Sec. 30308. Risk corridor program for self-insured group health plans and health insurance coverage offered in the large group market

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The Secretary of Health and Human Services (in this section referred to as the Secretary ), in coordination with the Secretary of Labor and the Secretary of the Treasury, shall establish and administer a program of risk corridors for plan years 2020 and 2021 under which the Secretary, in coordination with the Secretary of Labor and the Secretary of the Treasury, shall make payments in accordance with subsection

(b)to self-insured group health plans and health insurance issuers offering health insurance coverage in the large group market. The Secretary, in coordination with the Secretary of Labor and the Secretary of the Treasury, shall provide under the program established under subsection

(a)that if the allowable costs for a self-insured group health plan or health insurance coverage offered in the large group market for any plan year are more than 105 percent of the target amount, the Secretary shall pay to the plan, or issuer of such coverage, an amount equal to 75 percent of the allowable costs in excess of 105 percent of the target amount. The Secretary, the Secretary of Labor, and the Secretary of the Treasury may require self-insured group health plans and health insurance issuers of health insurance coverage offered in the large group market to report to the applicable Secretary, in a form, manner, and timeframe specified by the Secretaries, information necessary for purposes of carrying out this section in accordance with the process established under paragraph (2). The Secretary, the Secretary of Labor, and the Secretary of the Treasury shall jointly establish a process prescribing the form and manner under which information is collected from self-insured group health plans and health insurance issuers offering health insurance coverage in the large group market for purposes of carrying out this section. The amount of allowable costs of a self-insured group health plan or health insurance coverage offered in the large group market for any plan year is an amount equal to the total costs (other than administrative costs) of such plan or the issuer of such coverage in covering items and services furnished during such plan year under such plan or such coverage. Allowable costs of a self-insured group health plan or health insurance coverage offered in the large group market for a plan year shall be reduced by any— reinsurance payments received by such plan or coverage pursuant to a waiver approved under section 1332 of such Act ( 42 U.S.C. 18052 ) for such plan year; and other payments received by such plan or coverage (as specified by the Secretary) for such plan year. For purposes of this section, the terms excepted benefits , health insurance issuer , health insurance coverage , and large group market have the meanings given such terms in section 2791 of the Public Health Service Act ( 42 U.S.C. 300gg–91 ), section 733 of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1191b ), and section 9832 of the Internal Revenue Code of 1986, as applicable, and the term self-insured group health plan has the meaning given such term for purposes of section 2701(a)(5) of the Public Health Service Act ( 42 U.S.C. 300gg(a)(5) ). The target amount of— a self-insured group health plan for an applicable plan year is— in the case such plan was offered during the preceding plan year and was subject to the requirement of section 601(a) of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1161(a) ) during such preceding plan year, the expected cost to the plan for all individuals covered under such plan for such preceding plan year (without regard to whether such cost is paid by the employer or employee), taking into account applicable premiums (as defined in section 604(a) of such Act ( 29 U.S.C. 1164(1) )) for such plan and preceding plan year, reduced by any administrative costs for such preceding plan year and increased by 5 percent; or in the case such plan is not described in subclause (I), the expected cost to the plan for all individuals covered under such plan for such applicable plan year (as determined under a methodology specified by the Secretary), reduced by any administrative costs for such plan year; and health insurance coverage offered in the large group market for an applicable plan year is an amount equal to the total premiums (including any premium subsidies under any governmental program), as defined by the Secretary, for such plan year, reduced by the administrative costs of the coverage for such plan year. The term applicable plan year means plan year 2020 or plan year 2021, as applicable. The provisions of subsection

(c)shall be applied by the Secretary of Health and Human Services, the Secretary of Labor, and the Secretary of the Treasury to group health plans and health insurance issuers offering health insurance coverage in the large group market as if such subsection were included in the provisions of part A of title XXVII of the Public Health Service Act ( 42 U.S.C. 300gg et seq.), part 7 of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1181 et seq.), and subchapter B of chapter 100 of the Internal Revenue Code of 1986, as applicable. Payments made under this section with respect to an applicable plan year to a self-insured group health plan or health insurance issuer offering health insurance coverage in the large group market shall for purposes of section 2718(b) of the Public Health Service Act ( 42 U.S.C. 300gg–18(b) ) be included in the calculation of the premium revenue with respect to such plan or issuer, respectively, and year. The provisions of this section shall not apply with respect to— any group health plan or group or individual health insurance coverage in relation to its provision of excepted benefits; or a grandfathered health plan, as defined in section 1251(e) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18011(e) ). The Secretary, the Secretary of Labor, and the Secretary of the Treasury may implement the provisions of this section by subregulatory guidance, program instruction, or otherwise. There are appropriated, out of any monies in the Treasury not otherwise appropriated, such sums as may be necessary to carry out this section.

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