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Statutory Text

SEC. 1304 [42 U.S.C. 18024]. RELATED DEFINITIONS.
(a) DEFINITIONS RELATING TO MARKETS.—In this title:
(1) GROUP MARKET.—The term ‘‘group market’’ means the
health insurance market under which individuals obtain
health insurance coverage (directly or through any arrangement)
on behalf of themselves (and their dependents) through
a group health plan maintained by an employer.
(2) INDIVIDUAL MARKET.—The term ‘‘individual market’’
means the market for health insurance coverage offered to individuals
other than in connection with a group health plan.
(3) LARGE AND SMALL GROUP MARKETS.—The terms ‘‘large
group market’’ and ‘‘small group market’’ mean the health insurance
market under which individuals obtain health insurance
coverage (directly or through any arrangement) on behalf
of themselves (and their dependents) through a group health
plan maintained by a large employer (as defined in subsection
(b)(1)) or by a small employer (as defined in subsection (b)(2)),
respectively.
(b) EMPLOYERS.—In this title:
(1) LARGE EMPLOYER.—The term ‘‘large employer’’ means,
in connection with a group health plan with respect to a calendar
year and a plan year, an employer who employed an average
of at least 101 employees on business days during the
preceding calendar year and who employs at least 1 employee
on the first day of the plan year.
(2) SMALL EMPLOYER.—The term ‘‘small employer’’ means,
in connection with a group health plan with respect to a calendar
year and a plan year, an employer who employed an average
of at least 1 but not more than 100 employees on business
days during the preceding calendar year and who employs
at least 1 employee on the first day of the plan year.
(3) STATE OPTION TO TREAT 50 EMPLOYEES AS SMALL.—In
the case of plan years beginning before January 1, 2016, a
State may elect to apply this subsection by substituting ‘‘51
employees’’ for ‘‘101 employees’’ in paragraph (1) and by substituting
‘‘50 employees’’ for ‘‘100 employees’’ in paragraph (2).
(4) RULES FOR DETERMINING EMPLOYER SIZE.—For purposes
of this subsection—
(A) APPLICATION OF AGGREGATION RULE FOR EMPLOYERS.—All
persons 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 as 1 employer.
(B) EMPLOYERS NOT IN EXISTENCE IN PRECEDING
YEAR.—In the case of an employer which was not in existence
throughout the preceding calendar year, the determination
of whether such employer is a small or large employer
shall be based on the average number of employees
that it is reasonably expected such employer will employ
on business days in the current calendar year.
(C) PREDECESSORS.—Any reference in this subsection
to an employer shall include a reference to any predecessor
of such employer.
(D) CONTINUATION OF PARTICIPATION FOR GROWING
SMALL EMPLOYERS.—If—
(i) a qualified employer that is a small employer
makes enrollment in qualified health plans offered in
the small group market available to its employees
through an Exchange; and
(ii) the employer ceases to be a small employer by
reason of an increase in the number of employees of
such employer;
the employer shall continue to be treated as a small employer
for purposes of this subtitle for the period beginning
with the increase and ending with the first day on which
the employer does not make such enrollment available to
its employees.
(c) SECRETARY.—In this title, the term ‘‘Secretary’’ means the
Secretary of Health and Human Services.
(d) STATE.—In this title, the term ‘‘State’’ means each of the 50
States and the District of Columbia.
(e) EDUCATED HEALTH CARE CONSUMERS.—[As added by section
10104(d)] The term ‘‘educated health care consumer’’ means
an individual who is knowledgeable about the health care system,
and has background or experience in making informed decisions regarding
health, medical, and scientific matters.