Sec. 2. Transitional coverage
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Part C of title XXVII of the Public Health Service Act ( 42 U.S.C. 300gg–91 et seq. ) is amended— by redesignating the second section 2794 (relating to uniform fraud and abuse referral format) as section 2795; and by adding at the end the following: A health insurance issuer shall provide, in accordance with this section, that each enrollee in a qualified health plan who would lose coverage under the plan, or who would no longer be eligible for a tax credit under section 36B of the Internal Revenue Code of 1986, as a result of a qualifying event is entitled, under the plan, to elect, within the election period, continuation coverage under the plan.
For purposes of this section, the term continuation coverage means coverage that meets the following requirements: The coverage must consist of that coverage which the enrollee was enrolled in at the time of the qualifying event, except that if such coverage is later modified under the plan for any group of similarly situated enrollees, such coverage shall also be modified in the same manner for all individuals to which this section applies. The health insurance issuer may require payment of a premium for such coverage for any period of the continuation coverage, except that such premium— shall not exceed 100 percent of the premium amount applicable for the qualified health plan involved on the day before the qualifying event; shall not increase at any time during the period of continuation coverage; and may, at the election of the enrollee, be paid in monthly installments.
For purposes of this section, the term qualifying event means, with respect to any enrollee in a qualified health plan, a determination by the Supreme Court of the United States in the case of King v. Burwell
(2015)that would result in— the enrollee losing coverage under the plan; or making the enrollee ineligible to receive a tax credit under section 36B of the Internal Revenue Code of 1986 with respect to such plan. Except as provided in paragraph (2), the continuation coverage provided for under this section shall extend for at least the period beginning on the date of the qualifying event and ending: The date that is 18 months after the date of the qualifying event. Notwithstanding paragraph (1), the continuation coverage provided for under this section shall terminate with respect to an enrollee on— the date on which the issuer ceases to provide any qualified health plans to individuals (if any); and the date on which coverage ceases under the plan by reason of a failure to make timely payment of any premium required under the plan with respect to the enrollee. For purposes of this section, the term election period means the period which— begins on the date on which the qualifying event occurs; and ends 60 days after such date. The Secretary shall ensure that— a health insurance issuer shall provide, not later than 10 days after the date of a qualifying event, written notice to each enrollee in a qualified health plan of the rights provided under this section and the deadlines for exercising such rights, including a statement that any continuation coverage under this section shall expire as provided for in subsection (c); and each enrollee in a qualified health plan is responsible for notifying the health insurance issuer involved, within 45 days of receiving the notice under paragraph (1), of the intent of the enrollee to exercise the rights provided to the enrollee under this section. .
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- 42 USC 300gg–91
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Sec. 2
Transitional coverage
Cite42 USC 300gg–91
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