HR3200 PDF

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 in such plan. Protecting the choice to keep current coverage 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 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. 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 a 1 B ii IV of division B of the American Recovery and Reinvestment Act of PL —5.

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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 in such plan. Protecting the choice to keep current coverage 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 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. 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 a 1 B ii IV of division B of the American Recovery and Reinvestment Act of PL —5.

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.

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. Prohibiting preexisting condition exclusions A qualified health benefits plan may not impose any preexisting condition exclusion as defined in section 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 d 9 of the Public Health Service Act in relation to the individual or dependent.

Guaranteed issue and renewal for insured plans The requirements of sections other than subsections c and e and 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, and shall apply to the public health insurance option, in the same manner as such sections apply to employers and health insurance coverage offered in the small group market, except that such section 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 enrollee has an opportunity to correct such nonpayment.

Rescissions of such coverage shall be prohibited except in cases of fraud as defined in sections b 2 of such Act.

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. Nondiscrimination in benefits; parity in mental health and substance abuse disorder benefits a Nondiscrimination in benefits A qualified health benefits plan including the public health insurance option 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 of Employee Retirement Income Security Act of , of the Public Health Service Act, and section of the Internal Revenue Code of Ensuring adequacy of provider networks a In general A qualified health benefits plan including the public health insurance option 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.

Ensuring value and lower premiums 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.

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. Coverage of essential benefits package a.

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America's Affordable Health Choices Act of 2009

Congressional Budget Office is a non-partisan organization that analyzes the effect on the federal budget of proposed and existing legislation on behalf of the Congress. The cutoff changes to twenty or fewer employees the next year. The legislation does not specify any further phases, leaving that up to the officer to decide. Employers that currently offer insurance have a five-year grace period after the act begins before they would be subject to the standards. Individuals would be free to purchase their own private insurance, or work with the public option, in this period and afterward. It will consist of 9 more individuals who are not federal employees that are appointed by the President of the United States. It will also consist of 9 members who are appointed by the Comptroller General of the United States.

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