Sec. 10. Protection of consumers from excessive, unjustified, or unfairly discriminatory rates

833 words·~4 min read·/bill/116/hr/2463/ih/section-10

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

The first section 2794 of the Public Health Service Act ( 42 U.S.C. 300gg–94 ), as added by section 1003 of the Patient Protection and Affordable Care Act ( Public Law 111–148 ), is amended by adding at the end the following new subsection: Nothing in this section shall be construed to prohibit a State from imposing requirements (including requirements relating to rate review standards and procedures and information reporting) on health insurance issuers with respect to rates that are in addition to the requirements of this section and are more protective of consumers than such requirements.

In carrying out this section, the Secretary shall consult with the National Association of Insurance Commissioners and consumer groups. The Secretary shall determine, after the date of enactment of this subsection and periodically thereafter, the following: In which markets in each State the State insurance commissioner or relevant State regulator shall undertake the corrective actions under paragraph

(4), as a condition of the State receiving the grant in subsection (c), based on the Secretary’s determination that the State insurance commissioner or relevant State regulator is adequately undertaking and utilizing such actions in that market. In which markets in each State the Secretary shall undertake the corrective actions under paragraph

(4), in cooperation with the relevant State insurance commissioner or State regulator, based on the Secretary’s determination that the State is not adequately undertaking and utilizing such actions in that market. In accordance with the process established under this section, the Secretary or the relevant State insurance commissioner or State regulator shall take corrective actions to ensure that any excessive, unjustified, or unfairly discriminatory rates are corrected prior to implementation, or as soon as possible thereafter, through mechanisms such as— denying rates; modifying rates; or requiring rebates to consumers. Failure to comply with any corrective action taken by the Secretary under this subsection may result in the application of civil monetary penalties and, if the Secretary determines appropriate, make the plan involved ineligible for classification as a qualified health plan. . Such section is further amended— in subsection (a)— in the subsection heading, by striking and inserting premium ; rate in paragraph (1), by striking unreasonable increases in premiums and inserting potentially excessive, unjustified, or unfairly discriminatory rates, including premiums, ; and in paragraph (2)— by striking an unreasonable premium increase and inserting a potentially excessive, unjustified, or unfairly discriminatory rate ; by striking the increase and inserting the rate ; and by striking such increases and inserting such rates ; in subsection (b)— in the subsection heading, by striking and inserting Premium ; Rate by striking premium increases each place it appears and inserting rates ; in paragraph (1), in the paragraph heading, by striking and inserting Premium Increase ; and Rate in paragraph (2)— in the paragraph heading, by striking and inserting Premium Increases ; and Rates in subparagraph (B), by striking premium and inserting rate ; and in subsection (c)(1)— in the heading, by striking and inserting Premium ; Rate by inserting that satisfy the condition under subsection (e)(3)(A) after award grants to States ; and in subparagraph (A), by striking premium increases and inserting rates . Title XXVII of the Public Health Service Act ( 42 U.S.C. 300gg et seq.) is amended— in section 2723 ( 42 U.S.C. 300gg–22 )— in subsection (a)— in paragraph (1), by inserting and section 2794 (relating to the reasonableness of rates with respect to health insurance coverage) after this part ; and in paragraph (2), by inserting or such section 2794 after this part ; and in subsection (b)— in paragraph (1), by inserting and section 2794 (relating to the reasonableness of rates with respect to health insurance coverage) after this part ; and in paragraph (2)— in subparagraph (A), by inserting or such section 2794 that is after this part ; and in subparagraph (C)(ii), by inserting or such section 2794 after this part ; and in section 2761 ( 42 U.S.C. 300gg–61 )— in subsection (a)— in paragraph (1), by inserting and section 2794 (relating to the reasonableness of rates with respect to health insurance coverage) after this part ; and in paragraph (2)— by inserting or such section 2794 after set forth in this part ; and by inserting and such section 2794 after the requirements of this part ; and in subsection (b), by inserting and such section 2794 after this part . Section 1311(e)(2) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18031(e)(2) ) is amended by striking unjustified premium increases and inserting unjustified rates . Section 1251(a)(4)(A) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18011(a)(4)(A) ) is amended by adding at the end the following: Section 2794 (relating to reasonableness of rates with respect to health insurance coverage). . The amendments made by this section shall take effect on the date of enactment of this Act and shall be implemented with respect to health plans beginning not later than January 1, 2020.

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