,i #aac? ,,congress #a/ ,session ,h4 ,r4 #bafe ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,may #bc1 #bjac ,mr4 ,heck ( ,nevada 7= himself & ,mr4 ,fitzpatrick7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce1 & 9 addition to ! ,committees on ,education & ! ,work=ce1 ,ways & ,means1 & ! ,judici>y1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,a ,,bill ,to am5d ! ,public ,heal? ,s]vice ,act to provide individual & gr\p m>ket re=ms to protect heal? insurance consum]s1 to make su* re=ms & protections cont+5t on ! enactm5t ( legislation repeal+ ! ,pati5t ,protection & ,af=dable ,c>e ,act1 & = o!r purposes4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,ensur+ ,quality ,heal? ,c>e = ,all ,am]icans ,act ( #bjac4 7b7 ,table ( cont5ts ,! table ( cont5ts = ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4 ,sec4 #b4 ,effective date cont+5t on repeal ( ,,ppaca4 ,sec4 #c4 ,prohibit+ discrim9ation bas$ on heal? /atus4 ,sec4 #d4 ,gu>ante$ r5ewability ( cov]age4 ,sec4 #e4 ,prohibition ( preexi/+ condition exclusions & o!r discrim9ation bas$ on heal? /atus4 ,sec4 #f4 ,no lifetime or annual limits4 ,sec4 #g4 ,prohibition on rescissions4 ,sec4 #h4 ,ext5sion ( dep5d5t cov]age4 ,sec4 #i4 ,application ( gr\p m>ket re=ms to ,,erisa & ! ,int]nal ,rev5ue ,code ( #aihf4 ,sec4 #aj4 ,cata/rophic plan4 ,sec4 #aa4 ,grants = heal? insurance risk adju/m5t me*anisms4 ,sec4 #ab4 ,liability protections = heal? c>e provid]s4 #b4 ,effective date cont+5t on repeal ( ,,ppaca 7a7 ,9 g5]al ,?is ,act & ! am5dm5ts made by ?is ,act %all take effect ^u ! enactm5t ( ,,ppaca repeal legislation describ$ 9 subsection 7b7 & ?is ,act & ! am5dm5ts made by ?is ,act %all h no =ce or effect if su* ,,ppaca repeal legislation is n enact$4 7b7 ,,ppaca repeal legislation describ$ ,= purposes ( subsection 7a71 ,,ppaca repeal legislation describ$ 9 ?is subsection is legislation t-- 7#a7 repeals ,public ,law #aaa-adh1 & re/ores or revives ! provisions ( law am5d$ or repeal$1 respectively1 by su* ,act z if su* ,act _h n be5 enact$ & )\t fur!r am5dm5t to su* provisions ( law2 & 7#b7 repeals title ,i & subtitle ,b ( title ,,ii ( ! ,heal? ,c>e & ,education ,reconciliation ,act ( #bjaj 7,public ,law #aaa-aeb71 & re/ores or revives ! provisions ( law am5d$ or repeal$1 respectively1 by su* title or subtitle1 respectively1 z if su* title & subtitle _h n be5 enact$ & )\t fur!r am5dm5t to su* provisions ( law4 #c4 ,prohibit+ discrim9ation bas$ on heal? /atus 7a7 ,gr\p m>ket ,subp>t #c ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act is am5d$ by /rik+ section #bgaa ( su* ,act 7#db ,u4,s4,c4 #cjj;gg-#aa7 & ins]t+ ! foll[+3 #bgaa4 ,gu>ante$ availability ( cov]age 7a7 ,gu>ante$ issuance ( cov]age 9 ! gr\p m>ket 7#a7 ,9 g5]al ,subject to subsections 7b7 ?r\gh 7e71 ea* heal? insurance issu] t (f]s heal? insurance cov]age 9 ! gr\p m>ket 9 a ,/ate %all accept e employ] & e individual 9 a gr\p 9 ! ,/ate t applies = su* cov]age4 7#b7 ,special rule = associations ,an association %all be treat$ z an employ] = purposes ( ?is section if su* association seeks to provide gr\p heal? insurance cov]age to n less ?an #bjj qualifi$ individuals4 7b7 ,enrollm5t 7#a7 ,re/riction ,a heal? insurance issu] describ$ 9 subsection 7a7 may re/rict enrollm5t 9 cov]age describ$ 9 su* subsection to op5 or special enrollm5t p]iods4 7#b7 ,e/abli%m5t ,a heal? insurance issu] describ$ 9 subsection 7a7 %all1 9 accordance ) ! regulations promulgat$ "u p>agraph 7#c71 e/abli% special enrollm5t p]iods = qualify+ ev5ts 7z su* t]m is def9$ 9 section #fjc ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd74 7#c7 ,special rules = associations 7,a7 ,qualify+ ev5ts ,= purposes ( apply+ p>agraph 7#b7 to an association-- 7i7 ! t]m cov]$ employee 9 section #fjc ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd %all include a qualifi$ individual 7z su* t]m is def9$ 9 section #bgja7;d77#b77;,d772 7ii7 ! t]m employ] %all include an association 7z su* t]m is def9$ 9 section #bgja7;d77#b77;,a772 & 7iii7 ! t]m t]m9ation 7o!r ?an by reason ( su* employee's gross misconduct71 or r$uction ( h\rs1 ( ! cov]$ employee's employm5t %all include ! t]m9ation ( memb]%ip to ! association4 7,b7 ,enrollm5t ,) respect to heal? insurance cov]age provid$ to an association "u subsection 7a77#b71 a heal? insurance issu] %all p]mit a qualifi$ individual :o is eligible1 b n enroll$ 7or a dep5d5t ( su* individual if ! dep5d5t is eligible1 b n enroll$7 = su* cov]age to enroll = cov]age "u ! t]ms ( su* cov]age :5 any "o ( ! foll[+ ev5ts occur3 7i7 ,new memb]s & employees ,a qualifi$ individual1 & any dep5d5t ( su* individual1 may enroll dur+ ! #cj-;day p]iod foll[+ ! end ( ! p]iod describ$ "u section #bgja7;d77#b77;,d7 t applies to su* individual4 7ii7 ,annual enrollm5t ,a qualifi$ individual1 & any dep5d5t ( su* individual1 may enroll dur+ ! annual enrollm5t p]iod e/abli%$ "u ! t]ms ( ! cov]age 7,c7 ,t]m9ation ( enrollm5t ,) respect to gr\p heal? insurance cov]age provid$ by an association1 a qualifi$ individual or dep5d5t :o t]m9ates enrollm5t 9 su* cov]age may only re-enroll 9 su* cov]age dur+ ! annual enrollm5t p]iod describ$ "u subp>agraph 7,b77ii74 7,d7 ,def9itions ,= purposes ( ?is section1 ! t]ms association & qualifi$ individual h ! mean+ giv5 su* t]ms 9 section #bgja7;d77#b74 7#d7 ,regulations ,! ,secret>y %all promulgate regulations ) respect to enrollm5t p]iods "u ?is subsection4 7c7 ,special ,rules = ,network ,plans 7#a7 ,9 g5]al ,9 ! case ( a heal? insurance issu] t (f]s heal? insurance cov]age 9 ! gr\p m>ket 9 a ,/ate ?r\gh a network plan1 ! issu] may-- 7,a7 limit ! employ]s t may apply = su* cov]age to ^? ) eligible individuals :o live1 "w1 or reside 9 ! s]vice area = su* network plan2 & 7,b7 )9 ! s]vice area ( su* plan1 d5y su* cov]age to su* employ]s if ! issu] has demon/rat$1 if requir$1 to ! applicable ,/ate au?ority t-- 7i7 x w n h ! capacity to deliv] s]vices adequately to enrollees ( any additional gr\ps because ( its obligations to exi/+ gr\p contract hold]s & enrollees2 & 7ii7 x is apply+ ?is p>agraph uni=mly to all employ]s )\t reg>d to-- 7,i7 ! claims exp]i5ce ( ^? employ]s & _! employees 7& _! dep5d5ts72 or 7,,ii7 any heal?-/atus-relat$ factor relat+ to su* employees & dep5d5ts4 7#b7 #ahj-;day susp5sion ^u d5ial ( cov]age ,an issu]1 ^u d5y+ heal? insurance cov]age 9 any s]vice area 9 accordance ) p>agraph 7#a77;,b71 may n (f] cov]age 9 ! gr\p m>ket )9 su* s]vice area = a p]iod ( #ahj days aft] ! date su* cov]age is d5i$4 7d7 ,application ( ,f9ancial ,capacity ,limits 7#a7 ,9 g5]al ,a heal? insurance issu] may d5y heal? insurance cov]age 9 ! gr\p if ! issu] has demon/rat$1 if requir$1 to ! applicable ,/ate au?ority t-- 7,a7 x does n h ! f9ancial res]ves necess>y to und]write additional cov]age2 & 7,b7 x is apply+ ?is p>agraph uni=mly to all employ]s & individuals 9 ! gr\p m>ket 9 ! ,/ate-- 7i7 9 a mann] t is consi/5t ) applicable ,/ate law2 & 7ii7 )\t reg>d to-- 7,i7 ! claims exp]i5ce ( ^? individuals1 employ]s1 & _! employees 7& _! dep5d5ts72 or 7,,ii7 any heal?-/atus-relat$ factor relat+ to su* individuals1 employees1 & dep5d5ts4 7#b7 #ahj-;day susp5sion ^u d5ial ( cov]age ,a heal? insurance issu] ^u d5y+ heal? insurance cov]age 9 connection ) gr\p heal? plans 9 accordance ) p>agraph 7#a7 9 a ,/ate may n (f] cov]age 9 connection ) gr\p heal? plans 9 ! gr\p m>ket 9 ! ,/ate = a p]iod ( #ahj days aft] ! date su* cov]age is d5i$ or until ! issu] has demon/rat$ to ! applicable ,/ate au?ority1 if requir$ "u applicable ,/ate law1 t ! issu] has suffici5t f9ancial res]ves to und]write additional cov]age1 :i*ev] is lat]4 ,an applicable ,/ate au?ority may provide = ! application ( ?is subsection on a s]vice-area-specific basis4 4 7b7 ,individual m>ket ,subp>t #a ( "p ,b ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act is am5d$ by /rik+ section #bgda ( su* ,act 7#db ,u4,s4,c4 #cjj;gg-#da7 & ins]t+ ! foll[+3 #bgda4 ,gu>ante$ availability ( cov]age ,! provisions ( section #bgaa 7o!r ?an subsection 7a77#b7 & subsection 7b77#c77 %all apply to heal? insurance cov]age (f]$ to individuals by a heal? insurance issu] 9 ! individual m>ket 9 ! same mann] z su* provisions apply to heal? insurance cov]age (f]$ to employ]s by a heal? insurance issu] 9 connection ) heal? insurance cov]age 9 ! gr\p m>ket4 ,= purposes ( ?is section1 ! ,secret>y %all treat any ref]5ce ( ! ^w employ] 9 su* section z a ref]5ce to ! t]m individual4 4 #d4 ,gu>ante$ r5ewability ( cov]age ,section #bgab ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ab7 is am5d$-- 7#a7 9 subsection 7a7-- 7,a7 by ins]t+ 1 includ+ cov]age (f]$ be=e 9 connection ) a gr\p heal? plan2 & 7,b7 by ins]t+ employ] or o!r be=e plan sponsor ( ! plan2 7#b7 9 subsection 7b7-- 7,a7 9 ! matt] be=e p>agraph 7#a71 by /rik+ heal? insurance cov]age 9 connection ) a gr\p heal? plan 9 ! small or l>ge gr\p m>ket & ins]t su* heal? insurance cov]age2 & 7,b7 9 p>agraph 7#f7 by /rik+ "o or m bona fide associations & ins]t+ "o or m associations 7z su* t]m is def9$ 9 section #bgja7;d77#b77;,a772 7#c7 9 subsection 7c77#a77;,b71 by /rik+ to a gr\p heal? plan2 7#d7 9 subsection 7d7-- 7,a7 9 matt] be=e p>agraph 7#a71 by /rik+ to a gr\p heal? plan2 & 7,b7 9 p>agraph 7#b71 by /rik+ bona fide associations & ins]t+ associations 7z su* t]m is def9$ 9 section #bgja7;d77#b77;,a772 & 7#e7 9 subsection 7e71 by ins]t+ 7z su* t]m is def9$ 9 section #bgja7;d77#b77;,a77 aft] "o or m associations4 #e4 ,prohibition ( preexi/+ condition exclusions & o!r discrim9ation bas$ on heal? /atus 7a7 ,gr\p m>ket ,subp>t #a ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg et seq47 is am5d$ by /rik+ section #bgja & ins]t+ ! foll[+3 #bgja4 ,prohibition ( preexi/+ condition exclusions & o!r discrim9ation bas$ on heal? /atus 7a7 ,9 ,g5]al ,a gr\p heal? plan or a heal? insurance issu] (f]+ gr\p heal? insurance cov]age may n impose any preexi/+ condition exclusion ) respect to su* plan or cov]age4 7b7 ,def9itions ,= purposes ( ?is "p3 7#a7 ,preexi/+ condition exclusion 7,a7 ,9 g5]al ,! t]m preexi/+ condition exclusion means1 ) respect to a gr\p heal? plan or heal? insurance cov]age1 a limitation or exclusion ( b5efits relat+ to a condition bas$ on ! fact t ! condition 0 pres5t be=e ! date ( enrollm5t 9 su* plan or = su* cov]age1 :e!r or n any m$ical advice1 diagnosis1 c>e1 or treatm5t 0 recomm5d$ or receiv$ be=e su* date4 7,b7 ,treatm5t ( g5etic in=mation ,g5etic in=mation %all n be treat$ z a preexi/+ condition 9 ! abs5ce ( a diagnosis ( ! condition relat$ to su* in=mation4 7#b7 ,date ( enrollm5t ,! t]m date ( enrollm5t means1 ) respect to an individual cov]$ "u a gr\p heal? plan or heal? insurance cov]age1 ! date ( enrollm5t ( ! individual 9 ! plan or cov]age or1 if e>li]1 ! fir/ day ( ! wait+ p]iod = su* enrollm5t4 7#c7 ,wait+ p]iod ,! t]m wait+ p]iod means1 ) respect to a gr\p heal? plan & an individual :o is a pot5tial p>ticipant or b5efici>y 9 ! plan1 ! p]iod t mu/ pass ) respect to ! individual be=e ! individual is eligible to be cov]$ = b5efits "u ! t]ms ( ! plan4 7c7 ,special ,enrollm5t ,p]iods 7#a7 ,individuals los+ o!r cov]age ,a gr\p heal? plan1 & a heal? insurance issu] (f]+ gr\p heal? insurance cov]age 9 connection ) a gr\p heal? plan1 %all p]mit an employee :o is eligible1 b n enroll$1 = cov]age "u ! t]ms ( ! plan 7or a dep5d5t ( su* an employee if ! dep5d5t is eligible1 b n enroll$1 = cov]age "u su* t]ms7 to enroll = cov]age "u ! t]ms ( ! plan if ea* ( ! foll[+ conditions is met3 7,a7 ,! employee or dep5d5t 0 cov]$ "u a gr\p heal? plan or _h heal? insurance cov]age at ! "t cov]age 0 previ\sly (f]$ to ! employee or dep5d5t4 7,b7 ,! employee /at$ 9 writ+ at su* "t t cov]age "u a gr\p heal? plan or heal? insurance cov]age 0 ! reason = decl9+ enrollm5t1 b only if ! plan sponsor or issu] 7if applicable7 requir$ su* a /atem5t at su* "t & provid$ ! employee ) notice ( su* requirem5t 7& ! consequ5ces ( su* requirem5t7 at su* "t4 7,c7 ,! employee's or dep5d5t's cov]age describ$ 9 subp>agraph 7,a7-- 7i7 0 "u a ,,cobra cont9uation provision & ! cov]age "u su* provision 0 exhau/$2 or 7ii7 0 n "u su* a provision & ei!r ! cov]age 0 t]m9at$ z a result ( loss ( eligibility = ! cov]age 7includ+ z a result ( legal sep>ation1 divorce1 dea?1 t]m9ation ( employm5t1 or r$uction 9 ! numb] ( h\rs ( employm5t7 or employ] contributions t[>d su* cov]age 7 t]m9at$4 7,d7 ,"u ! t]ms ( ! plan1 ! employee reque/s su* enrollm5t n lat] ?an #cj days aft] ! date ( exhau/ion ( cov]age describ$ 9 subp>agraph 7,c77i7 or t]m9ation ( cov]age or employ] contribution describ$ 9 subp>agraph 7,c77ii74 7#b7 ,= dep5d5t b5efici>ies 7,a7 ,9 g5]al ,if-- 7i7 a gr\p heal? plan makes cov]age available ) respect to a dep5d5t ( an individual2 7ii7 ! individual is a p>ticipant "u ! plan 7or has met any wait+ p]iod applicable to becom+ a p>ticipant "u ! plan & is eligible to be enroll$ "u ! plan b = a failure to enroll dur+ a previ\s enrollm5t p]iod72 & 7iii7 a p]son becomes su* a dep5d5t ( ! individual ?r\gh m>riage1 bir?1 or adoption or placem5t = adoption1 ! gr\p heal? plan %all provide = a dep5d5t special enrollm5t p]iod describ$ 9 subp>agraph 7,b7 dur+ :i* ! p]son 7or1 if n o!rwise enroll$1 ! individual7 may be enroll$ "u ! plan z a dep5d5t ( ! individual1 & 9 ! case ( ! bir? or adoption ( a *ild1 ! sp\se ( ! individual may be enroll$ z a dep5d5t ( ! individual if su* sp\se is o!rwise eligible = cov]age4 7,b7 ,dep5d5t special enrollm5t p]iod ,a dep5d5t special enrollm5t p]iod "u ?is subp>agraph %all be a p]iod ( n less ?an #cj days & %all beg9 on ! lat] (-- 7i7 ! date dep5d5t cov]age is made available2 or 7ii7 ! date ( ! m>riage1 bir?1 or adoption or placem5t = adoption 7z ! case may be7 describ$ 9 subp>agraph 7,a77iii74 7,c7 ,no wait+ p]iod ,if an individual seeks to enroll a dep5d5t dur+ ! fir/ #cj days ( su* a dep5d5t special enrollm5t p]iod1 ! cov]age ( ! dep5d5t %all become effective-- 7i7 9 ! case ( m>riage1 n lat] ?an ! fir/ day ( ! fir/ mon? beg9n+ aft] ! date ! complet$ reque/ = enrollm5t is receiv$2 7ii7 9 ! case ( a dep5d5t's bir?1 z ( ! date ( su* bir?2 or 7iii7 9 ! case ( a dep5d5t's adoption or placem5t = adoption1 ! date ( su* adoption or placem5t = adoption4 7#c7 ,special rules = application 9 case ( ,m$icaid & *ip 7,a7 ,9 g5]al ,a gr\p heal? plan1 & a heal? insurance issu] (f]+ gr\p heal? insurance cov]age 9 connection ) a gr\p heal? plan1 %all p]mit an employee :o is eligible1 b n enroll$1 = cov]age "u ! t]ms ( ! plan 7or a dep5d5t ( su* an employee if ! dep5d5t is eligible1 b n enroll$1 = cov]age "u su* t]ms7 to enroll = cov]age "u ! t]ms ( ! plan or cov]age if ei!r ( ! foll[+ conditions is met3 7i7 ,t]m9ation ( m$icaid or *ip cov]age ,! employee or dep5d5t is cov]$ "u a ,m$icaid plan "u title ,,xix ( ! ,social ,security ,act or "u a ,/ate *ild heal? plan "u title ,,xxi ( su* ,act & cov]age ( ! employee or dep5d5t "u su* a plan is t]m9at$ z a result ( loss ( eligibility = su* cov]age & ! employee reque/s cov]age "u ! gr\p heal? plan 7or heal? insurance cov]age7 n lat] ?an #fj days aft] ! date ( t]m9ation ( su* cov]age4 7ii7 ,eligibility = employm5t assi/ance "u m$icaid or *ip ,! employee or dep5d5t becomes eligible = assi/ance1 ) respect to cov]age "u ! gr\p heal? plan or heal? insurance cov]age1 "u su* ,m$icaid plan or ,/ate *ild heal? plan 7includ+ "u any waiv] or demon/ration project conduct$ "u or 9 relation to su* a plan71 if ! employee reque/s cov]age "u ! gr\p heal? plan or heal? insurance cov]age n lat] ?an #fj days aft] ! date ! employee or dep5d5t is det]m9$ to be eligible = su* assi/ance4 7,b7 ,coord9ation ) m$icaid & *ip 7i7 ,outrea* to employees reg>d+ availability ( m$icaid & *ip cov]age 7,i7 ,9 g5]al ,ea* employ] t ma9ta9s a gr\p heal? plan 9 a ,/ate t provides m$ical assi/ance "u a ,/ate ,m$icaid plan "u title ,,xix ( ! ,social ,security ,act1 or *ild heal? assi/ance "u a ,/ate *ild heal? plan "u title ,,xxi ( su* ,act1 9 ! =m ( premium assi/ance = ! pur*ase ( cov]age "u a gr\p heal? plan1 %all provide to ea* employee a writt5 notice in=m+ ! employee ( pot5tial opportunities !n curr5tly available 9 ! ,/ate 9 :i* ! employee resides = premium assi/ance "u su* plans = heal? cov]age ( ! employee or ! employee's dep5d5ts4 ,= purposes ( compliance ) ?is subclause1 ! employ] may use any ,/ate-specific model notice develop$ 9 accordance ) section #gja7;f77#c77;,b77i77,,ii7 ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd 7#bi ,u4,s4,c4 #aaha7;f77#c77;,b77i77,,ii774 7,,ii7 ,option to provide concurr5t ) provision ( plan mat]ials to employee ,an employ] may provide ! model notice applicable to ! ,/ate 9 :i* an employee resides concurr5t ) ! furni%+ ( mat]ials notify+ ! employee ( heal? plan eligibility1 concurr5t ) mat]ials provid$ to ! employee 9 connection ) an op5 season or election process conduct$ "u ! plan1 or concurr5t ) ! furni%+ ( ! summ>y plan description z provid$ 9 section #ajd7;b7 ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd4 7ii7 ,disclosure ab\t gr\p heal? plan b5efits to ,/ates = m$icaid- & ,,*ip-eligible individuals ,9 ! case ( an enrollee 9 a gr\p heal? plan :o is cov]$ "u a ,m$icaid plan ( a ,/ate "u title ,,xix ( ! ,social ,security ,act or "u a ,/ate *ild heal? plan "u title ,,xxi ( su* ,act1 ! plan adm9i/rator ( ! gr\p heal? plan %all disclose to ! ,/ate1 ^u reque/1 in=mation ab\t ! b5efits available "u ! gr\p heal? plan 9 suffici5t specificity1 z det]m9$ "u regulations ( ! ,secret>y ( ,heal? & ,human ,s]vices 9 consultation ) ! ,secret>y t require use ( ! model cov]age coord9ation disclosure =m develop$ "u section #caa7;b77#a77;,c7 ( ! ,*ildr5's ,heal? ,insurance ,reau?orization ,act ( #bjji1 s z to p]mit ! ,/ate to e/abli% 7"u p>agraph 7#b77;,b71 7#c71 or 7#aj7 ( section #baje7;c7 ( ! ,social ,security ,act or o!rwise7 ! co/ effectiv5ess ( ! ,/ate provid+ m$ical or *ild heal? assi/ance ?r\gh premium assi/ance = ! pur*ase ( cov]age "u su* gr\p heal? plan & 9 ord] = ! ,/ate to provide supplem5tal b5efits requir$ "u p>agraph 7#aj77;,e7 ( su* section or o!r au?ority4 7d7 ,application to association plans 7#a7 ,9 g5]al ,a gr\p heal? plan or heal? insurance issu] t provides cov]age to an association z requir$ "u section #bgaa7;a77#b7 %all accept e qualifi$ individual t ! association seeks heal? insurance cov]age =1 )\t reg>d to ! heal? /atus ( su* individual4 7#b7 ,def9itions relat$ to associations ,= purposes ( ?is subsection3 7,a7 ,association ,! t]m association means an association t-- 7i7 has a con/itution & bylaws2 7ii7 is det]m9$ by ! ,secret>y to be an association :i* is op]at+ 9 good fai? = a prim>y purpose o!r ?an t ( obta9+ insurance2 & 7iii7 has be5 9 exi/5ce = a p]iod ( at lea/ #e ye>s4 7,b7 ,dep5d5t ,! t]m dep5d5t1 ) respect to a qualifi$ individual1 has ! mean+ giv5 su* t]m 9 section #bgad1 ) respect to a policy hold]4 7,c7 ,qualifi$ actu>y ,! t]m qualifi$ actu>y means a memb] 9 good /&+ ( ! ,am]ican ,academy ( ,actu>ies1 or a successor organization approv$ by ! ,secret>y4 7,d7 ,qualifi$ individuals ,! t]m qualifi$ individual means1 ) respect to an association1 an individual :o meets any ( ! foll[+3 7i7 ,a memb] ( ! association :o has be5 su* a memb] = a p]iod ( at lea/ #cj days4 7ii7 ,an employee ( su* memb] :o has be5 employ$ by su* memb] = a p]iod ( at lea/ #cj days4 7iii7 ,an employee ( ! association :o has be5 employ$ by ! association = a p]iod ( at lea/ #cj days4 4 7b7 ,individual m>ket ,subp>t #a ( "p ,b ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#da et seq47 is am5d$ by add+ at ! end ! foll[+3 #bgdf4 ,prohibition ( preexi/+ condition exclusions or o!r discrim9ation bas$ on heal? /atus ,! provisions ( section #bgja 7o!r ?an subp>agraphs 7,a77ii7 & 7,b7 ( subsection 7c77#c77 %all apply to heal? insurance cov]age (f]$ to individuals by a heal? insurance issu] 9 ! individual m>ket 9 ! same mann] z x applies to heal? insurance cov]age (f]$ by a heal? insurance issu] 9 ! gr\p m>ket4 4 #f4 ,no lifetime or annual limits 7a7 ,gr\p m>ket ,subp>t #b ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#d et seq47 is am5d$ by add+ at ! end ! foll[+3 #bgjh4 ,no lifetime or annual limits 7a7 ,9 g5]al ,a gr\p heal? plan & a heal? insurance issu] (f]+ gr\p heal? insurance cov]age may n e/abli%-- 7#a7 lifetime limits on ! doll> value ( b5efits = any p>ticipant or b5efici>y2 or 7#b7 unreasonable annual limits 7)9 ! mean+ ( section #bbc ( ! ,int]nal ,rev5ue ,code ( #aihf7 on ! doll> value ( b5efits = any p>ticipant or b5efici>y4 7b7 ,p] ,b5efici>y ,limits ,a gr\p heal? plan or heal? insurance cov]age may n place annual or lifetime p] b5efici>y limits on specific cov]$ b5efits unless su* limits are o!rwise p]mitt$ "u ,f$]al or ,/ate law4 4 7b7 ,individual m>ket ,subp>t #b ( "p ,b ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ea et seq47 is am5d$ by add+ at ! end ! foll[+3 #bged4 ,no lifetime or annual limits ,! provisions ( section #bgjh %all apply to heal? insurance cov]age (f]$ to individuals by a heal? insurance issu] 9 ! individual m>ket 9 ! same mann] z x applies to heal? insurance cov]age (f]$ by a heal? insurance issu] 9 ! gr\p m>ket4 4 #g4 ,prohibition on rescissions 7a7 ,gr\p m>ket ,subp>t #a ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg et seq47 is am5d$ by add+ at ! end ! foll[+3 #bgjc4 ,prohibition on rescissions ,a gr\p heal? plan & a heal? insurance issu] (f]+ gr\p heal? insurance cov]age %all n resc9d su* plan or cov]age ) respect to an enrollee once ! enrollee is cov]$ "u su* plan or cov]age involv$1 except t ?is section %all n apply to a cov]$ individual :o has p]=m$ an act or practice t con/itutes fraud or makes an int5tional misrepres5tation ( mat]ial fact z prohibit$ by ! t]ms ( ! plan or cov]age4 ,su* plan or cov]age may n be cancell$ except ) prior notice to ! enrollee1 & only z p]mitt$ "u section #bgab7;b74 4 7b7 ,individual m>ket ,subp>t #a ( "p ,b ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#da et seq47 is am5d$ by add+ at ! end ! foll[+3 #bgdg4 ,prohibition on rescissions ,! provisions ( section #bgjc %all apply to heal? insurance cov]age (f]$ to individuals by a heal? insurance issu] 9 ! individual m>ket 9 ! same mann] z x applies to heal? insurance cov]age (f]$ by a heal? insurance issu] 9 ! gr\p m>ket4 4 #h4 ,ext5sion ( dep5d5t cov]age 7a7 ,gr\p m>ket 7#a7 ,9 g5]al ,subp>t #a ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg et seq47 is am5d$ by add+ at ! end3 #bgjc;,a4 ,ext5sion ( dep5d5t cov]age 7a7 ,9 ,g5]al ,a gr\p heal? plan & a heal? insurance issu] (f]+ gr\p heal? insurance cov]age t provides dep5d5t cov]age ( *ildr5 %all cont9ue to make su* cov]age available = su* a dep5d5t aft] su* dep5d5t turns #ah ye>s ( age until ! fir/ ( ! foll[+ ev5ts occurs3 7#a7 ,! dep5d5t turns #bf ye>s ( age4 7#b7 ,! dep5d5t m>ries4 7#c7 ,subject to subsection 7c71 ! dep5d5t no long] resides 9 ! home (-- 7,a7 ! policy hold] ?r\gh :i* su* dep5d5t is eligible = dep5d5t cov]age2 or 7,b7 9 ! case t ! policy hold] ?r\gh :i* su* dep5d5t is eligible = dep5d5t cov]age provides su* cov]age subject to an ord] to provide *ild support1 ! dep5d5t's p>5t or legal gu>dian4 7b7 ,exception = college /ud5ts ,p>agraph 7#c7 ( subsection 7a7 %all n apply to a dep5d5t = any p]iod ( "t dur+ :i* su* dep5d5t is enroll$ z a full-"t /ud5t at a po/second>y educational in/itution 7includ+ an in/itution ( high] education z def9$ 9 section #ajb ( ! ,high] ,education ,act ( #aife74 7c7 ,limitation ,no?+ 9 ?is section %all require a plan or an issu] describ$ 9 subsection 7a7 to make cov]age available = a *ild ( an individual receiv+ dep5d5t cov]age pursuant to ?is section4 7d7 ,rule ( ,con/ruction ,no?+ 9 ?is section %all be con/ru$ to modify ! def9ition ( dep5d5t z us$ 9 ! ,int]nal ,rev5ue ,code ( #aihf ) respect to ! tax treatm5t ( ! co/ ( cov]age4 4 7#b7 ,regulations ,! ,secret>y %all promulgate regulations to def9e ! dep5d5ts to :i* cov]age %all be made available "u section #bgjc;,a ( ! ,public ,heal? ,s]vice ,act1 z add$ by p>agraph 7#a74 7b7 ,individual m>ket ,subp>t #a ( "p ,b ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#da et seq47 is am5d$ by add+ at ! end ! foll[+3 #bgdh4 ,ext5sion ( dep5d5t cov]age ,! provisions ( section #bgjc;,a %all apply to heal? insurance cov]age (f]$ to individuals by a heal? insurance issu] 9 ! individual m>ket 9 ! same mann] z x applies to heal? insurance cov]age (f]$ by a heal? insurance issu] 9 ! gr\p m>ket4 4 #i4 ,application ( gr\p m>ket re=ms to ,,erisa & ! ,int]nal ,rev5ue ,code ( #aihf 7a7 ,,erisa 7#a7 ,9 g5]al ,subp>t ,a ( title ,,vii ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd 7#bi ,u4,s4,c4 #aaha et seq47 is am5d$-- 7,a7 by /rik+ sections #gja & #gjc2 & 7,b7 by ins]t+ be=e section #gjb ! foll[+3 #gja4 ,application ( c]ta9 ,,phsa requirem5ts 7a7 ,9 g5]al ,sections #bgja1 #bgjc1 #bgjc;,a1 #bgjh1 #bgaa1 & #bgab ( ! ,public ,heal? ,s]vice ,act %all apply to gr\p heal? plans1 & heal? insurance issu]s provid+ heal? insurance cov]age 9 connection ) gr\p heal? plans1 z if includ$ 9 ?is subp>t4 7b7 ,conflict ,to ! ext5t t any provision ( ?is "p conflicts ) a provision ( any section ( ! ,public ,heal? ,s]vice ,act li/$ 9 subsection 7a7 ) respect to gr\p heal? plans1 or heal? insurance issu]s provid+ heal? insurance cov]age 9 connection ) gr\p heal? plans1 ! provisions ( su* sections %all apply4 4 7#b7 ,con=m+ am5dm5t ,! table ( cont5ts 9 section #a ( su* ,act 7#bi ,u4,s4,c4 #ajja note7 is am5d$-- 7,a7 by /rik+ ! item relat$ to section #gja & ins]t+ ,sec4 #gja4 ,application ( c]ta9 ,,phsa requirem5ts42 & 7,b7 by /rik+ ! item relat$ to section #gjc4 7b7 ,int]nal ,rev5ue ,code ( #aihf ,sub*apt] ,a ( *apt] #ajj ( ! ,int]nal ,rev5ue ,code ( #aihf 7relat+ to gr\p heal? plan requirem5ts7 is am5d$-- 7#a7 by /rik+ sections #ihja & #ihjc2 & 7#b7 by ins]t+ be=e section #ihjb ! foll[+3 #ihja4 ,application ( c]ta9 ,,phsa requirem5ts 7a7 ,9 g5]al ,sections #bgja1 #bgjc1 #bgjc;,a1 #bgjh1 #bgaa1 & #bgab ( ! ,public ,heal? ,s]vice ,act %all apply to gr\p heal? plans1 & heal? insurance issu]s provid+ heal? insurance cov]age 9 connection ) gr\p heal? plans1 z if includ$ 9 ?is sub*apt]4 7b7 ,conflict ,to ! ext5t t any provision ( ?is sub*apt] conflicts ) a provision ( any section ( ! ,public ,heal? ,s]vice ,act li/$ 9 subsection 7a7 ) respect to gr\p heal? plans1 or heal? insurance issu]s provid+ heal? insurance cov]age 9 connection ) gr\p heal? plans1 ! provisions ( su* sections %all apply4 4 #aj4 ,cata/rophic plan ,subp>t #a ( "p ,b ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#da et seq47 is am5d$ by add+ at ! end ! foll[+3 #bgdi4 ,cata/rophic plan 7a7 ,9 g5]al ,ea* heal? insurance issu] t (f]s heal? insurance cov]age 9 ! individual m>ket 9 a ,/ate %all (f] a cata/rophic plan 9 su* ,/ate 9 su* m>ket4 7b7 ,cov]age requirem5ts ,to meet ! requirem5ts ( ?is section1 a cata/rophic plan mu/ provide = ! ess5tial heal? b5efits1 z def9$ by ! ,secret>y "u subsection 7c74 7c7 ,ess5tial heal? b5efits ,! ,secret>y %all def9e ! ess5tial heal? b5efits1 except t su* b5efits %all include-- 7#a7 cov]age = at lea/ ?ree prim>y c>e visits dur+ a plan ye>2 & 7#b7 at lea/ ! foll[+ g5]al categories & ! items & s]vices cov]$ )9 ! categories3 7,a7 ,ambulatory pati5t s]vices4 7,b7 ,em]g5cy s]vices4 7,c7 ,hospitalization4 7,d7 ,mat]nity & newborn c>e4 7,e7 ,m5tal heal? & sub/ance use disord] s]vices1 includ+ behavioral heal? treatm5t4 7,f7 ,prescription drugs4 7,g7 ,rehabilitative & habilitative s]vices & devices4 7,h7 ,laboratory s]vices4 7,i7 ,prev5tive & wellness s]vices & *ronic disease managem5t4 7,j7 ,p$iatric s]vices1 includ+ oral & vision c>e4 7d7 ,re/riction to individual m>ket ,if a heal? insurance issu] (f]s a heal? plan describ$ 9 ?is section1 ! issu] may only (f] ! plan 9 ! individual m>ket4 4 #aa4 ,grants = heal? insurance risk adju/m5t me*anisms 7a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices %all make grants to ,/ates = plann+ = ! e/abli%m5t & implem5tation ( heal? insurance risk adju/m5t me*anisms4 7b7 ,am\nt 7#a7 ,9 g5]al ,! ,secret>y %all det]m9e ! am\nt ( a grant made to a ,/ate "u ?is section pursuant to a =mula1 issu$ by rule n lat] ?an "o ye> aft] ! date ( ! enactm5t ( ! ,,ppaca repeal legislation describ$ 9 section #b7;b71 t takes into acc\nt ! numb] ( high-risk individuals 9 su* ,/ate4 7#b7 ,limitation ,! am\nt ( a grant made to a ,/ate "u ?is section %all n exce$ #a1jjj1jjj = any fiscal ye>4 7c7 ,use ( funds ,! grant funds made available to a ,/ate "u ?is section may only be us$ by a ,/ate = ! co/ associat$ ) plann+ = ! e/abli%m5t & implem5tation ( heal? insurance risk adju/m5t me*anisms4 ,su* funds may n be us$ = co/s relat$ to adm9i/]+ su* me*anisms4 7d7 ,def9itions ,= purposes ( ?is section3 7#a7 ,high-risk individual ,! t]m high-risk individual means an individual :o-- 7,a7 is a citiz5 or national ( ! ,unit$ ,/ates or is lawfully pres5t 9 ! ,unit$ ,/ates2 7,b7 has n be5 cov]$ "u cr$itable cov]age 7z def9$ 9 section #bgja7;c77#a7 ( ! ,public ,heal? ,s]vice ,act z 9 effect on ,m>* #bb1 #bjaj7 dur+ ! previ\s #f-mon? p]iod2 & 7,c7 has a preexi/+ condition1 z det]m9$ 9 a mann] consi/5t ) guidance issu$ by ! ,secret>y4 7#b7 ,heal? insurance risk-adju/m5t me*anisms 7,a7 ,9 g5]al ,) respect to a ,/ate1 ! t]m heal? insurance risk-adju/m5t me*anism %all be a me*anism t applies to-- 7i7 all heal? insurance issu]s :o (f] heal? insurance cov]age 9 su* ,/ate2 & 7ii7 all cov]$ lives = heal? insurance cov]age (f]$ 9 su* ,/ate t is subject to ! requirem5ts ( section #bgaa or section #bgda ( ! ,public ,heal? ,s]vice ,act1 z add$ by section #c ( ?is ,act4 7,b7 ,fur!r def9ition ,) respect to a ,/ate1 any fur!r def9ition ( su* t]m %all be det]m9$ by ! ,/ate insurance commission]1 act+ 9 coop]ation ) heal? insurance issu]s :o (f] heal? insurance cov]age 9 su* ,/ate4 7#c7 ,/ate ,! t]m ,/ate means ea* ( ! #ej ,/ates & ! ,di/rict ( ,columbia4 7e7 ,sunset date ,! ,secret>y may n make any grants "u ?is section aft] ! date t is #b ye>s aft] ! date ( ! enactm5t ( ! ,,ppaca repeal legislation describ$ 9 section #b7;b74 #ab4 ,liability protections = heal? c>e provid]s 7a7 ,heal? c>e provid]s protect$ ,! liability protections 9 subsection 7c7 %all apply 9 any civil action1 includ+ an action be=e any c\rt ( any ,/ate1 aga9/ a heal? c>e provid]1 aris+ f heal? c>e goods or s]vices t-- 7#a7 7 provid$ by a heal? c>e provid] 9 a hospital to :i* ! requirem5ts ( section #ahfg ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;dd7 apply2 & 7#b7 7 provid$ only because !y 7 requir$ "u section #ahfg ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;dd74 7b7 ,burd5 ( pro( ,9 any proce$+ "u subsection 7a71 ! burd5 ( pro( %all be on ! def5dant to e/abli% ! elem5ts 9 p>agraphs 7#a7 & 7#b7 ( subsection 7a74 7c7 ,liability protections 7#a7 ,cap on noneconomic damages ,! am\nt ( noneconomic damages1 if available1 %all n exce$ #bej1jjj1 reg>dless ( ! numb] ( p>ties aga9/ :om ! action is br\ght ) respect to ! same injury4 ,an aw>d = noneconomic damages 9 excess ( #bej1jjj %all be r$uc$ ei!r be=e entry ( ! ord] grant+ judgm5t1 or by am5dm5t ( su* ord]4 7#b7 ,in/allm5t paym5ts ,if ! aw>d = damages exce$s #ej1jjj1 ! def5dant may pay su* damages 9 in/allm5ts1 z det]m9$ by ! c\rt4 7#c7 ,attorney fees ,any cont+5t fee = a p>ty's attorney %all n exce$-- 7,a7 #dj p]c5t ( ! portion ( ! aw>d am\nt t does n exce$ #ej1jjj2 7,b7 #cca_/c p]c5t ( ! portion ( ! aw>d am\nt t exce$s #ej1jjj b does n exce$ #ajj1jjj2 7,c7 #be p]c5t ( ! portion ( ! aw>d am\nt t exce$s #ajj1jjj b does n exce$ #fjj1jjj2 & 7,d7 #ae p]c5t ( ! portion ( ! aw>d am\nt t exce$s #fjj1jjj4 7#d7 ,disclosure ( collat]al s\rce b5efits ,any p]son br++ a civil action describ$ 9 subsection 7a7 %all1 & any p>ty may1 disclose or introduce evid5ce ( collat]al s\rce b5efits4 7#e7 ,preemption 7,a7 ,9 g5]al ,! provisions ( ?is ,act preempt1 subject to subp>agraphs 7,b7 & 7,c71 ,/ate law to ! ext5t t ,/ate law prev5ts ! application ( any provisions ( law e/abli%$ by or "u ?is ,act4 ,! provisions gov]n+ an action describ$ 9 subsection 7a7 set =? 9 ?is ,act sup]s$e *apt] #aga ( title #bh1 ,unit$ ,/ates ,code1 to ! ext5t t su* *apt]-- 7i7 provides = a great] am\nt ( damages or cont+5t fees1 a long] p]iod 9 :i* a heal? c>e lawsuit may be comm5c$1 or a r$uc$ applicability or scope ( p]iodic paym5t ( future damages1 ?an provid$ 9 ?is ,act2 or 7ii7 prohibits ! introduction ( evid5ce reg>d+ collat]al s\rce b5efits1 or m&ates or p]mits subrogation or a li5 on collat]al s\rce b5efits4 7,b7 ,great] protections pres]v$ ,?is ,act %all n preempt or sup]s$e any ,/ate or ,f$]al law t imposes great] proc$ural or sub/antive protections = heal? c>e provid]s f liability1 loss1 or damages ?an ^? provid$ by ?is ,act or create a cause ( action4 7,c7 ,rule ( con/ruction ,no provision ( ?is ,act %all be con/ru$ to preempt-- 7i7 any ,/ate law 7:e!r effective be=e1 on1 or aft] ! date ( ! enactm5t ( ?is ,act7 t specifies a p>ticul> monet>y am\nt ( comp5satory or punitive damages 7or ! total am\nt ( damages7 t may be aw>d$ 9 an action describ$ 9 subsection 7a71 reg>dless ( :e!r su* monet>y am\nt is great] or less] ?an is provid$ = "u ?is ,act2 or 7ii7 any def5se available to a p>ty 9 an action describ$ 9 subsection 7a7 "u any o!r provision ( ,/ate or ,f$]al law4 7#f7 ,def9itions 7,a7 ,collat]al s\rce b5efits ,z us$ 9 ?is section1 ! t]m collat]al s\rce b5efits means any am\nt paid or reasonably likely to be paid 9 ! future to or on behalf ( ! claimant1 or any s]vice1 product1 or o!r b5efit provid$ or reasonably likely to be provid$ 9 ! future to or on behalf ( ! claimant1 z a result ( ! p]sonal h>m1 pursuant to-- 7i7 any ,/ate or ,f$]al heal?1 sickness1 income-disability1 accid5t1 or work]s' comp5sation law2 7ii7 any heal?1 sickness1 income-disability1 or accid5t insurance t provides heal? b5efits or income-disability cov]age2 7iii7 any contract or agreem5t ( any gr\p1 organization1 p>tn]%ip1 or corporation to provide1 pay =1 or reimburse ! co/ ( m$ical1 hospital1 d5tal1 or income-disability b5efits2 & 7iv7 any o!r publicly or privately fund$ program4 7,b7 ,noneconomic damages ,z us$ 9 ?is section1 ! t]m noneconomic damages means damages = physical & emotional pa91 suff]+1 inconv5i5ce1 physical impairm5t1 m5tal angui%1 disfigurem5t1 loss ( enjoym5t ( life1 loss ( society & companion%ip1 loss ( consortium 7o!r ?an loss ( dome/ic s]vice71 h$onic damages1 injury to reputation1 & all o!r nonpecuni>y losses ( any k9d or nature4 7,c7 ,heal? c>e provid] ,z us$ 9 ?is section1 ! t]m heal? c>e provid] means any p]son or entity requir$ by ,/ate or ,f$]al laws or regulations to be lic5s$1 regi/]$1 or c]tifi$ to provide heal? c>e s]vices1 & be+ ei!r s lic5s$1 regi/]$1 or c]tifi$1 or exempt$ f su* requirem5t by o!r /atute4 7,d7 ,heal? c>e goods or s]vices ,z us$ 9 ?is section1 ! t]m heal? c>e goods or s]vices means any goods or s]vices provid$ by a heal? c>e organization1 provid]1 or by any individual work+ "u ! sup]vision ( a heal? c>e provid]1 t relates to ! diagnosis1 prev5tion1 or treatm5t ( any human disease or impairm5t1 or ! assessm5t or c>e ( ! heal? ( human be+s4