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Statutory Text

SEC. 1301 [42 U.S.C. 18021]. QUALIFIED HEALTH PLAN DEFINED.
(a) QUALIFIED HEALTH PLAN.—In this title:
(1) IN GENERAL.—The term ‘‘qualified health plan’’ means
a health plan that—
(A) has in effect a certification (which may include a
seal or other indication of approval) that such plan meets
the criteria for certification described in section 1311(c)
issued or recognized by each Exchange through which such
plan is offered;
(B) provides the essential health benefits package described
in section 1302(a); and
(C) is offered by a health insurance issuer that—
(i) is licensed and in good standing to offer health
insurance coverage in each State in which such issuer
offers health insurance coverage under this title;
(ii) agrees to offer at least one qualified health
plan in the silver level and at least one plan in the
gold level in each such Exchange;
(iii) agrees to charge the same premium rate for
each qualified health plan of the issuer without regard
to whether the plan is offered through an Exchange or
whether the plan is offered directly from the issuer or
through an agent; and
(iv) complies with the regulations developed by
the Secretary under section 1311(d) and such other requirements
as an applicable Exchange may establish.
[Paragraphs (2)-(4) substituted for previous paragraph (2) by
section 10104(a)]
(2) INCLUSION OF CO-OP PLANS AND MULTI-STATE QUALIFIED
HEALTH PLANS.—Any reference in this title to a qualified
health plan shall be deemed to include a qualified health plan
offered through the CO-OP program under section 1322, and a
multi-State plan under section 1334, unless specifically provided
for otherwise.
(3) TREATMENT OF QUALIFIED DIRECT PRIMARY CARE MED- ICAL HOME PLANS.—The Secretary of Health and Human Services
shall permit a qualified health plan to provide coverage
through a qualified direct primary care medical home plan that
meets criteria established by the Secretary, so long as the
qualified health plan meets all requirements that are otherwise
applicable and the services covered by the medical home
plan are coordinated with the entity offering the qualified
health plan.
(4) VARIATION BASED ON RATING AREA.—A qualified health
plan, including a multi-State qualified health plan, may as appropriate
vary premiums by rating area (as defined in section
2701(a)(2) of the Public Health Service Act).
(b) TERMS RELATING TO HEALTH PLANS.—In this title:
(1) HEALTH PLAN.— (A) IN GENERAL.—The term ‘‘health plan’’ means
health insurance coverage and a group health plan.
(B) EXCEPTION FOR SELF-INSURED PLANS AND MEWAS.— Except to the extent specifically provided by this title, the
term ‘‘health plan’’ shall not include a group health plan
or multiple employer welfare arrangement to the extent
the plan or arrangement is not subject to State insurance
regulation under section 514 of the Employee Retirement
Income Security Act of 1974.
(2) HEALTH INSURANCE COVERAGE AND ISSUER.—The terms
‘‘health insurance coverage’’ and ‘‘health insurance issuer’’ have
the meanings given such terms by section 2791(b) of the Public
Health Service Act.
(3) GROUP HEALTH PLAN.—The term ‘‘group health plan’’
has the meaning given such term by section 2791(a) of the
Public Health Service Act.