Sec. 121. Limiting application of requirements to consumer protections

2,222 words·~10 min read·/bill/114/s/2985/is/section-121

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

Notwithstanding any other provision of law, with respect to group health plans and health insurance coverage whether or not offered through an Exchange, except as provided in paragraphs

(2)and (3), the provisions of title XXVII of the Public Health Service Act ( 42 U.S.C. 300gg et seq. ) as in effect before the date of the enactment of PPACA shall apply instead of the provisions of such title as in effect after such date. The following sections of the Public Health Service Act, that were added or amended by subtitles A and C of title I of PPACA, shall continue to apply to group health plans and to health insurance coverage offered in the individual and group market: Section 2711 (relating to no lifetime or annual limits), except in the case of limited benefit insurance (as defined in section 122(b)). Section 2714 (relating to extension of dependent coverage). Section 2702 (relating to guaranteed availability of coverage), subject to paragraph

(3)and subsection (c). Section 2703 (relating to guaranteed renewability of coverage). Section 2704 (relating to prohibition on preexisting conditions). Section 2705 (relating to prohibiting discrimination against individual participants and beneficiaries based on health status), subject to subsection (c). Section 2706 (relating to non-discrimination in health care). In the case of an individual who seeks to enroll in health insurance coverage and who, as of the effective date of such enrollment, does not have a continuous period of at least 12-months of creditable coverage, there shall be imposed a late enrollment penalty in the form of an increase in the monthly premiums for coverage of under the plan of 20 percent of the monthly premium otherwise determined for each consecutive full 12-month period (ending before such effective date) in which the individual was not enrolled in creditable coverage. Such increase shall apply during a period, to be specified under regulations of the Secretary but in no case longer than 3 times the length of the most recent period in which the individual did not have continuous coverage. A State may apply to the Secretary for a waiver of the provisions of subparagraph

(A)and the application of alternative provisions providing incentives for State residents to enroll in creditable coverage and maintain continuous creditable coverage. The Secretary shall approve such waiver if the Secretary determines that the alternative provisions provide similar or greater incentives for such enrollment than the incentives otherwise applicable. In applying this subsection, the provisions described in paragraph

(2)shall be treated as if they were included in title XXVII of the Public Health Service Act, as in effect on the day before the date of enactment of PPACA, and, with respect to group health plans and health insurance coverage offered in connection with such plans, in part 7 of subtitle B of title I of the Employee Retirement and Income Security Act of 1974 ( 29 U.S.C. 181 et seq. ), and, with respect to group health plans, in chapter 100 of the Internal Revenue Code of 1986 as follows: The provisions described in paragraphs (2)(A) and (2)(B) shall be treated as included— with respect to group health plans (and health insurance coverage offered with respect to such plans), under subpart 2 of part A of title XXVII of the Public Health Service Act and subpart B of part 7 of subtitle B of title I of the Employee Retirement and Income Security Act of 1974; with respect to group health plans, under subchapter B of chapter 100 of the Internal Revenue Code of 1986; and with respect to individual health insurance coverage, under subpart 2 of part B of title XXVII of the Public Health Service Act. The provision described in paragraph

(2)(other than in subparagraph

(A)or

(B)of such paragraph) shall be treated as included— with respect to group health plans (and health insurance coverage offered with respect to such plans), under subpart 1 of part A of title XXVII of the Public Health Service Act and subpart A of part 7 of subtitle B of title I of the Employee Retirement and Income Security Act of 1974; also with respect to group health plans, under subchapter A of chapter 100 of the Internal Revenue Code of 1986; and with respect to individual health insurance coverage, under subpart 1 of part B of title XXVII of the Public Health Service Act. In the case described in paragraph

(1)where there is a conflict between a provision described in paragraph

(2)and a provision of law described in paragraph (1), the provision described in paragraph

(2)shall control and the Secretary, in consultation with the Secretary of the Treasury and the Secretary of Labor, shall establish such rules as may be necessary to carry out this subparagraph. Section 715 of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1185d ) is amended— in subsection (a), by striking subsection

(b)and inserting subsections

(b)and

(b)and inserting subsections

(b)and

(c); and by adding at the end the following new subsection: Pursuant to section 121 of the World’s Greatest Healthcare Plan Act of 2016 , the provisions of part A of title XXVII of the Public Health Service Act referred to in subsection (a), other than those provisions specified in section 121(a)(2) of the World’s Greatest Healthcare Plan Act of 2016 , shall not apply to plans described in subsection (a). . With respect to health insurance coverage offered in a State, the State may, in consultation with the Secretary, take such steps, such as limiting the availability of general open enrollment periods, imposing delays in the effectiveness for coverage, permitting differentials in premiums based on age and other factors, as the State determines necessary in order to ensure an orderly market for health insurance coverage in the State that is not offered through an Exchange. Such steps may include the establishment of such initial open enrollment period during which qualified residents may enroll in health insurance coverage without the imposition of any underwriting as the State determines to be appropriate in ensuring initial access to such coverage. Nothing in this section shall be construed as preventing a State from continuing to apply, to health insurance coverage issued in the State, requirements under the provisions of title XXVII of the Public Health Service Act (as amended by subtitles A and C of title I of PPACA) that are not continued under subsection (a). A State may waive such provisions of part 2 of subtitle D of title I of PPACA, in relation to the establishment of an Exchange in such State, as the State determines appropriate in order for the State to implement and administer a market-based system for the availability of health insurance coverage throughout the State. Subject to subparagraph (D), a State may elect to provide for the enrollment of residents of the State who are uninsured in default health insurance coverage (as defined in subparagraph (B)) and establishing a Roth HSA for such residents who do not have a Roth HSA unless the resident has affirmatively elected not to be so enrolled and not to have such an account. respectively. If a State makes such an election, the State shall permit eligible residents to enroll in such coverage on a continuous basis. In this paragraph, the term default health insurance coverage means, with respect to a State, health insurance coverage that— is a high deductible health plan (within the meaning of section 223(c)(2) of the Internal Revenue Code of 1986) with prescription drug coverage limited to generic drugs for a limited number of chronic conditions (commonly referred to as tier I pharmacy benefit); meets such requirements as may apply to qualify for the payment of plan premiums from a health savings account under section 223 of such Code (such as age-related premiums and limitation on imposition of preexisting condition exclusions); has a provider network for covered benefits that is adequate (as determined consistent with guidelines issued by the Secretary) to ensure access to health benefits under such plan; provides for coverage of childhood immunizations without cost sharing requirements to the extent such immunizations have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved; and meets such other requirements as the State may specify. In this paragraph, the term Roth HSA shall have the meaning given such term by section 530A(c) of the Internal Revenue Code of 1986. As a condition of a State providing for the enrollment function described in subparagraph (A), the State shall establish an easy-to-use and transparent means by which individuals may elect not to be enrolled in default health insurance coverage or to have a Roth HSA established on the individual’s behalf, or both. Notwithstanding any other provision of law, no health benefits plan shall be required by reason of Federal law to comply with the requirements of sections 1301(a)(1)(B) and 1302 of PPACA ( 42 U.S.C. 18021(a)(1)(B) , 18022). Nothing in this subsection shall be construed as preventing a State from applying, at its option with respect to health insurance coverage offered through an Exchange or otherwise in the State, the requirements referred to in paragraph (1). Subsections (a), (b), and

(c)shall apply to plan years beginning after the date of the enactment of this Act. No contribution shall be required under section 1341 of PPACA ( 42 U.S.C. 18061 ) from any group health plan or health insurance issuer for portions of plans years occurring in months beginning more than 30 days after the date of the enactment of this Act. The Secretary of Health and Human Services, in coordination with the Secretary of Labor and the Secretary of the Treasury, shall provide such guidance as may be necessary for the coordinated implementation of this section on a timely basis. In the case of an individual who is covered under health insurance coverage or as a beneficiary or participant in a group health plan (as such terms are defined in section 2791 of the Public Health Service Act), if such coverage is ended and the individual obtains other health insurance coverage, group health plan coverage, or other creditable coverage (as defined for purposes of title XXVII of such Act), the issuer of the prior coverage or administrator of the prior plan shall forward information respecting such prior coverage to the issuer of the new coverage or administrator of the new plan or coverage, as the case may be, subject to such rules as the Secretary establishes regarding the right of the beneficiary or participant to object to such forwarding of information. The requirement of paragraph

(1)shall apply as if it were included in part A of title XXVII of the Public Health Service Act, including for purposes of applying section 715 of the Employee Retirement Income Security Act of 1976 ( 29 U.S.C. 1185d ) and section 9815 of the Internal Revenue Code of 1986. Any issuer that offers health insurance coverage in the individual market in any of the 50 States or the District of Columbia shall participate in a risk adjustment mechanism under this subsection with respect to any health insurance coverage it so offers in such market, whether or not such coverage is offered through an Exchange. The Secretary shall, in consultation with the National Association of Insurance Commissioners and other interested parties, develop a mechanism to permit the adjustment of risk among health insurance coverage offered in the individual market throughout the 50 States and the District of Columbia. Such mechanism shall be designed to effect the same type of risk adjustment among such coverage that is applicable to risk adjustment of payments among Medicare Advantage organizations under part C of title XVIII of the Social Security Act ( 42 U.S.C. 1395w–21 et seq. ). The mechanism developed under paragraph

(2)shall provide for transitional protection, over a 3-year period, in the case of health insurance coverage that has not been previously marketed. The Secretary shall request the National Association of Insurance Commissioners to develop a permanent model for adjustment of risk among health insurance issuers with respect to health insurance coverage offered in the individual market, with the intention that such a model would substitute for the mechanism developed under paragraph (2). The requirement of paragraph

Connectionstraces to 5

Traces to 5 documents

U.S. Code

1 reference not yet in our index

42 USC 1395w–21

Citation graph

cites case law

Sec. 121

Limiting application of requirements to consumer protections

Cite42 USC 1395w–21

Cites 6Cited by 0 across 0 sources