§ 18063. Risk adjustment
491 words·~2 min read·
/usc/title-42/section-18063A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(a)In general
(1)Low actuarial risk plans Using the criteria and methods developed under subsection (b), each State shall assess a charge on health plans and health insurance issuers (with respect to health insurance coverage) described in subsection
(c)if the actuarial risk of the enrollees of such plans or coverage for a year is less than the average actuarial risk of all enrollees in all plans or coverage in such State for such year that are not self-insured group health plans (which are subject to the provisions of the Employee Retirement Income Security Act of 1974 [29 U.S.C. 1001 et seq.]).
(2)High actuarial risk plans Using the criteria and methods developed under subsection (b), each State shall provide a payment to health plans and health insurance issuers (with respect to health insurance coverage) described in subsection
(c)if the actuarial risk of the enrollees of such plans or coverage for a year is greater than the average actuarial risk of all enrollees in all plans and coverage in such State for such year that are not self-insured group health plans (which are subject to the provisions of the Employee Retirement Income Security Act of 1974).
(b)Criteria and methods The Secretary, in consultation with States, shall establish criteria and methods to be used in carrying out the risk adjustment activities under this section. The Secretary may utilize criteria and methods similar to the criteria and methods utilized under part C or D of title XVIII of the Social Security Act [42 U.S.C. 1395w–21 et seq., 1395w–101 et seq.]. Such criteria and methods shall be included in the standards and requirements the Secretary prescribes under section 18041 of this title.
(c)Scope A health plan or a health insurance issuer is described in this subsection if such health plan or health insurance issuer provides coverage in the individual or small group market within the State. This subsection shall not apply to a grandfathered health plan or the issuer of a grandfathered health plan with respect to that plan.
(Pub. L. 111–148, title I, § 1343, Mar. 23, 2010, 124 Stat. 212.)
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- NoticesDEPARTMENT OF HEALTH AND HUMAN SERVICES
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- Presidential DocumentsIntroduction to the Regulatory Plan and the Unified Agenda of Federal Regulatory and Deregulatory Actions
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statute-compilations
bill
- Sec. 2Protection of certain health insurance disclosures
- Sec. 2Disclosure of health insurance information to consumers
- Sec. 2Sunsetting funding under sections 1341 and 1342, and repealing section 1343, of PPACA
- Sec. 2Special Inspector General for Monitoring the Affordable Care Act
- Sec. 2Shift in the collection of the payment for the transitional reinsurance program
- Sec. 2Shift in the collection of the payment for the transitional reinsurance program
- Sec. 2Special Inspector General for Monitoring the Affordable Care Act
- Sec. 3Special Inspector General for Monitoring the Affordable Care Act
- Sec. 2Establishment and administration of a public health plan
- Sec. 205Improve Marketplace stability to prevent sabotage from raising premiums
- Sec. 3Reinsurance
- Sec. 3Reinsurance
- Sec. 30307Risk corridor program for health insurance coverage offered in the individual or small group market
- Sec. 30307Risk corridor program for health insurance coverage offered in the individual or small group market
- Sec. 4Reinsurance
- Sec. 30602Establishing a health insurance affordability fund
- Sec. 4Reinsurance
- Sec. 4Reinsurance
- Sec. 4Reinsurance
6 references not yet in our index
- Pub. L. 111–148, title I, § 1343
- 124 Stat. 212
- Pub. L. 93–406
- 88 Stat. 829
- act Aug. 14, 1935, ch. 531
- 49 Stat. 620
Citation graph
cites case law
§ 18063
Risk adjustment
Fed. Reg.×31
Bills×19
Stat. Comp.×1
Stat.×1
Pub. L.Pub. L. 111–148, title I, § 1343
Stat.124 Stat. 212
Pub. L.Pub. L. 93–406
Stat.88 Stat. 829
Actact Aug. 14, 1935, ch. 531
Cites 10 · showing 9Cited by 52 across 4 sources