§ 300gg. Fair health insurance premiums
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/usc/title-42/section-300ggA research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(a)11 So in original. No subsec.
(b)has been enacted. Prohibiting discriminatory premium rates
(1)In general With respect to the premium rate charged by a health insurance issuer for health insurance coverage offered in the individual or small group market—
(A)such rate shall vary with respect to the particular plan or coverage involved only by—
(i)whether such plan or coverage covers an individual or family;
(ii)rating area, as established in accordance with paragraph (2);
(iii)age, except that such rate shall not vary by more than 3 to 1 for adults (consistent with section 300gg–6(c) of this title); and
(iv)tobacco use, except that such rate shall not vary by more than 1.5 to 1; and
(B)such rate shall not vary with respect to the particular plan or coverage involved by any other factor not described in subparagraph (A).
(2)Rating area
(A)In general Each State shall establish 1 or more rating areas within that State for purposes of applying the requirements of this subchapter.
(B)Secretarial review The Secretary shall review the rating areas established by each State under subparagraph
(A)to ensure the adequacy of such areas for purposes of carrying out the requirements of this subchapter. If the Secretary determines a State’s rating areas are not adequate, or that a State does not establish such areas, the Secretary may establish rating areas for that State.
(3)Permissible age bands The Secretary, in consultation with the National Association of Insurance Commissioners, shall define the permissible age bands for rating purposes under paragraph (1)(A)(iii).
(4)Application of variations based on age or tobacco use With respect to family coverage under a group health plan or health insurance coverage, the rating variations permitted under clauses
(iii)and
(iv)of paragraph (1)(A) shall be applied based on the portion of the premium that is attributable to each family member covered under the plan or coverage.
(5)Special rule for large group market If a State permits health insurance issuers that offer coverage in the large group market in the State to offer such coverage through the State Exchange (as provided for under section 18032(f)(2)(B) of this title), the provisions of this subsection shall apply to all coverage offered in such market (other than self-insured group health plans offered in such market) in the State.
(July 1, 1944, ch. 373, title XXVII, § 2701, as added and amended Pub. L. 111–148, title I, § 1201(4), title X, § 10103(a), Mar. 23, 2010, 124 Stat. 155, 892.)
Connections786 cite this · traces to 6
Cited by 786 sections · top 60
U.S. Code
- § 1396aState plans for medical assistance
- § 1395mSpecial payment rules for particular items and services
- § 201Definitions
- § 300ggFair health insurance premiums
- § 18031Affordable choices of health benefit plans
- § 2000bbCongressional findings and declaration of purposes
- § 18022Essential health benefits requirements
- § 1397eePayments to States
- § 1108Exemptions from prohibited transactions
- § 1397ccCoverage requirements for children’s health insurance
- § 1320dDefinitions
- § 18021Qualified health plan defined
- § 1397jjDefinitions
- § 2101Short title
- § 18001Immediate access to insurance for uninsured individuals with a preexisting condition
- § 1395ssCertification of medicare supplemental health insurance policies
- § 1181Increased portability through limitation on preexisting condition exclusions
- § 18041State flexibility in operation and enforcement of Exchanges and related requirements
- § 1185aParity in mental health and substance use disorder benefits
- § 18011Preservation of right to maintain existing coverage
- § 300eRequirements of health maintenance organizations
- § 313Federal Insurance Office
- § 1320b–5Authority to waive requirements during national emergencies
- § 1395qCoverage period
- § 41Credit for increasing research activities
- § 18054Multi-State plans
- § 35Health insurance costs of eligible individuals
- § 9801Increased portability through limitation on preexisting condition exclusions
- § 9833Regulations
- § 18042Federal program to assist establishment and operation of nonprofit, member-run health insurance issuers
- § 1185dAdditional market reforms
- § 1395oEligible individuals
- § 1162Continuation coverage
- § 9812Parity in mental health and substance use disorder benefits
- § 1185ePreventing surprise medical bills
- § 5000ARequirement to maintain minimum essential coverage
- § 18003Immediate information that allows consumers to identify affordable coverage options
- § 4980BFailure to satisfy continuation coverage requirements of group health plans
- § 1110bTRICARE program: extension of dependent coverage
- § 1165Election
- § 833Treatment of Blue Cross and Blue Shield organizations, etc.
- § 1185fEnding surprise air ambulance bills
- § 9816Preventing surprise medical bills
- § 1397iiMiscellaneous provisions
- § 1191cRegulations
- § 18091Requirement to maintain minimum essential coverage; findings
- § 1185iProtecting patients and improving the accuracy of provider directory information
- § 300gg–41Guaranteed availability of individual health insurance coverage to certain individuals with prior group coverage
- § 9817Ending surprise air ambulance bills
- § 9819Maintenance of price comparison tool
- § 18014Treatment of expatriate health plans under ACA
- § 18111Definitions
- § 9818Continuity of care
- § 9823Air ambulance report requirements
- § 18012Rating reforms must apply uniformly to all health insurance issuers and group health plans
- § 45REmployee health insurance expenses of small employers
- § 9820Protecting patients and improving the accuracy of provider directory information
- § 18013Annual report on self-insured plans
Traces to 6 documents
27 references not yet in our index
- July 1, 1944, ch. 373
- Pub. L. 111–148, title I, § 1201(4)
- 124 Stat. 155
- act July 1, 1944, ch. 373, title XXVII, § 2701
- Pub. L. 104–191, title I, § 102(a)
- 110 Stat. 1955
- Pub. L. 111–3, title III, § 311(b)(2)
- 123 Stat. 70
- Pub. L. 111–5, div. B, title I, § 1899D(c)
- 123 Stat. 426
- Pub. L. 111–344, title I, § 114(c)
- 124 Stat. 3615
- Pub. L. 112–40, title II, § 242(a)(3)
- 125 Stat. 419
- Pub. L. 111–148, title I
- 124 Stat. 154
- Pub. L. 111–148, § 10103(a)
- Pub. L. 111–148, title I, § 1255
- 124 Stat. 162
- Pub. L. 111–148
- Pub. L. 104–191, title I, § 102(c)
- 110 Stat. 1976
- Pub. L. 104–191, title I, § 195
- 110 Stat. 1991
- Pub. L. 104–191, title I, § 191
- 110 Stat. 1987
- Pub. L. 104–191
Citation graph
cites case law
§ 300gg
Fair health insurance premiums
Bills×293
Fed. Reg.×241
U.S.C.×199
Stat.×29
Pub. L.×11
Stat. Comp.×11
C.F.R.×2
ActJuly 1, 1944, ch. 373
Pub. L.Pub. L. 111–148, title I, § 1201(4)
Stat.124 Stat. 155
Actact July 1, 1944, ch. 373, title XXVII, § 2701
Pub. L.Pub. L. 104–191, title I, § 102(a)
Cites 33 · showing 11Cited by 786 across 7 sources