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Statutory Text

SEC. 1303 [42 U.S.C. 18023]. SPECIAL RULES.
[Replaced by section 10104(c)]
(a) STATE OPT-OUT OF ABORTION COVERAGE.—
(1) IN GENERAL.—A State may elect to prohibit abortion
coverage in qualified health plans offered through an Exchange
in such State if such State enacts a law to provide for such prohibition.
(2) TERMINATION OF OPT OUT.—A State may repeal a law
described in paragraph (1) and provide for the offering of such
services through the Exchange.
(b) SPECIAL RULES RELATING TO COVERAGE OF ABORTION SERV- ICES.— (1) VOLUNTARY CHOICE OF COVERAGE OF ABORTION SERV- ICES.— (A) IN GENERAL.—Notwithstanding any other provision
of this title (or any amendment made by this title)—
(i) nothing in this title (or any amendment made
by this title), shall be construed to require a qualified
health plan to provide coverage of services described
in subparagraph (B)(i) or (B)(ii) as part of its essential
health benefits for any plan year; and
(ii) subject to subsection (a), the issuer of a qualified
health plan shall determine whether or not the
plan provides coverage of services described in subparagraph
(B)(i) or (B)(ii) as part of such benefits for
the plan year.
(B) ABORTION SERVICES.— (i) ABORTIONS FOR WHICH PUBLIC FUNDING IS PRO- HIBITED.—The services described in this clause are
abortions for which the expenditure of Federal funds
appropriated for the Department of Health and
Human Services is not permitted, based on the law as
in effect as of the date that is 6 months before the beginning
of the plan year involved.
(ii) ABORTIONS FOR WHICH PUBLIC FUNDING IS ALLOWED.—The
services described in this clause are
abortions for which the expenditure of Federal funds
appropriated for the Department of Health and
Human Services is permitted, based on the law as in
effect as of the date that is 6 months before the beginning
of the plan year involved.
(2) PROHIBITION ON THE USE OF FEDERAL FUNDS.—
(A) IN GENERAL.—If a qualified health plan provides
coverage of services described in paragraph (1)(B)(i), the
issuer of the plan shall not use any amount attributable
to any of the following for purposes of paying for such
services:
(i) The credit under section 36B of the Internal
Revenue Code of 1986 (and the amount (if any) of the
advance payment of the credit under section 1412 of
the Patient Protection and Affordable Care Act).
(ii) Any cost-sharing reduction under section 1402
of the Patient Protection and Affordable Care Act (and
the amount (if any) of the advance payment of the reduction
under section 1412 of the Patient Protection
and Affordable Care Act).
(B) ESTABLISHMENT OF ALLOCATION ACCOUNTS.—In the
case of a plan to which subparagraph (A) applies, the
issuer of the plan shall—
(i) collect from each enrollee in the plan (without
regard to the enrollee’s age, sex, or family status) a
separate payment for each of the following:
(I) an amount equal to the portion of the premium
to be paid directly by the enrollee for coverage
under the plan of services other than services
described in paragraph (1)(B)(i) (after reduction
for credits and cost-sharing reductions described
in subparagraph (A)); and
(II) an amount equal to the actuarial value of
the coverage of services described in paragraph
(1)(B)(i), and
(ii) shall deposit all such separate payments into
separate allocation accounts as provided in subparagraph
(C).
In the case of an enrollee whose premium for coverage
under the plan is paid through employee payroll deposit,
the separate payments required under this subparagraph
shall each be paid by a separate deposit.
(C) SEGREGATION OF FUNDS.— (i) IN GENERAL.—The issuer of a plan to which
subparagraph (A) applies shall establish allocation accounts
described in clause (ii) for enrollees receiving
amounts described in subparagraph (A).
(ii) ALLOCATION ACCOUNTS.—The issuer of a plan
to which subparagraph (A) applies shall deposit—
(I) all payments described in subparagraph
(B)(i)(I) into a separate account that consists solely
of such payments and that is used exclusively
to pay for services other than services described in
paragraph (1)(B)(i); and
(II) all payments described in subparagraph
(B)(i)(II) into a separate account that consists solely
of such payments and that is used exclusively
to pay for services described in paragraph
(1)(B)(i).
(D) ACTUARIAL VALUE.—
(i) IN GENERAL.—The issuer of a qualified health
plan shall estimate the basic per enrollee, per month
cost, determined on an average actuarial basis, for including
coverage under the qualified health plan of the
services described in paragraph (1)(B)(i).
(ii) CONSIDERATIONS.—In making such estimate,
the issuer—
(I) may take into account the impact on overall
costs of the inclusion of such coverage, but may
not take into account any cost reduction estimated
to result from such services, including prenatal
care, delivery, or postnatal care;
(II) shall estimate such costs as if such coverage
were included for the entire population covered;
and
(III) may not estimate such a cost at less than
$1 per enrollee, per month.
(E) ENSURING COMPLIANCE WITH SEGREGATION RE- QUIREMENTS.— (i) IN GENERAL.—Subject to clause (ii), State
health insurance commissioners shall ensure that
health plans comply with the segregation requirements
in this subsection through the segregation of
plan funds in accordance with applicable provisions of
generally accepted accounting requirements, circulars
on funds management of the Office of Management
and Budget, and guidance on accounting of the Government
Accountability Office.
(ii) CLARIFICATION.—Nothing in clause (i) shall
prohibit the right of an individual or health plan to
appeal such action in courts of competent jurisdiction.
(3) RULES RELATING TO NOTICE.— (A) NOTICE.—A qualified health plan that provides for
coverage of the services described in paragraph (1)(B)(i)
shall provide a notice to enrollees, only as part of the summary
of benefits and coverage explanation, at the time of
enrollment, of such coverage.
(B) RULES RELATING TO PAYMENTS.—The notice described
in subparagraph (A), any advertising used by the
issuer with respect to the plan, any information provided
by the Exchange, and any other information specified by
the Secretary shall provide information only with respect
to the total amount of the combined payments for services
described in paragraph (1)(B)(i) and other services covered
by the plan.
(4) NO DISCRIMINATION ON BASIS OF PROVISION OF ABORTION.—No
qualified health plan offered through an Exchange
may discriminate against any individual health care provider
or health care facility because of its unwillingness to provide,
pay for, provide coverage of, or refer for abortions
(c) APPLICATION OF STATE AND FEDERAL LAWS REGARDING
ABORTION.—
(1) NO PREEMPTION OF STATE LAWS REGARDING ABORTION.—Nothing
in this Act shall be construed to preempt or
otherwise have any effect on State laws regarding the prohibition
of (or requirement of) coverage, funding, or procedural requirements
on abortions, including parental notification or consent
for the performance of an abortion on a minor.
(2) NO EFFECT ON FEDERAL LAWS REGARDING ABORTION.—
(A) IN GENERAL.—Nothing in this Act shall be construed
to have any effect on Federal laws regarding—
(i) conscience protection;
(ii) willingness or refusal to provide abortion; and
(iii) discrimination on the basis of the willingness
or refusal to provide, pay for, cover, or refer for abortion
or to provide or participate in training to provide
abortion.
(3) NO EFFECT ON FEDERAL CIVIL RIGHTS LAW.—Nothing in
this subsection shall alter the rights and obligations of employees
and employers under title VII of the Civil Rights Act of
1964.
(d) APPLICATION OF EMERGENCY SERVICES LAWS.—Nothing in
this Act shall be construed to relieve any health care provider from
providing emergency services as required by State or Federal law,
including section 1867 of the Social Security Act (popularly known
as ‘‘EMTALA’’).