Sec. 612. Health plan finders
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Not later than 12 months after the date of the enactment of this Act, each State may contract with a private entity to develop and operate a plan finder website (referred to in this section as a State plan finder ) which shall provide information to individuals in such State on plans of health insurance coverage that are available to individuals in such State (in this section referred to as a health insurance plan ). Such State may not operate a plan finder itself. A private entity may operate a multi-State finder that operates under this section in the States involved in the same manner as a State plan finder would operate in a single State.
States shall regulate the manner in which data is shared between plan finders to ensure consistency and accuracy in the information about health insurance plans contained in such finders. Each plan finder shall meet the following requirements: The plan finder shall ensure that each health insurance plan in the plan finder meets the requirements for such plans under subsection (d). The plan finder shall present complete information on the costs and benefits of health insurance plans (including information on monthly premium, copayments, and deductibles) in a uniform manner that— uses the standard definitions developed under paragraph (3); and is designed to allow consumers to easily compare such plans.
The plan finder shall be available on the Internet and accessible to all individuals in the State or, in the case of a multi-State plan finder, in all States covered by the multi-State plan finder. The plan finder shall allow consumers to search and sort data on the health insurance plans in the plan finder on criteria such as coverage of specific benefits (such as coverage of disease management services or pediatric care services), as well as data available on quality. The plan finder shall meet all relevant State laws and regulations, including laws and regulations related to the marketing of insurance products.
In the case of a multi-State plan finder, the finder shall meet such laws and regulations for all of the States involved. The plan finder shall meet solvency, financial, and privacy requirements established by the State or States in which the plan finder operates or the Secretary for multi-State finders. The plan finder and the employees of the plan finder shall be appropriately licensed in the State or States in which the plan finder operates, if such licensure is required by such State or States.
Notwithstanding subsection (f)(1), the plan finder shall assist individuals who are eligible for the Medicaid program under title XIX of the Social Security Act or State Children’s Health Insurance Program under title XXI of such Act by including information on Medicaid options, eligibility, and how to enroll. Each State shall ensure that health insurance plans participating in the State plan finder or in a multi-State plan finder meet the requirements of paragraph
(2)(relating to adequacy of insurance coverage, consumer protection, and financial strength). In order to participate in a plan finder, a health insurance plan must meet all of the following requirements, as determined by each State in which such plan operates: The health insurance plan shall be actuarially sound. The health insurance plan may not have a history of abusive policy rescissions. The health insurance plan shall meet financial and solvency requirements. The health insurance plan shall disclose— all financial arrangements involving the sale and purchase of health insurance, such as the payment of fees and commissions; and such arrangements may not be abusive. The health insurance plan shall maintain electronic health records that comply with the requirements of the American Recovery and Reinvestment Act of 2009 ( Public Law 111–5 ) related to electronic health records. The health insurance plan shall make available to plan enrollees via the finder, whether by information provided to the finder or by a website link directing the enrollee from the finder to the health insurance plan website, data that includes the price and cost to the individual of services offered by a provider according to the terms and conditions of the health plan. Data described in this paragraph is not made public by the finder, only made available to the individual once enrolled in the health plan. The State plan finder may not directly enroll individuals in health insurance plans. A health insurance issuer offering a health insurance plan through a plan finder may not— be the private entity developing and maintaining a plan finder under subsections
(a)and (b); or have an ownership interest in such private entity or in the plan finder. An individual employed by a health insurance issuer offering a health insurance plan through a plan finder may not serve as a director or officer for— the private entity developing and maintaining a plan finder under subsections
(a)and (b); or the plan finder. Nothing in this section shall be construed to allow the Secretary authority to regulate benefit packages or to prohibit health insurance brokers and agents from— utilizing the plan finder for any purpose; or marketing or offering health insurance products. For purposes of this section, the term plan finder means a State plan finder under subsection
(a)or a multi-State plan finder under subsection (b). In this section, the term State has the meaning given such term for purposes of title XIX of the Social Security Act.
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- Pub. L. 111-5
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Sec. 612
Health plan finders
Pub. L.Pub. L. 111-5
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