Health Insurance Exchange employees of the employer (and their dependents) in Exchange-eligible health benefits plans.
(3) EMPLOYMENT-RELATED DEFINITIONS.—The terms “employer”, “employee”, “full-time employee”, and “part-time employee” have the meanings given such terms by the Commissioner for purposes of this division.
(c) Transition.—Individuals and employers shall only be eligible to enroll or participate in the Health Insurance Exchange in accordance with the following transition schedule:
(1) FIRST YEAR.—In Y1 (as defined in section 100(c))—
(A) individuals described in subsection (d)(1), including individuals described in paragraphs (3), (4), and (5) of subsection (d); and
(B) smallest employers described in subsection (e)(1).
(A) individuals and employers described in paragraph (1); and
(B) smaller employers described in subsection (e)(2).
(A) individuals and employers described in paragraph (2);
(B) larger employers described in subsection (e)(3); and
(C) largest employers as permitted by the Commissioner under subsection (e)(4).
(4) FOURTH AND SUBSEQUENT YEARS.—In Y4 and subsequent years—
(A) individuals and employers described in paragraph (3); and
(B) largest employers as permitted by the Commissioner under subsection (e)(4).
(1) INDIVIDUAL DESCRIBED.—Subject to the succeeding provisions of this subsection, an individual described in this paragraph is an individual who—
(A) is not enrolled in coverage described in subparagraphs (C) through (F) of paragraph (2); and
(B) is not enrolled in coverage as a full-time employee (or as a dependent of such an employee) under a group health plan if the coverage and an employer contribution under the plan meet the requirements of section 312.
For purposes of subparagraph (B), in the case of an individual who is self-employed, who has at least 1 employee, and who meets the requirements of section 312, such individual shall be deemed a full-time employee described in such subparagraph.
(2) ACCEPTABLE COVERAGE.—For purposes of this division, the term “acceptable coverage” means any of the following:
(A) QUALIFIED HEALTH BENEFITS PLAN COVERAGE.—Coverage under a qualified health benefits plan.
(B) GRANDFATHERED HEALTH INSURANCE COVERAGE; COVERAGE UNDER CURRENT GROUP HEALTH PLAN.—Coverage under a grandfathered health insurance coverage (as defined in subsection (a) of section 102) or under a current group health plan (described in subsection (b) of such section).
(C) MEDICARE.—Coverage under part A of title XVIII of the Social Security Act.
(D) MEDICAID.—Coverage for medical assistance under title XIX of the Social Security Act, excluding such coverage that is only available because of the application of subsection (u), (z), or (aa) of section 1902 of such Act
(E) MEMBERS OF THE ARMED FORCES AND DEPENDENTS (INCLUDING TRICARE).—Coverage under chapter 55 of title 10, United States Code, including similar coverage furnished under section 1781 of title 38 of such Code.
(F) VA.—Coverage under the veteran’s health care program under chapter 17 of title 38, United States Code, but only if the coverage for the individual involved is determined by the Commissioner in coordination with the Secretary of Treasury to be not less than a level specified by the Commissioner and Secretary of Veteran’s Affairs, in coordination with the Secretary of Treasury, based on the individual’s priority for services as provided under section 1705(a) of such title.
(G) OTHER COVERAGE.—Such other health benefits coverage, such as a State health benefits risk pool, as the Commissioner, in coordination with the Secretary of the Treasury, recognizes for purposes of this paragraph.
The Commissioner shall make determinations under this paragraph in coordination with the Secretary of the Treasury.
(3) TREATMENT OF CERTAIN NON-TRADITIONAL MEDICAID ELIGIBLE INDIVIDUALS.—An individual who is a non-traditional Medicaid eligible individual (as defined in section 205(e)(4)(C)) in a State may be an Exchange-eligible individual if the individual was enrolled in a qualified health benefits plan, grandfathered health insurance coverage, or current group health plan during the 6 months before the individual became a non-traditional Medicaid eligible individual. During the period in which such an individual has chosen to enroll in an Exchange-participating health benefits plan, the individual is not also eligible for medical assistance under Medicaid.
(4) CONTINUING ELIGIBILITY PERMITTED.—
(A) IN GENERAL.—Except as provided in subparagraph (B), once an individual qualifies as an Exchange-eligible individual under this subsection (including as an employee or dependent of an employee of an Exchange-eligible employer) and enrolls under an Exchange-participating health benefits plan through the Health Insurance Exchange, the individual shall continue to be treated as an Exchange-eligible individual until the individual is no longer enrolled with an Exchange-participating health benefits plan.
(i) IN GENERAL.—Subparagraph (A) shall not apply to an individual once the individual becomes eligible for coverage—
(I) under part A of the Medicare program;
(II) under the Medicaid program as a Medicaid eligible individual, except as permitted under paragraph (3) or clause (ii); or
(III) in such other circumstances as the Commissioner may provide.
(ii) TRANSITION PERIOD.—In the case described in clause (i)(II), the Commissioner shall permit the individual to continue treatment under subparagraph (A) until such limited time as the Commissioner determines it is administratively feasible, consistent with minimizing disruption in the individual’s access to health care.
(5) ADVERSELY AFFECTED RETIREE HEALTH BENEFITS GROUP PARTICIPANTS AND BENEFICIARIES.—
(A) IN GENERAL.—Beginning in Y1, an individual who is a participant or beneficiary in an adversely affected retiree health benefits group who does not have coverage described in paragraph (2)(C) is an Exchange eligible individual, whether or not such an individual has other acceptable coverage.
(B) ADVERAGE AFFECTED RETIREE HEALTH BENEFIT GROUP DEFINED.—In this paragraph, the term “adversely affected retiree health benefits group” means the retired participants and their beneficiaries of a group health plan that cancelled or substantially reduced the amount, type, level, or form of health benefit or option provided prior January 1, 2008.
(1) SMALLEST EMPLOYERS.—Subject to paragraph (5), smallest employers described in this paragraph are employers with 15 or fewer employees.
(2) SMALLER EMPLOYERS.—Subject to paragraph (5), smaller employers described in this paragraph are employers that are not smallest employers described in paragraph (1) and that have 25 or fewer employees.
(3) LARGER EMPLOYERS.—Subject to paragraph (5), larger employers described in this paragraph are employers that are not smallest employers described in paragraph (1) or smaller employers described in paragraph (2) and that have 50 or fewer employees.
(A) IN GENERAL.—Beginning with Y3, the Commissioner may permit employers not described in paragraphs (1) (2), or (3) to be Exchange-eligible employers.
(B) PHASE-IN.—In applying subparagraph (A), the Commissioner may phase-in the application of such subparagraph based on the number of full-time employees of an employer and such other considerations as the Commissioner deems appropriate.
(5) CONTINUING ELIGIBILITY.—Once an employer is permitted to be an Exchange-eligible employer under this subsection and enrolls employees through the Health Insurance Exchange, the employer shall continue to be treated as an Exchange-eligible employer for each subsequent plan year regardless of the number of employees involved unless and until the employer meets the requirement of section 311(a) through paragraph (1) of such section by offering a group health plan and not through offering Exchange-participating health benefits plan.
(6) EMPLOYER PARTICIPATION AND CONTRIBUTIONS.—
(A) SATISFACTION OF EMPLOYER RESPONSIBILITY.—For any year in which an employer is an Exchange-eligible employer, such employer may meet the requirements of section 312 with respect to employees of such employer by offering such employees the option of enrolling with Exchange-participating health benefits plans through the Health Insurance Exchange consistent with the provisions of subtitle B of title III.
(B) EMPLOYEE CHOICE.—Any employee offered Exchange-participating health benefits plans by the employer of such employee under subparagraph (A) may choose coverage under any such plan. That choice includes, with respect to family coverage, coverage of the dependents of such employee.
(7) AFFILIATED GROUPS.—Any employer which is part of a group of employers who are treated as a single employer under subsection (b), (c), (m), or (o) of section 414 of the Internal Revenue Code of 1986 shall be treated, for purposes of this subtitle, as a single employer.
(8) OTHER COUNTING RULES.—The Commissioner shall establish rules relating to how employees are counted for purposes of carrying out this subsection.
(9) TREATMENT OF MULTIEMPLOYER PLANS.—The plan sponsor of a group health plan (as defined in section 733(a) of the Employee Retirement Income Security Act of 1974) that is multiemployer plan (as defined in section 3(37) of such Act) may obtain health insurance coverage with respect to participants in the plan through the Exchange to the same extent as an employer not described in paragraph (1) or (2) is permitted by the Commissioner to obtain health insurance coverage through the Exchange as an Exchange-eligible employer
(f) Special situation authority.—The Commissioner shall have the authority to establish such rules as may be necessary to deal with special situations with regard to uninsured individuals and employers participating as Exchange-eligible individuals and employers, such as transition periods for individuals and employers who gain, or lose, Exchange-eligible participation status, and to establish grace periods for premium payment.
(g) Surveys of individuals and employers.—The Commissioner shall provide for periodic surveys of Exchange-eligible individuals and employers concerning satisfaction of such individuals and employers with the Health Insurance Exchange and Exchange-participating health benefits plans.
(1) IN GENERAL.—The Commissioner shall conduct a study of access to the Health Insurance Exchange for individuals and for employers, including individuals and employers who are not eligible and enrolled in Exchange-participating health benefits plans. The goal of the study is to determine if there are significant groups and types of individuals and employers who are not Exchange eligible individuals or employers, but who would have improved benefits and affordability if made eligible for coverage in the Exchange.
(2) ITEMS INCLUDED IN STUDY.—Such study also shall examine—
(A) the terms, conditions, and affordability of group health coverage offered by employers and QHBP offering entities outside of the Exchange compared to Exchange-participating health benefits plans; and
(B) the affordability-test standard for access of certain employed individuals to coverage in the Health Insurance Exchange.
(3) REPORT.—Not later than January 1 of Y3, in Y6, and thereafter, the Commissioner shall submit to Congress on the study conducted under this subsection and shall include in such report recommendations regarding changes in standards for Exchange eligibility for for individuals and employers.
(a) In general.—The Commissioner shall specify the benefits to be made available under Exchange-participating health benefits plans during each plan year, consistent with subtitle C of title I and this section.
(b) Limitation on health benefits plans offered by offering entities.—The Commissioner may not enter into a contract with a QHBP offering entity under section 204(c) for the offering of an Exchange-participating health benefits plan in a service area unless the following requirements are met:
(1) REQUIRED OFFERING OF BASIC PLAN.—The entity offers only one basic plan for such service area.
(2) OPTIONAL OFFERING OF ENHANCED PLAN.—If and only if the entity offers a basic plan for such service area, the entity may offer one enhanced plan for such area.
(3) OPTIONAL OFFERING OF PREMIUM PLAN.—If and only if the entity offers an enhanced plan for such service area, the entity may offer one premium plan for such area.
(4) OPTIONAL OFFERING OF PREMIUM-PLUS PLANS.—If and only if the entity offers a premium plan for such service area, the entity may offer one or more premium-plus plans for such area.
All such plans may be offered under a single contract with the Commissioner.(c) Specification of benefit levels for plans.—
(1) IN GENERAL.—The Commissioner shall establish the following standards consistent with this subsection and title I:
(A) BASIC, ENHANCED, AND PREMIUM PLANS.—Standards for 3 levels of Exchange-participating health benefits plans: basic, enhanced, and premium (in this division referred to as a “basic plan”, “enhanced plan”, and “premium plan”, respectively).
(B) PREMIUM-PLUS PLAN BENEFITS.—Standards for additional benefits that may be offered, consistent with this subsection and subtitle C of title I, under a premium plan (such a plan with additional benefits referred to in this division as a “premium-plus plan”) .
(A) IN GENERAL.—A basic plan shall offer the essential benefits package required under title I for a qualified health benefits plan.
(B) TIERED COST-SHARING FOR AFFORDABLE CREDIT ELIGIBLE INDIVIDUALS.—In the case of an affordable credit eligible individual (as defined in section 242(a)(1)) enrolled in an Exchange-participating health benefits plan, the benefits under a basic plan are modified to provide for the reduced cost-sharing for the income tier applicable to the individual under section 244(c).
(3) ENHANCED PLAN.—A enhanced plan shall offer, in addition to the level of benefits under the basic plan, a lower level of cost-sharing as provided under title I consistent with section 123(b)(5)(A).
(4) PREMIUM PLAN.—A premium plan shall offer, in addition to the level of benefits under the basic plan, a lower level of cost-sharing as provided under title I consistent with section 123(b)(5)(B).
(5) PREMIUM-PLUS PLAN.—A premium-plus plan is a premium plan that also provides additional benefits, such as adult oral health and vision care, approved by the Commissioner. The portion of the premium that is attributable to such additional benefits shall be separately specified.
(6) RANGE OF PERMISSIBLE VARIATION IN COST-SHARING.—The Commissioner shall establish a permissible range of variation of cost-sharing for each basic, enhanced, and premium plan, except with respect to any benefit for which there is no cost-sharing permitted under the essential benefits package. Such variation shall permit a variation of not more than plus (or minus) 10 percent in cost-sharing with respect to each benefit category specified under section 122.
(d) Treatment of State benefit mandates.—Insofar as a State requires a health insurance issuer offering health insurance coverage to include benefits beyond the essential benefits package, such requirement shall continue to apply to an Exchange-participating health benefits plan, if the State has entered into an arrangement satisfactory to the Commissioner to reimburse the Commissioner for the amount of any net increase in affordability premium credits under subtitle C as a result of an increase in premium in basic plans as a result of application of such requirement.
(a) Contracting duties.—In carrying out section 201(b)(1) and consistent with this subtitle:
(1) OFFERING ENTITY AND PLAN STANDARDS.—The Commissioner shall—
(A) establish standards necessary to implement the requirements of this title and title I for—
(i) QHBP offering entities for the offering of an Exchange-participating health benefits plan; and
(ii) for Exchange-participating health benefits plans; and
(B) certify QHBP offering entities and qualified health benefits plans as meeting such standards and requirements of this title and title I for purposes of this subtitle.
(2) SOLICITING AND NEGOTIATING BIDS; CONTRACTS.—The Commissioner shall—
(A) solicit bids from QHBP offering entities for the offering of Exchange-participating health benefits plans;
(B) based upon a review of such bids, negotiate with such entities for the offering of such plans; and
(C) enter into contracts with such entities for the offering of such plans through the Health Insurance Exchange under terms (consistent with this title) negotiated between the Commissioner and such entities.
(3) FAR NOT APPLICABLE.—The provisions of the Federal Acquisition Regulation shall not apply to contracts between the Commissioner and QHBP offering entities for the offering of Exchange-participating health benefits plans under this title.
(b) Standards for QHBP offering entities to offer Exchange-participating health benefits plans.—The standards established under subsection (a)(1)(A) shall require that, in order for a QHBP offering entity to offer an Exchange-participating health benefits plan, the entity must meet the following requirements:
(1) LICENSED.—The entity shall be licensed to offer health insurance coverage under State law for each State in which it is offering such coverage.
(2) DATA REPORTING.—The entity shall provide for the reporting of such information as the Commissioner may specify, including information necessary to administer the risk pooling mechanism described in section 206(b) and information to address disparities in health and health care.
(3) IMPLEMENTING AFFORDABILITY CREDITS.—The entity shall provide for implementation of the affordability credits provided for enrollees under subtitle C, including the reduction in cost-sharing under section 244(c).
(4) ENROLLMENT.—The entity shall accept all enrollments under this subtitle, subject to such exceptions (such as capacity limitations) in accordance with the requirements under title I for a qualified health benefits plan. The entity shall notify the Commissioner if the entity projects or anticipates reaching such a capacity limitation that would result in a limitation in enrollment.
(5) RISK POOLING PARTICIPATION.—The entity shall participate in such risk pooling mechanism as the Commissioner establishes under section 206(b).
(6) ESSENTIAL COMMUNITY PROVIDERS.—With respect to the basic plan offered by the entity, the entity shall contract for outpatient services with covered entities (as defined in section 340B(a)(4) of the Public Health Service Act, as in effect as of July 1, 2009). The Commissioner shall specify the extent to which and manner in which the previous sentence shall apply in the case of a basic plan with respect to which the Commissioner determines provides substantially all benefits through a health maintenance organization, as defined in section 2791(b)(3) of the Public Health Service Act.
(7) CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES AND COMMUNICATIONS.—The entity shall provide for culturally and linguistically appropriate communication and health services.
(8) ADDITIONAL REQUIREMENTS.—The entity shall comply with other applicable requirements of this title, as specified by the Commissioner, which shall include standards regarding billing and collection practices for premiums and related grace periods and which may include standards to ensure that the entity does not use coercive practices to force providers not to contract with other entities offering coverage through the Health Insurance Exchange.
(1) BID APPLICATION.—To be eligible to enter into a contract under this section, a QHBP offering entity shall submit to the Commissioner a bid at such time, in such manner, and containing such information as the Commissioner may require.
(2) TERM.—Each contract with a QHBP offering entity under this section shall be for a term of not less than one year, but may be made automatically renewable from term to term in the absence of notice of termination by either party.
(3) ENFORCEMENT OF NETWORK ADEQUACY.—In the case of a health benefits plan of a QHBP offering entity that uses a provider network, the contract under this section with the entity shall provide that if—
(A) the Commissioner determines that such provider network does not meet such standards as the Commissioner shall establish under section 115; and
(B) an individual enrolled in such plan receives an item or service from a provider that is not within such network;
then any cost-sharing for such item or service shall be equal to the amount of such cost-sharing that would be imposed if such item or service was furnished by a provider within such network.
(4) OVERSIGHT AND ENFORCEMENT RESPONSIBILITIES.—The Commissioner shall establish processes, in coordination with State insurance regulators, to oversee, monitor, and enforce applicable requirements of this title with respect to QHBP offering entities offering Exchange-participating health benefits plans and such plans, including the marketing of such plans. Such processes shall include the following:
(A) GRIEVANCE AND COMPLAINT MECHANISMS.—The Commissioner shall establish, in coordination with State insurance regulators, a process under which Exchange-eligible individuals and employers may file complaints concerning violations of such standards.
(B) ENFORCEMENT.—In carrying out authorities under this division relating to the Health Insurance Exchange, the Commissioner may impose one or more of the intermediate sanctions described in section 142(c).
(i) IN GENERAL.—The Commissioner may terminate a contract with a QHBP offering entity under this section for the offering of an Exchange-participating health benefits plan if such entity fails to comply with the applicable requirements of this title. Any determination by the Commissioner to terminate a contract shall be made in accordance with formal investigation and compliance procedures established by the Commissioner under which—
(I) the Commissioner provides the entity with the reasonable opportunity to develop and implement a corrective action plan to correct the deficiencies that were the basis of the Commissioner’s determination; and
(II) the Commissioner provides the entity with reasonable notice and opportunity for hearing (including the right to appeal an initial decision) before terminating the contract.
(ii) EXCEPTION FOR IMMINENT AND SERIOUS RISK TO HEALTH.—Clause (i) shall not apply if the Commissioner determines that a delay in termination, resulting from compliance with the procedures specified in such clause prior to termination, would pose an imminent and serious risk to the health of individuals enrolled under the qualified health benefits plan of the QHBP offering entity.
(D) CONSTRUCTION.—Nothing in this subsection shall be construed as preventing the application of other sanctions under subtitle E of title I with respect to an entity for a violation of such a requirement.
(1) OUTREACH.—The Commissioner shall conduct outreach activities consistent with subsection (c), including through use of appropriate entities as described in paragraph (4) of such subsection, to inform and educate individuals and employers about the Health Insurance Exchange and Exchange-participating health benefits plan options. Such outreach shall include outreach specific to vulnerable populations, such as children, individuals with disabilities, individuals with mental illness, and individuals with other cognitive impairments.
(2) ELIGIBILITY.—The Commissioner shall make timely determinations of whether individuals and employers are Exchange-eligible individuals and employers (as defined in section 202).
(3) ENROLLMENT.—The Commissioner shall establish and carry out an enrollment process for Exchange-eligible individuals and employers, including at community locations, in accordance with subsection (b).
(1) IN GENERAL.—The Commissioner shall establish a process consistent with this title for enrollments in Exchange-participating health benefits plans. Such process shall provide for enrollment through means such as the mail, by telephone, electronically, and in person.
(A) OPEN ENROLLMENT PERIOD.—The Commissioner shall establish an annual open enrollment period during which an Exchange-eligible individual or employer may elect to enroll in an Exchange-participating health benefits plan for the following plan year and an enrollment period for affordability credits under subtitle C. Such periods shall be during September through November of each year, or such other time that would maximize timeliness of income verification for purposes of such subtitle. The open enrollment period shall not be less than 30 days.
(B) SPECIAL ENROLLMENT.—The Commissioner shall also provide for special enrollment periods to take into account special circumstances of individuals and employers, such as an individual who—
(i) loses acceptable coverage;
(ii) experiences a change in marital or other dependent status;
(iii) moves outside the service area of the Exchange-participating health benefits plan in which the individual is enrolled; or
(iv) experiences a significant change in income.
(C) ENROLLMENT INFORMATION.—The Commissioner shall provide for the broad dissemination of information to prospective enrollees on the enrollment process, including before each open enrollment period. In carrying out the previous sentence, the Commissioner may work with other appropriate entities to facilitate such provision of information.
(3) AUTOMATIC ENROLLMENT FOR NON-MEDICAID ELIGIBLE INDIVIDUALS.—
(A) IN GENERAL.—The Commissioner shall provide for a process under which individuals who are Exchange-eligible individuals described in subparagraph (B) are automatically enrolled under an appropriate Exchange-participating health benefits plan. Such process may involve a random assignment or some other form of assignment that takes into account the health care providers used by the individual involved or such other relevant factors as the Commissioner may specify.
(B) SUBSIDIZED INDIVIDUALS DESCRIBED.—An individual described in this subparagraph is an Exchange-eligible individual who is either of the following:
(i) AFFORDABILITY CREDIT ELIGIBLE INDIVIDUALS.—The individual—
(I) has applied for, and been determined eligible for, affordability credits under subtitle C;
(II) has not opted out from receiving such affordability credit; and
(III) does not otherwise enroll in another Exchange-participating health benefits plan.
(ii) INDIVIDUALS ENROLLED IN A TERMINATED PLAN.—The individual is enrolled in an Exchange-participating health benefits plan that is terminated (during or at the end of a plan year) and who does not otherwise enroll in another Exchange-participating health benefits plan.
(4) DIRECT PAYMENT OF PREMIUMS TO PLANS.—Under the enrollment process, individuals enrolled in an Exchange-partcipating health benefits plan shall pay such plans directly, and not through the Commissioner or the Health Insurance Exchange.
(c) Coverage information and assistance.—
(1) COVERAGE INFORMATION.—The Commissioner shall provide for the broad dissemination of information on Exchange-participating health benefits plans offered under this title. Such information shall be provided in a comparative manner, and shall include information on benefits, premiums, cost-sharing, quality, provider networks, and consumer satisfaction.
(2) CONSUMER ASSISTANCE WITH CHOICE.—To provide assistance to Exchange-eligible individuals and employers, the Commissioner shall—
(A) provide for the operation of a toll-free telephone hotline to respond to requests for assistance and maintain an Internet website through which individuals may obtain information on coverage under Exchange-participating health benefits plans and file complaints;
(B) develop and disseminate information to Exchange-eligible enrollees on their rights and responsibilities;
(C) assist Exchange-eligible individuals in selecting Exchange-participating health benefits plans and obtaining benefits through such plans; and
(D) ensure that the Internet website described in subparagraph (A) and the information described in subparagraph (B) is developed using plain language (as defined in section 133(a)(2)).
(3) USE OF OTHER ENTITIES.—In carrying out this subsection, the Commissioner may work with other appropriate entities to facilitate the dissemination of information under this subsection and to provide assistance as described in paragraph (2).
(d) Special duties related to Medicaid and CHIP.—
(1) COVERAGE FOR CERTAIN NEWBORNS.—
(A) IN GENERAL.—In the case of a child born in the United States who at the time of birth is not otherwise covered under acceptable coverage, for the period of time beginning on the date of birth and ending on the date the child otherwise is covered under acceptable coverage (or, if earlier, the end of the month in which the 60-day period, beginning on the date of birth, ends), the child shall be deemed—
(i) to be a non-traditional Medicaid eligible individual (as defined in subsection (e)(5)) for purposes of this division and Medicaid; and
(ii) to have elected to enroll in Medicaid through the application of paragraph (3).
(B) EXTENDED TREATMENT AS TRADITIONAL MEDICAID ELIGIBLE INDIVIDUAL.—In the case of a child described in subparagraph (A) who at the end of the period referred to in such subparagraph is not otherwise covered under acceptable coverage, the child shall be deemed (until such time as the child obtains such coverage or the State otherwise makes a determination of the child’s eligibility for medical assistance under its Medicaid plan pursuant to section 1943(c)(1) of the Social Security Act) to be a traditional Medicaid eligible individual described in section 1902(l)(1)(B) of such Act.
(2) CHIP TRANSITION.—A child who, as of the day before the first day of Y1, is eligible for child health assistance under title XXI of the Social Security Act (including a child receiving coverage under an arrangement