Improving health is our policy
Amended by section 10104 of the Manager’s Amendment. Requires Qualified Health Plans (QHPs) to be certified by Exchanges, cover essential health benefits and be offered by state-licensed issuers in good standing that offer at least one silver and one gold QHP. Includes CO-OPs and multi-state plans in the definition of QHPs. Permits a QHP to provide coverage through a qualified direct...
Amended by section 10104 of the Manager’s Amendment. Defines the essential health benefits (EHB) package as coverage providing HHS-defined EHBs, limiting cost sharing and having a certain actuarial value (AV) as denoted by certain metallic categories. Provides for HHS-defined EHBs within at least 10 general, statutory categories. Specifies that such EHBs should be equal in scope to the benefits provided...
Amended by section 10104 of the Manager’s Amendment. Allows States to prohibit abortion coverage in Qualified Health Plans (QHPs) offered through Exchanges by enacting such a law and provides that subject to this, issuers of QHPs will determine whether plans provide coverage of abortion. If a QHP covers certain abortion services for which the use of federal funds is prohibited,...
Amended by section 10104 of the Manager’s Amendment. Defines the large market as the health insurance market under which individuals obtain health insurance coverage through a group health plan maintained by a large employer, defined as employing an average of at least 101 employees on business days during the preceding calendar year. Defines the small group market as applying to those...
Amended by section 10104 of the Manager’s Amendment. Appropriates funding to HHS by March 23, 2011, to award planning and establishment grants to States to assist with the creation of Exchanges – available through January 1, 2015 – and provides for renewability if certain parameters are met. Requires States to create an Exchange, including a Small Business Health Options Program...
Amended by section 10104 of the Manager’s Amendment. Permits qualified individuals, excluding incarcerated individuals and including only U.S. citizens or nationals or aliens who are lawfully present, to enroll in any available Qualified Health Plan (QHP) for which they are eligible. Specifies that qualified employers – generally defined as a small employer that elects to make all full-time employees of...
Amended by section 10104 of the Manager’s Amendment. Requires Exchanges to account for activities, receipts and expenditures, with annual reporting to HHS, and provides for HHS investigations and audits of Exchanges. Specifies protocol for rescissions of HHS payments for serious misconduct and allows HHS to implement approaches to reduce fraud and abuse. Includes provisions regarding the application of the False...
Requires HHS to issue regulations “as soon as practicable after the date of enactment” – consulting with the National Association of Insurance Commissioners – regarding the establishment and operation of Exchanges, including SHOP Exchanges, the offering of Qualified Health Plans through Exchanges and the establishment of the reinsurance and risk adjustment programs. Requires HHS to – directly or through agreement...
Amended by section 10104 of the Manager’s Amendment. Directs HHS to establish the Consumer Operated and Oriented Plan (CO-OP) program under which qualified nonprofit health insurance issuers – subject to specified criteria, excluding organizations that were health insurance issuers on July 16, 2009 – will offer Qualified Health Plans in the individual and small group markets. Provides for HHS to...
Stricken by section 10104 of the Manager’s Amendment.
Added by section 1204 of HCERA. Provides that territories electing to establish an Exchange will be treated as States for such purposes and entitled for Federal funding and that territories not making this election will be given an increase in the Federal dollar limitation for Medicaid funding. Specifies terms and conditions for territories electing to establish Exchanges and appropriates $1B...
Amended by section 10104 of the Manager’s Amendment. Provides that notwithstanding any other provision of law, any health insurance coverage offered by a private health insurance issuer shall not be subject to any Federal or State law described in this section – including such laws and regulations as guaranteed renewal, rating and solvency and financial requirements, among others – if...
Amended by section 10104 of the Manager’s Amendment. Directs HHS to establish a Basic Health Plan Program in which States may contract to offer 1 or more standard health plans offering essential health benefits to eligible individuals – those who are under age 65, are not eligible for Medicaid, generally have incomes between 133 and 200 percent of the Federal...
Allows States to apply to HHS for waivers of up to five years starting in plan years beginning in January 1, 2017, of ACA health insurance coverage requirements including Exchanges, Qualified Health Plans, cost-sharing reductions, advance premium tax credits, employer shared responsibility requirements and individual responsibility requirements. Provides for HHS to annually determine and provide via alternate means to the...
By July 1, 2013, requires HHS, in consultation with the National Association of Insurance Commissioners, to issue regulations for the creation of healthcare choice compacts under which States – beginning January 1, 2016 – may enter into an agreement to offer Qualified Health Plans in their individual markets but, with certain conditions, be subject only to the laws and regulations of...
Modified by section 10104 of the Manager’s Amendment. Directs the Office of Personnel Management (OPM) to contract with health insurance issuers, at least one of which is a non-profit, to offer at least 2 Multi-State Qualified Health Plans (QHPs) through each Exchange in each State in a manner similar to that under the Federal Employees Health Benefits Program contracting process....
Amended by section 10104 of the Manager’s Amendment. Requires States to implement a reinsurance program created under this section for the individual market under which an applicable reinsurance entity, which must be a non-profit, collects mandatory reinsurance payments from health insurance issuers, and third party administrators on behalf of group health plans during a 3-year period beginning on January 1, 2014,...
Requires HHS to establish and administer a risk corridor program for calendar years 2014, 2015 and 2016 providing payment adjustments to Qualified Health Plans offered in the individual or small group market based on the ratio of the allowable costs of the plan to the plan’s aggregate premiums. Enumerates a methodology under which participating plans receive payments from HHS if...
Requires States to assess a charge on health plans and health insurance issuers in the individual and small group market (except grandfathered plans) that have enrollees with below-average actuarial risk and make a payment to health plans and health insurance issuers with above-average-risk enrollees in the same year.
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