Index for HR3962: Affordable Health Care for America Act

ABORTION on minor ;   Coverage or procedural requirements on abortions including parental notification or consent for performance of

ADOPTION of benefit standards so recommended as package ;   Proposing

ADOPTION of recommended standards by deadline specified in subsection ;   Secretary otherwise to be unable to propose initial

APPOINTMENT members ;   Excepting that terms of initial members to be adjusted in order to provide for staggered term of

APPOINTMENTS to be made not later than 60 days after date of enactment of Act ;   Initial

ASSESSMENT and counseling ;   Secretary supporting need for assessment and brief counseling for domestic violence as part of behavioral health assessment or primary care visit and determining appropriate coverage for

CONTRACTS with pharmacy benefit manager or other entity to manage prescription drug coverage or otherwise controlling prescription drug costs under qualified health benefits planning ;   QHBP offering entity

VISION carrier ;   Offers 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

DISCLOSURE with standards established by Commissioner under paragraph ;   Secretary of Labor updating and harmonizing Secretary's rules concerning accurate and timely disclosure to participants by group health plans of plan disclosure, plan terms and conditioning and periodic financial

DISCLOSURES under paragraphs and provided in plain language  ;  

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

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

DRUG having higher cost for QHBP offering entity ;   Information on percentage and number of cases under contract in which individuals switched because of PBM policies or direct or indirect control of PBM from prescribed drug having lower cost for QHBP offering entity to

EMPLOYMENT-based health plan or otherwise excepting that section 2712(b)(1) applying only if issuer providing enrollee with notice of nonpayment of premiums and grace period during that enrollee 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

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 midsize employers to self-insuring or creating adverse selection in

HEALTH plans under section 802(a)(1) of Employee Retirement Income Security Act of 1974 ;   Previous sentence not to be construed as providing for applicability of rights or remedies under State laws with respect to requirements applicable to employers or other plan sponsors in connection with arrangements treated as group

TITLE VII of Civil Rights acting of 1964 ;   Nothing in section altering rights and obligations of employees and employers under

EMPLOYMENT-based health plans ;   Case of health insurance coverage not offered through Health Insurance Exchange and case of

EMPLOYMENT-based health plan in which coverage consisting only of one or more of coverage or benefits described in clauses ;   No case

EMPLOYMENT related to health care ;   Nothing in division to be construed to alter or supersede statutory or other obligation to engage in collective bargaining over terms or conditions of

EXEMPTION for Hawaii Prepaid Health Care Act ;   Nothing in division to be construed to modify or limit application of

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

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

FINANCIAL security ;   Term essential benefits packaging means health benefiting coverage, consistent with standards adopted under section 224, ensuring provision of quality health care and

CONTRACT or certificate of insurance ;   Nothing in division to be construed as affecting offering outside of Health Insurance Exchange and State law of health benefits in form of excepted benefits if benefits offered under separate policy,

HEALTH and representing balance among various sectors of health care system so ;   Labor, health insurance issuers, experts in health care financing and delivery, experts in oral health care, experts in racial and ethnic disparities, experts on health care needs and disparities of individuals with disabilities, representatives of relevant governmental agencies and one practicing physician or other health professional and expert in child and adolescent

HEALTH benefits or benefit structures for qualifing health benefits ;   Qualified health benefits planning complying with standards established by Commissioner to prohibit discrimination in

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

HEALTH benefits planning ;   Case of qualified health benefits planning being not Exchange-participating

DISCLOSURE to Commissioner and public 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 ;   QHBP offering entity offering Exchange-participating health benefits planning complying with standards established by Commissioner for accurate and timely

HEALTH benefits planing offered through Exchange ;   Providing for dissemination of information related to end-of-life planning to individuals seeking enrollment in Exchange-participating

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

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 following ;   Qualified

HEALTH benefits planning being health insurance coverage not varying excepting as following ;   Premium rate charged for qualified

DISCRIMINATION in health benefits or benefit structures for qualifing health benefits ;   Qualified health benefits planning complying with standards established by Commissioner to prohibit

HEALTH benefits planning ;   Case of health insurance coverage offered under qualified

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

HEALTH benefits planing being health insurance coverage ;   QHBP offering entities meeting with respect to qualified

HEALTH Benefits planing not offered through health insurance Exchange ;   Application to qualified

HEALTH benefits planning offers in same manner as 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

HEALTH benefits planing involving individuals and multiple plan coverage ;   Commissioner establishing standards for coordination and subrogation of benefits and reimbursement of payments in cases of qualified

HEALTH benefits planing offers ;   QHBP offering entity required to comply with administrative simplification provisions under part C of title XI of Social Security Act with respect to qualified

CERTIFICATION under applicable State law ;   Act not to be construed as superseding laws of State or jurisdiction designed to prohibit qualified health benefits planning from discriminating with respect to participation, reimbursement, covered services, indemnification or related requirements under plan against health care provider acting within scope of provider's license or

HEALTH benefits planning ;   Duration or scope of medical benefits otherwise covered under qualified

HEALTH benefits planning under title and enforcement of standards ;   Including concerning standards for health insurance coverage being qualified

HEALTH benefits planning ;   Assistance to individuals in choosing qualified

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

HEALTH care to adults as part of essential benefits packaging ;   Secretary of Health and Human Services submitting to Congress report containing results of study determining need and cost of providing accessible and affordable oral

DISABILITIES, representatives of relevant governmental agencies and one practicing physician or other health professional and expert in child and adolescent health and representing balance among various sectors of health care system so ;   Labor, health insurance issuers, experts in health care financing and delivery, experts in oral health care, experts in racial and ethnic disparities, experts on health care needs and disparities of individuals with

HEALTH care professional ;   Term health care entity including individual physician or other

FINANCIAL security ;   Term essential benefits packaging means health benefiting coverage, consistent with standards adopted under section 224, ensuring provision of quality health care and

EMPLOYMENT-based health plan or otherwise excepting that section 2712(b)(1) applying only if issuer providing enrollee with notice of nonpayment of premiums and grace period during that enrollee 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

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

HEALTH plans ;   Similarities and differences between typical insured and self-insured

HEALTH care providers ;   Secretary of Health and Human Services conducting study of potential methods to increase use of qualified electronic health records by small

INFORMATION on plan ;   Using provider network providing current listing of providers in network on Website and data to be available on Health Insurance Exchange Website as part of basic

DISSEMINATION of information related to end-of-life planning to individuals seeking enrollment in Exchange-participating health benefits planing offered through Exchange ;   Providing for

INFORMATION including options to maintain ;   Information presented under paragraph not presuming withdrawal of treatment and including end-of-life planning

INFORMATION in same manner as provisions applying to manufacturer with agreement under sectioning that failing to provide information under subsection of sectioning or knowingly providing false information under section ;   Provisions of subsection of section 1927 applying to PBM failing to provide information required under subsection or knowingly providing false

INFORMATION in form and manner to be determined by Commissioner ;   PBM providing annually to Commissioner and QHBP offering entity offering plan following

INFORMATION relating to violation ;   Attorney general of State

DRUG prices and spending ;   Commissioner preparing public report providing industrywide aggregate or average information to be used in assessing overall impact of PBMS on prescription

INFORMATION as determined appropriate by Commissioner ;   QHBP offering entity offering Exchange-participating health benefits planning complying with standards established by Commissioner for accurate and timely disclosure to Commissioner and public 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 in sales and marketing practices of pharmaceutical manufacturers ;   Secretary of Health and Human Services conducting study on use of physician prescriber

INFORMATION needed to seek appeal of decision or determination ;   Helping individuals determining relevant

INFORMATION ;   Report not disclosing identity of specific PBM or prices charged by PBM or specific retailer, manufacturer or wholesaler or other confidential or trade secret

HEALTH insurance in connection with providing health insurance ;   Person engaged in business of

INSURANCE ;   Nothing in division to be construed as affecting offering outside of Health Insurance Exchange and State law of health benefits in form of excepted benefits if benefits offered under separate policy, contract or certificate of

HEALTH insurance issuer from using medical management practicing so long as management practices based on valid medical evidence and relevant to patient whose medical treatment under review ;   Nothing in Act to be construed to prohibit group health plan or

DENTAL ;   Nothing in division to be construed as prohibiting qualified health benefits planning from subcontracting with stand alone health insurance issuers or insurers for provision of

DISABILITIES, representatives of relevant governmental agencies and one practicing physician or other health professional and expert in child and adolescent health and representing balance among various sectors of health care system so ;   Labor, health insurance issuers, experts in health care financing and delivery, experts in oral health care, experts in racial and ethnic disparities, experts on health care needs and disparities of individuals with

HEALTH insurance issuers generally with respect to requirement referred in paragraph ;   Nothing in paragraph to be construed as preventing application of rights and remedies under State laws to

HEALTH insurance ;   Person engaged in business of health insurance in connection with providing

HEALTH insurance issuer offering coverage not enrolling individual in coverageing if first effective date of coverage after first day of Y1 ;   Individual

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

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

HEALTH benefits planning ;   Case of health insurance coverage offered under qualified

EMPLOYMENT-based health plans ;   Case of health insurance coverage not offered through Health Insurance Exchange and case of

HEALTH insurance coverage not varying excepting as following ;   Premium rate charged for qualified health benefits planning being

HEALTH insurance coverage offered in large group market ;   Same manner as provisions applying to

HEALTH insurance coverage ;   QHBP offering entities meeting with respect to qualified health benefits planing being

HEALTH insurance coverage including insurance-related terms ;   Commissioner providing for development of standards for definitions of terms used in

HEALTH benefits planning under title and enforcement of standards ;   Including concerning standards for health insurance coverage being qualified

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

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