Sec. 9. Protection of consumers from excessive, unjustified, or unfairly discriminatory rates
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/bill/118/s/4231/is/section-9·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Section 2794 of the Public Health Service Act ( 42 U.S.C. 300gg–94 ) 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), 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 described in subparagraph
(B)and, if the Secretary determines appropriate, make the plan involved ineligible for classification as a qualified health plan. The provisions of section 1128A of the Social Security Act, other than subsection
(a)and
(b)and the first sentence of subsection (c)(1) of such section, shall apply to civil monetary penalties under this paragraph in the same manner as such provisions apply to a penalty or proceeding under section 1128A of the Social Security Act. The provisions of subparagraph
(C)of section 2723(b)(2) shall apply to civil monetary penalties under this paragraph in the same manner as such provisions apply to a penalty under such section. . Section 2794 of the Public Health Service Act ( 42 U.S.C. 300gg–94 ) 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 ; and 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 subparagraph (B), by striking excessive or unjustified and inserting excessive, unjustified, or unfairly discriminatory ; and in paragraph (2)— in the paragraph heading, by striking and inserting Premium Increases ; and Rates in subparagraph (B), by striking premium and inserting rate . Section 1311(e)(2) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18031(e)(2) ) is amended by striking excessive or unjustified premium increases and inserting excessive, unjustified, or unfairly discriminatory rates . Section 1251(a)(5) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18011(a)(5) ) is amended— by striking Sections 2799A–1 and inserting the following: Sections 2799A–1 ; and by adding at the end the following: Section 2794 of the Public Health Service Act shall apply to grandfathered health plans for plan years beginning on or after January 1, 2025. . 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, 2025.
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- 42 USC 300gg–94
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Sec. 9
Protection of consumers from excessive, unjustified, or unfairly discriminatory rates
Cite42 USC 300gg–94
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