Sec. 205. Improve Marketplace stability to prevent sabotage from raising premiums
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/bill/115/hr/5155/ih/section-205·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
There is hereby established the National Reinsurance Program Fund to be administered by the Secretary of Health and Human Services for purposes of carrying out a national reinsurance program to make reinsurance payments, in accordance with this section. There is hereby appropriated to the Fund established under paragraph (1), out of any funds in the Treasury not otherwise appropriated, such sums as are necessary for carrying out the purpose described in such paragraph. The Secretary of Health and Human Services shall use amounts available in the Fund to establish a national reinsurance program under which the Secretary makes reinsurance payments to health insurance issuers with respect to claims for individuals enrolled under qualifying reinsurance plans offered by such issuers for plan year 2019 or a subsequent plan year that exceed, subject to paragraph (2), $50,000 in an amount equal to 75 percent of the amount of such claims, but not to exceed $1,000,000.
For plan year 2020 or subsequent plan year, in lieu of each dollar amount specified in paragraph (1), each such dollar amount applied under this subsection for such plan year shall be the dollar amount applied under this subsection for the previous year, increased by the annual percentage increase in the Consumer Price Index for All Urban Consumers (all items; United States city average as of June of the previous fiscal year). Payments under this subsection shall be based on such a method as the Secretary determines.
The Secretary may establish a payment method by which interim payments of amounts under this subsection are made during a plan year based on the Secretary’s best estimate of amounts that will be payable after obtaining all of necessary information. For purposes of this section, the term qualifying reinsurance plan means, with respect to a health insurance issuer a qualified health plan (as defined in section 1301 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18021 )) offered by such issuer on the individual market.
Such term does not include a grandfathered health plan (as defined in section 1251 of such Act ( 42 U.S.C. 18011 )), transitional health plan, or a standard health plan offered in connection with a basic health program established under section 1331 of such Act ( 42 U.S.C. 18051 ). For purposes of paragraph (1), the term transitional health plan means a plan continued under the letter issued by the Centers for Medicare & Medicaid Services on November 14, 2013, to the State Insurance Commissioners outlining a transitional policy for coverage in the individual and small group markets to which section 1251 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18011 ) does not apply, and under the extension of the transitional policy for such coverage set forth in the Insurance Standards Bulletin Series guidance issued by the Centers for Medicare & Medicaid Services on March 5, 2014, February 29, 2016, and February 13, 2017, or under any subsequent extensions thereof.
The Secretary shall make adjustments to the risk adjustment program operated under section 1343 of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18063 ), as appropriate, to account for the effects of this section on the actuarial risk of enrollees.
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Sec. 205
Improve Marketplace stability to prevent sabotage from raising premiums
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