,i  #aad? ,,congress  #a/ ,session  ,h4 
,r4 #bfej  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,june #d1 #bjae ,mr4  
,tom ,price ( ,georgia introduc$ !      
foll[+ bill2 :i* 0 ref]r$ to !          
,committee on ,en]gy & ,comm]ce1 & 9    
addition to ! ,committees on ,ways &    
,means & ,education & ! ,work=ce1 = 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      
re/ore equity1 save cov]age1 & undo     
errors 9 ! case ( individuals :o lose   
heal? insurance subsidies "u ,k+ v4     
,burwell1 & o!r individuals1 & = o!r    
purposes4  #a4 ,%ort title2 table (     
cont5ts2 cont+5cy & limitation on       
application  7a7 ,%ort title ,?is ,act  
may be cit$ z ! ,re/or+ ,equity1 ,sav+  
,cov]age1 & ,undo+ ,errors ,act ( #bjae 
or z ! ,,rescue ,am]ica's ,heal? ,c>e   
,act ( #bjae4  7b7 ,table ( cont5ts ,!  
table ( cont5ts ( ?is ,act is z foll[s3 
,sec4 #a4 ,%ort title2 table ( cont5ts2 

cont+5cy & limitation on application4   
,sec4 #b4 ,refundable tax cr$it = heal? 
insurance cov]age4 ,sec4 #c4 ,re/or+ to 
,/ates ! fre$om & flexibility to        
regulate heal? insurance m>kets4 ,sec4  
#d4 ,pool re=m = individual memb]%ip    
expansion4 ,sec4 #e4 ,requirem5ts =     
individual heal? insurance4  7c7        
,cont+5cy & limitation on application   
7#a7 ,dep5d5t ^u ,supreme ,c\rt         
det]m9ation 9 ,k+ v4 ,burwell ,! succe$+
 provisions ( ?is ,act 7includ+ !       
am5dm5ts made by ?is ,act7 %all only    
apply if ! ,supreme ,c\rt det]m9es t !  
premium tax cr$it "u section #cf;,b ( ! 
,int]nal ,rev5ue ,code ( #aihf is n     
available to individuals :o are enroll$ 
9 a qualifi$ heal? plan (f]$ ?r\gh !    
f$]ally op]at$ ,ex*ange e/abli%$        
pursuant to section #acba7;c7 ( !       
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahjda7;c774  7#b7  
,application 9 ,/ates )\t a ,/ate-op]at$
 ,ex*ange ,9 ! case ( a ,/ate t has n   
e/abli%$ an ,ex*ange "u section #acaa ( 

! ,pati5t ,protection & ,af=dable ,c>e  
,act 7#db ,u4,s4,c4 #ahjca7 = :i* a     
premium tax cr$it is available pursuant 
to section #cf;,b7b77#a77;,a7 ( !       
,int]nal ,rev5ue ,code ( #aihf1 z       
int]pret$ by ! ,supreme ,c\rt1 ! succe$+
 provisions ( ?is ,act 7includ+ !       
am5dm5ts made by ?is ,act7 %all apply1  
subject to p>agraphs 7#a7 & 7#d71 to !  
,/ate & to individuals resid+ 9 ! ,/ate 
z ( ! date on :i* su* cr$it becomes no  
long] available to su* individuals      
pursuant to ! ,supreme ,c\rt det]m9ation
 describ$ 9 p>agraph 7#a7 7su* date     
ref]r$ to 9 ?is ,act z ! ,k+ v4 ,burwell
 effective date7 4  7#c7 ,option (      
application 9 ,/ates ) a ,/ate-op]at$   
,ex*ange ,9 ! case ( a ,/ate t has      
e/abli%$ an ,ex*ange "u section #acaa ( 
! ,pati5t ,protection & ,af=dable ,c>e  
,act 7#db ,u4,s4,c4 #ahjca7 = :i* a     
premium tax cr$it is available pursuant 
to section #cf;,b7b77#a77;,a7 ( !       
,int]nal ,rev5ue ,code ( #aihf1 z       
int]pret$ by ! ,supreme ,c\rt--  7,a7 ! 

,/ate may at any "t t]m9ate op]ation (  
su* ,ex*ange2 &  7,b7 if ! ,/ate        
t]m9ates op]ation ( any su* ,ex*ange    
e/abli%$ "u su* section #acaa1 !        
provisions ( ?is ,act 7includ+ !        
am5dm5ts made by ?is ,act7 %all apply1  
subject to p>agraphs 7#a7 & 7#d71 to !  
,/ate & to individuals resid+ 9 ! ,/ate 
z ( ! date on :i* ! op]ation ( su*      
,ex*ange is t]m9at$1 b 9 no case %all   
su* provisions & am5dm5ts apply e>li]   
?an ! ,k+ v4 ,burwell effective date4   
7#d7 ,no application to ,/ates ) an     
,ex*ange = :i* premium cr$it is         
available ,! succe$+ provisions ( ?is   
,act 7includ+ ! am5dm5ts made by ?is    
,act7 %all n apply to a ,/ate & to      
individuals resid+ 9 a ,/ate s long z   
!re is op]at+ 9 ! ,/ate an ,ex*ange =   
:i* a premium tax cr$it is available    
pursuant to section #cf;,b7b77#a77;,a7 (
 ! ,int]nal ,rev5ue ,code ( #aihf to su*
 individuals1 z int]pret$ by ! ,supreme 
,c\rt4  #b4 ,refundable tax cr$it =     
heal? insurance cov]age  7a7 ,9 g5]al   

,subp>t ,c ( "p ,,iv ( sub*apt] ,a (    
*apt] #a ( ! ,int]nal ,rev5ue ,code (   
#aihf is am5d$ by ins]t+ aft] section   
#cf;,b ! foll[+ new section3  #cf;,c4   
,heal? insurance cov]age  7a7 ,9 g5]al  
,9 ! case ( an individual1 !re %all be  
all[$ z a cr$it aga9/ ! tax impos$ by   
subtitle ,a ! aggregate mon?ly cr$it    
am\nts det]m9$ "u subsection 7b7 )      
respect to ! taxpay] & ! taxpay]'s      
qualify+ family memb]s = eligible       
cov]age mon?s beg9n+ dur+ ! taxable ye>4
  7b7 ,mon?ly cr$it am\nts  7#a7 ,9     
g5]al ,! mon?ly cr$it am\nt ) respect to
 any individual = any eligible cov]age  
mon? is #a_/ab (-- 7,a7 #ijj 9 ! case ( 
an individual :o has n atta9$ age #ah z 
( ! beg9n+ ( su* mon?1  7,b7 #a1bjj 9 ! 
case ( an individual :o has s atta9$ age
 #ah b :o has n s atta9$ age #ce1  7,c7 
#b1ajj 9 ! case ( an individual :o has s
 atta9$ age #ce1 b :o has n s atta9$ age
 #ej1 &  7,d7 #c1jjj 9 ! case ( an      
individual :o has s atta9$ age #ej4     
7#b7 ,inflation adju/m5t ,9 ! case ( any

 taxable ye> beg9n+ 9 a cal5d> ye> aft] 
#bjaf1 ea* doll> am\nt conta9$ 9        
p>agraph 7#a7 %all be increas$ by an    
am\nt equal to--  7,a7 su* doll> am\nt1 
multipli$ by  7,b7 ! co/-(-liv+ adju/m5t
 det]m9$ "u section #a7;f77#c7 = !      
cal5d> ye> 9 :i* ! taxable ye> beg9s1   
det]m9$ by sub/itut+ cal5d> ye> #bjae = 
cal5d> ye> #aiib 9 subp>agraph 7,b7     
!re(4  ,any increase det]m9$ "u ! prec$+
 s5t5ce %all be r\nd$ to ! ne>e/        
multiple ( #ej4  7c7 ,eligible cov]age  
mon? ,= purposes ( ?is section1 ! t]m   
eligible cov]age mon? means1 ) respect  
to any individual1 any mon? if1 z ( !   
fir/ day ( su* mon?1 ! individual--     
7#a7 is cov]$ by qualifi$ heal?         
insurance1  7#b7 does n h o!r specifi$  
cov]age1 &  7#c7 is n imprison$ "u      
,f$]al1 ,/ate1 or local au?ority4  7d7  
,qualify+ family memb] ,= purposes ( ?is
 section1 ! t]m qualify+ family memb]   
means--  7#a7 9 ! case ( a jo9t return1 
! taxpay]'s sp\se1 &  7#b7 any dep5d5t (
 ! taxpay]4  7e7 ,qualifi$ heal?        

insurance ,= purposes ( ?is section1 !  
t]m qualifi$ heal? insurance means heal?
 insurance cov]age 7o!r ?an except$     
b5efits z def9$ 9 section #ihcb7;c77 :i*
 con/itutes m$ical c>e4  7f7 ,o!r       
specifi$ cov]age ,= purposes ( ?is      
section1 an individual has o!r specifi$ 
cov]age = any mon? if1 z ( ! fir/ day ( 
su* mon?--  7#a7 ,cov]age "u ,m$ic>e1   
,m$icaid1 or ,,s*ip ,su* individual--   
7,a7 is entitl$ to b5efits "u "p ,a (   
title ,,xviii ( ! ,social ,security ,act
 or is enroll$ "u "p ,b ( su* title1 or 
7,b7 is enroll$ 9 ! program "u title    
,,xix or ,,xxi ( su* ,act 7o!r ?an "u   
section #aibh ( su* ,act74  7#b7 ,c]ta9 
o!r cov]age ,su* individual-- 7,a7 is   
enroll$ 9 a heal? b5efits plan "u *apt] 
#hi ( title #e1 ,unit$ ,/ates ,code1    
7,b7 is entitl$ to receive b5efits "u   
*apt] #ee ( title #aj1 ,unit$ ,/ates    
,code1  7,c7 is entitl$ to receive      
b5efits "u *apt] #ag ( title #ch1 ,unit$
 ,/ates ,code1  7,d7 is enroll$ 9 a gr\p
 heal? plan 7)9 ! mean+ ( section       

#ejjj7;b77#a77 :i* is subsidiz$ by !    
employ]1 or  7,e7 is a memb] ( a heal?  
c>e %>+ m9i/ry4  7#c7 ,heal? c>e %>+    
m9i/ry ,= purposes ( ?is subsection1 !  
t]m heal? c>e %>+ m9i/ry means an       
organization--  7,a7 :i* is describ$ 9  
section #eja7;c77#c7 & is exempt f      
taxation "u section #eja7;a71  7,b7     
memb]s ( :i* %>e a common set ( e?ical  
or religi\s beliefs & %>e m$ical exp5ses
 among memb]s 9 accordance ) ^? beliefs 
& )\t reg>d to ! ,/ate 9 :i* a memb]    
resides or is employ$1  7,c7 memb]s (   
:i* reta9 memb]%ip ev5 aft] !y develop a
 m$ical condition1  7,d7 :i* 7or a      
pr$ecessor ( :i*7 has be5 9 exi/5ce at  
all times s9ce ,decemb] #ca1 #aiii1 &   
m$ical exp5ses ( its memb]s h be5 %>$   
cont9u\sly & )\t int]ruption s9ce at    
lea/ ,decemb] #ca1 #aiii1 &  7,e7 :i*   
conducts an annual audit :i* is p]=m$ by
 an indep5d5t c]tifi$ public acc\nt+    
firm 9 accordance ) g5]ally accept$     
acc\nt+ pr9ciples & :i* is made         
available to ! public ^u reque/4  7g7   

,special rules  7#a7 ,cr$it 9 excess (  
premiums only payable to a heal? sav+s  
acc\nt  7,a7 ,9 g5]al ,if ! cr$it all[$ 
"u subsection 7a7 7det]m9$ )\t reg>d to 
clause 7ii77 = any taxable ye> exce$s ! 
am\nt ( premiums paid by ! taxpay] =    
cov]age ( ! taxpay] & ! taxpay]'s       
qualify+ family memb]s "u qualifi$ heal?
 insurance = eligible cov]age mon?s     
beg9n+ 9 ! taxable ye>--  7i7 at !      
reque/ ( ! taxpay]1 ! ,secret>y %all pay
 ! am\nt ( su* excess to "o or m heal?  
sav+s acc\nts ( ! taxpay] or ( any      
qualify+ family memb] ( ! taxpay]1 &    
7ii7 ! cr$it all[$ "u subsection 7a7 =  
su* taxable ye> %all n exce$ ! am\nt (  
su* premiums4  7,b7 ,m$ical & heal?     
sav+s acc\nts ,am\nts di/ribut$ f an    
,ar*] ,,msa 7z def9$ 9 section #bbj7;d77
 or f a heal? sav+s acc\nt 7z def9$ 9   
section #bbc7;d77 %all n be tak5 into   
acc\nt z premiums paid "u subp>agraph   
7,a74  7,c7 ,insurance :i* cov]s o!r    
individuals ,= purposes ( ?is p>agraph1 
rules simil> to ! rules ( section       

#bac7;d77#f7 %all apply ) respect to any
 contract = qualifi$ heal? insurance "u 
:i* am\nts are payable = cov]age ( an   
individual o!r ?an ! taxpay] & qualify+ 
family memb]s4  7,d7 ,contributions     
treat$ z rollov]s1 etc  7i7 ,9 g5]al    
,any am\nt paid ! ,secret>y to a heal?  
sav+s acc\nt "u ?is p>agraph %all be    
treat$ = purposes ( ?is title 9 ! same  
mann] z a rollov] contribution describ$ 
9 section #bbc7;f77#e74  7ii7           
,coord9ation ) limitation on rollov]s   
,any am\nt describ$ 9 clause 7i7 %all n 
be tak5 into acc\nt 9 apply+ section    
#bbc7;f77#e77;,b7 ) respect to any o!r  
am\nt & ! limitation ( section          
#bbc7;f77#e77;,b7 %all n apply ) respect
 to ! application ( clause 7i74  7iii7  
,e/abli%m5t ( ,h,s,as ,no?+ 9 any       
provision ( law %all be con/ru$-- 7,i7  
to prev5t an individual f e/abli%+ a    
heal? sav+s acc\nt 7z def9$ 9 section   
#bbc7;d77 m]ely because su* individual  
is n an eligible individual 7z def9$ 9  
section #bbc7;c771 or  7,,ii7 to prev5t 

su* an acc\nt f be+ treat$ z a heal?    
sav+s acc\nt m]ely because all or a     
sub/antial portion ( ! contributions to 
su* acc\nt are describ$ 9 ?is p>agraph4 
7#b7 ,coord9ation ) advance paym5ts (   
cr$it ,) respect to any taxable ye>--   
7,a7 ! am\nt :i* w\ld 7b = ?is          
subsection7 be all[$ z a cr$it to !     
taxpay] "u subsection 7a7 %all be r$uc$ 
7b n bel[ z]o7 by ! aggregate am\nt paid
 on behalf ( su* taxpay] "u section     
#gebi = mon?s beg9n+ 9 su* taxable ye>1 
&  7,b7 ! tax impos$ by section #a = su*
 taxable ye> %all be increas$ by !      
excess 7if any7 (-- 7i7 ! aggregate     
am\nt paid on behalf ( su* taxpay] "u   
section #gebi = mon?s beg9n+ 9 su*      
taxable ye>1 ov]  7ii7 ! am\nt :i* w\ld 
7b = ?is subsection7 be all[$ z a cr$it 
to ! taxpay] "u subsection 7a74  7#c7   
,coord9ation ) o!r provisions ,=        
purposes ( any d$uction all[$ "u section
 #afb7l71 #bac1 or #bbd1 & any cr$it    
all[$ "u section #ce1 any heal?         
insurance premiums :i* w\ld 7b = ?is    

p>agraph7 be tak5 into acc\nt %all be   
r$uc$ 7b n bel[ z]o7 by ! am\nt ( !     
cr$it all[$ "u ?is section 7det]m9$ )\t 
reg>d to p>agraphs 7#a7 & 7#b7 ( ?is    
subsection74  7#d7 ,d5ial ( cr$it to    
dep5d5ts & nonp]man5t resid5t ali5      
individuals ,no cr$it %all be all[$ "u  
?is section to any individual :o is--   
7,a7 n a citiz5 or lawful p]man5t       
resid5t ( ! ,unit$ ,/ates = ! cal5d> ye>
 9 :i* ! taxable ye> beg9s1 or  7,b7 a  
dep5d5t ) respect to ano!r taxpay] = a  
taxable ye> beg9n+ 9 ! cal5d> ye> 9 :i* 
su* individual's taxable ye> beg9s4     
7#e7 ,regulations ,! ,secret>y may      
prescribe su* regulations & o!r guidance
 z may be necess>y or appropriate to    
c>ry out ?is section1 section #fjej,w1 &
 section #gebi4  4  7b7 ,advance paym5t 
( cr$it  7#a7 ,9 g5]al ,*apt] #gg ( !   
,int]nal ,rev5ue ,code ( #aihf 7relat+  
to miscellane\s provisions7 is am5d$ by 
add+ at ! end ! foll[+3  #gebi4 ,advance
 paym5t ( cr$it = heal? insurance       
cov]age  7a7 ,g5]al rule ,n lat] ?an    

,janu>y #a1 #bjaf1 ! ,secret>y %all     
e/abli% a program = mak+ paym5ts to     
provid]s ( qualifi$ heal? insurance 7z  
def9$ 9 section #cf;,c7e77 on behalf (  
taxpay]s eligible = ! cr$it "u section  
#cf;,c4  7b7 ,limitation ,! aggregate   
paym5ts made "u ?is section ) respect to
 any taxpay]1 det]m9$ z ( any "t dur+   
any cal5d> ye>1 %all n exce$ ! mon?ly   
cr$it am\nts det]m9$ ) respect to su*   
taxpay] "u section #cf;,c = mon?s dur+  
su* cal5d> ye> :i* h end$ z ( su* "t4   
7c7 ,application ( rule t cr$its 9      
excess ( premiums only payable to a     
heal? sav+s acc\nt ,"u rules simil> to !
 rules ( section #cf;,c7g77#a71 any     
am\nt o!rwise payable on behalf ( !     
taxpay] "u subsection 7a7 ) respect to  
any eligible cov]age mon? :i* is 9      
excess ( ! am\nt ( premiums paid by !   
taxpay] = cov]age ( ! taxpay] & !       
taxpay]'s qualify+ family memb]s "u     
qualifi$ heal? insurance = su* mon? %all
 be payable only to "o or m heal? sav+s 
acc\nts ( ! taxpay] or ( any qualify+   

family memb] ( ! taxpay]4  7d7          
,c]tification process & pro( ( cov]age  
,! ,secret>y %all e/abli% a process "u  
:i* individuals are c]tifi$ z eligible =
 paym5t "u ?is section4 ,su* process    
%all include an initial application by !
 taxpay] to det]m9e eligibility &       
!reaft] cont9u$ eligibility %all be     
det]m9$1 to ! maximum ext5t feasible1 by
 ! ,secret>y on ! basis ( in=mation     
provid$ "u section #fjej,x4  7e7        
,def9itions ,= purposes ( ?is section1  
t]ms us$ 9 ?is section :i* are also us$ 
9 section #cf;,c %all h ! same mean+ z  
:5 us$ 9 section #cf;,c4  4  7#b7       
,in=mation report+  7,a7 ,9 g5]al       
,subp>t ,b ( "p ,,iii ( sub*apt] ,a (   
*apt] #fa ( su* ,code 7relat+ to        
in=mation conc]n+ transactions ) o!r    
p]sons7 is am5d$ by add+ at ! end !     
foll[+ new section3  #fjej,x4 ,returns  
relat+ to cr$it = heal? insurance       
cov]age  7a7 ,requirem5t ( report+ ,e   
p]son :o provides qualifi$ heal?        
insurance = any mon? ( any cal5d> ye> ) 

respect to any individual %all1 at su*  
"t z ! ,secret>y may prescribe1 make !  
return describ$ 9 subsection 7b7 )      
respect to ea* su* individual4 ,)       
respect to any individual ) respect to  
:om paym5ts "u section #gebi are made by
 ! ,secret>y1 ! ,secret>y may require t 
report+ "u subsection 7b7 be made on a  
mon?ly basis4  7b7 ,=m & mann] ( returns
 ,a return is describ$ 9 ?is subsection 
if su* return-- 7#a7 is 9 su* =m z !    
,secret>y may prescribe1 &  7#b7        
conta9s1 ) respect to ea* policy (      
qualifi$ heal? insurance-- 7,a7 ! "n1   
address1 & ,,t9 ( ea* individual cov]$  
"u su* policy1  7,b7 ! premiums paid )  
respect to su* policy1 &  7,c7 su* o!r  
in=mation z ! ,secret>y may prescribe4  
7c7 ,/atem5ts ,to ,be ,furni%$ to       
,individuals ,) ,respect to ,:om        
,in=mation ,is ,requir$ ,e p]son requir$
 to make a return "u subsection 7a7 %all
 furni% to ea* individual ^: "n is      
requir$ to be set =? 9 su* return a     
writt5 /atem5t %[+--  7#a7 ! "n &       

address ( ! p]son requir$ to make su*   
return & ! phone numb] ( ! in=mation    
contact = su* p]son1 &  7#b7 ! in=mation
 requir$ to be %[n on ! return ) respect
 to su* individual4  ,! writt5 /atem5t  
requir$ "u ! prec$+ s5t5ce %all be      
furni%$ on or be=e ,janu>y #ca ( ! ye>  
foll[+ ! cal5d> ye> to :i* su* /atem5t  
relates4  7d7 ,def9itions ,= purposes ( 
?is section1 t]ms us$ 9 ?is section :i* 
are also us$ 9 section #cf;,c %all h !  
same mean+ z :5 us$ 9 section #cf;,c4  4
  7,b7 ,assessable p5alties  7i7        
,subp>agraph 7,b7 ( section             
#fgbd7;d77#a7 ( su* ,code is am5d$ by   
/rik+ or at ! end ( clause 7xxiv71 by   
/rik+ & at ! end ( clause 7xxv7 & ins]t+
 or1 & by ins]t+ aft] clause 7xxv7 !    
foll[+ new clause3  7xxvi7 section      
#fjej,x 7relat+ to returns relat+ to    
cr$it = heal? insurance cov]age71 &  4  
7ii7 ,p>agraph 7#b7 ( section #fgbd7;d7 
( su* ,code is am5d$ by /rik+ or at !   
end ( subp>agraph 7,,gg71 by /rik+ !    
p]iod at ! end ( subp>agraph 7,,hh7 &   

ins]t+ 1 or1 & by add+ aft] subp>agraph 
7,,hh7 ! foll[+ new subp>agraph3  7,,ii7
 section #fjej,x 7relat+ to returns     
relat+ to cr$it = heal? insurance       
cov]age74  4  7#c7 ,disclosure ( return 
in=mation = purposes ( advance paym5t ( 
cr$it z premiums = qualifi$ heal?       
insurance  7,a7 ,9 g5]al ,subsection 7l7
 ( section #fajc ( su* ,code is am5d$ by
 add+ at ! end ! foll[+ new p>agraph3   
7#bc7 ,disclosure ( return in=mation    
relat$ to paym5ts ( ! heal? insurance   
cov]age cr$it ,! ,secret>y may1 on      
behalf ( taxpay]s eligible = ! cr$it "u 
section #cf;,c1 disclose to a provid] ( 
qualifi$ heal? insurance 7z def9$ 9     
section #cf7;e77 or a tru/ee ( a heal?  
sav+s acc\nt 7& p]sons act+ on behalf ( 
su* provid] or su* tru/ee71 return      
in=mation ) respect to any su* taxpay]  
only to ! ext5t necess>y 7z prescrib$ by
 regulations issu$ by ! ,secret>y7 to   
c>ry out sections #cf;,c7g77#a7 7relat+ 
to cr$it 9 excess ( premiums only       
payable to a heal? sav+s acc\nt7 & #gebi

 7relat+ to advance paym5t ( cr$it =    
heal? insurance cov]age74  4  7,b7      
,confid5tiality ( in=mation ,p>agraph   
7#c7 ( section #fajc7;a7 ( su* ,code is 
am5d$ by /rik+ or 7#ba7 & ins]t+ 7#ba71 
or 7#bb74  7,c7 ,unau?oriz$ disclosure  
,p>agraph 7#b7 ( section #gbac7;a7 ( su*
 ,code is am5d$ by /rik+ or 7#ba7 &     
ins]t+ 7#ba71 or 7#bb74  7#d7 ,effective
 date ,subject to section #a7;c71 !     
am5dm5ts made by ?is section %all take  
effect on ! date ( ! enactm5t ( ?is     
,act4  7c7 ,con=m+ am5dm5ts  7#a7       
,p>agraph 7#b7 ( section #acbd7;b7 (    
title #ca1 ,unit$ ,/ates ,code1 is am5d$
 by ins]t+ #cf;,c1 aft] #cf;,b14  7#b7  
,! table ( sections = subp>t ,c ( "p    
,,iv ( sub*apt] ,a ( *apt] #a ( !       
,int]nal ,rev5ue ,code ( #aihf is am5d$ 
by ins]t+ aft] ! item relat+ to section 
#cf;,b ! foll[+ new item3  ,sec4 #cf;,c4
 ,heal? insurance cov]age4  4  7#c7 ,!  
table ( sections = subp>t ,b ( "p ,,iii 
( sub*apt] ,a ( *apt] #fa ( su* ,code is
 am5d$ by add+ at ! end ! foll[+ new    

item3  ,sec4 #fjej,x4 ,returns relat+ to
 cr$it = heal? insurance cov]age4  4    
7#d7 ,! table ( sections = *apt] #gg (  
su* ,code is am5d$ by add+ at ! end !   
foll[+ new item3  ,sec4 #gebi4 ,advance 
paym5t ( cr$it = heal? insurance        
cov]age4  4  7d7 ,effective date        
,subject to section #a7;c71 ! am5dm5ts  
made by ?is section %all apply ) respect
 to cov]age mon?s beg9n+ on or aft] !   
,k+ v4 ,burwell effective date4  #c4    
,re/or+ to ,/ates ! fre$om & flexibility
 to regulate heal? insurance m>kets  7a7
 ,elim9ation ( ,,ppaca re/rictions on ! 
insurance m>ket ,any provision ( title  
,i ( ! ,pati5t ,protection & ,af=dable  
,c>e ,act 7,public ,law #aaa-adh7 or ( !
 ,heal? ,c>e & ,education               
,reconciliation ,act ( #bjaj 7,public   
,law #aaa-aeb7 am5d+ title ,,xxvii ( !  
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;gg et seq471 or am5d+ !  
,int]nal ,rev5ue ,code ( #aihf or !     
,employee ,retirem5t ,income ,security  
,act ( #aigd 9 ord] to incorporate or   

apply su* an am5dm5t to su* title       
,,xxvii1 is repeal$ & ! provisions ( law
 am5d$ by su* provisions ( title ,i ( ! 
,pati5t ,protection & ,af=dable ,c>e    
,act & ! ,heal? ,c>e & ,education       
,reconciliation ,act ( #bjaj are re/or$ 
or reviv$ z if su* title & ,act _h n be5
 enact$4  7b7 ,h,s,as & ,f,s,as ,any    
provision (1 or am5dm5t made by1 !      
,pati5t ,protection & ,af=dable ,c>e    
,act 7,public ,law #aaa-adh7 or ! ,heal?
 ,c>e & ,education ,reconciliation ,act 
( #bjaj 7,public ,law #aaa-aeb7 apply+ a
 requirem5t or re/riction on a heal?    
sav+s acc\nt 7)9 ! mean+ ( section      
#bbc7;d7 ( ! ,int]nal ,rev5ue ,code (   
#aihf7 or a heal? flexible sp5d+        
arrangem5t 7)9 ! mean+ ( section        
#ajf7;c7 ( ! ,int]nal ,rev5ue ,code (   
#aihf7 is repeal$ & ! provisions ( law  
am5d$ by su* provisions ( ! ,pati5t     
,protection & ,af=dable ,c>e ,act & !   
,heal? ,c>e & ,education ,reconciliation
 ,act ( #bjaj are re/or$ or reviv$ z if 
su* ,acts _h n be5 enact$4  7c7 ,exp&$  

,heal? ,plan ,selection  7#a7 ,9 g5]al  
,section #acja7;a77#a7 ( ! ,pati5t      
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjba7;a77#a77 is am5d$ by   
/rik+ a heal? plan t & all t foll[s     
?r\gh ! p]iod at ! end & ins]t+ any     
heal? plan 7z def9$ 9 subsection 7b7744 
7#b7 ,direct prim>y c>e m$ical home     
plans ,section #acja7;a77#c7 ( su* ,act 
7#db ,u4,s4,c4 #ahjba7;a77#c77 is am5d$ 
by /rik+ m$ical home plan t meets       
crit]ia & all t foll[s ?r\gh ! p]iod at 
! end & ins]t+ m$ical home plan4 4  7#c7
 ,/&-alone d5tal b5efits ,section       
#acaa7;d77#b77;,b77ii7 ( su* ,act 7#db  
,u4,s4,c4 #ahjca7;d77#b77;,b77ii77 is   
am5d$ by /rik+ heal? plan7 if ! plan &  
all t foll[s ?r\gh ! p]iod at ! end &   
ins]t+ heal? plan74 4  7#d7 ,con=m+     
am5dm5ts ,! foll[+ provisions ( !       
,pati5t ,protection & ,af=dable ,c>e    
,act 7,public ,law #aaa-adh7 %all h no  
=ce or effect aft] ! date ( ! enactm5t (
 ?is ,act3  7,a7 ,section               
#acja7;b77#a77;,b7 ( su* ,act 7#db      

,u4,s4,c4 #ahjba7;b77#a77;,b774  7,b7   
,p>agraphs 7#a71 7#b71 & 7#f7 ( section 
#acaa7;c7 ( su* ,act 7#db ,u4,s4,c4     
#ahjca7;c774  7,c7 ,section             
#acaa7;d77#d77;,a7 ( su* ,act 7#db      
,u4,s4,c4 #ahjca7;d77#d77;,a774  7,d7   
,section #acaa7;e7 ( su* ,act 7#db      
,u4,s4,c4 #ahjca7;e774  7,e7 ,section   
#acaa7;j7 ( su* ,act 7#db ,u4,s4,c4     
#ahjca7;j774  7,f7 ,subp>agraphs 7,b7 & 
7,d7 ( section #acba7;a77#a7 ( su* ,act 
7#db ,u4,s4,c4 #ahjda7;a77#a774  #d4    
,pool re=m = individual memb]%ip        
expansion ,! ,public ,heal? ,s]vice ,act
 is fur!r am5d$ by add+ at ! end !      
foll[+3  ,,xxxiv ,pool ,re=m =          
,individual ,memb]%ip ,expansion  #cdjj4
 ,purpose ,! purpose ( ?is title is to  
provide1 ?r\gh ! e/abli%m5t ( individual
 heal? pools 7or ,i,h,ps71 = ! re=m (1 &
 expansion ( enrollm5t 91 heal?         
insurance cov]age = individuals & small 
employ]s4  #cdja4 ,def9ition (          
individual heal? pool 7,,ihp7  7a7 ,9   
g5]al ,= purposes ( ?is title1 ! t]ms   

individual heal? pool & ,,ihp mean a    
legal nonpr(it entity t meets ! foll[+  
requirem5ts3 7#a7 ,organization ,!      
,,ihp--  7,a7 has be5 =m$ & ma9ta9$ 9   
good fai? = a purpose t includes !      
=mation ( a risk pool 9 ord] to (f]     
heal? insurance cov]age to its memb]s2  
7,b7 does n condition memb]%ip 9 ! ,,ihp
 on any heal? /atus-relat$ factor relat+
 to an individual 7includ+ an employee (
 an employ] or a dep5d5t ( an employee72
  7,c7 does n make heal? insurance      
cov]age (f]$ ?r\gh ! ,,ihp available o!r
 ?an 9 connection ) a memb] ( ! ,,ihp2  
7,d7 is n a heal? insurance issu]2 &    
7,e7 does n receive any consid]ation    
directly or indirectly f any heal?      
insurance issu] 9 connection ) !        
enrollm5t ( any individuals1 or         
employees ( employ]s1 9 any heal?       
insurance cov]age1 except 9 conjunction 
) s]vices (f]$ ?r\gh ! ,,ihp4  7#b7     
,(f]+ heal? b5efits cov]age  7,a7       
,diff]5t gr\ps ,! ,,ihp1 9 conjunction )
 ^? heal? insurance issu]s t (f] heal?  

b5efits cov]age ?r\gh ! ,,ihp1 makes    
available heal? b5efits cov]age 9 !     
mann] describ$ 9 subsection 7b7 to all  
memb]s ( ! ,,ihp & ! dep5d5ts ( su*     
memb]s 7&1 9 ! case ( small employ]s1   
employees & _! dep5d5ts7 9 ! mann]      
describ$ 9 subsection 7c77#b7 at rates t
 are e/abli%$ by ! heal? insurance issu]
 on a policy or product specific basis &
 t may v>y = individuals cov]$ ?r\gh an 
,,ihp4  7,b7 ,nondiscrim9ation 9 cov]age
 (f]$  7i7 ,9 g5]al ,subject to clause  
7ii71 ! ,,ihp may n (f] heal? b5efits   
cov]age to a memb] ( an ,,ihp unless !  
same cov]age is (f]$ to all su* memb]s (
 ! ,,ihp4  7ii7 ,con/ruction ,no?+ 9 ?is
 title %all be con/ru$ z requir+ or     
p]mitt+ a heal? insurance issu] to      
provide cov]age outside ! s]vice area ( 
! issu]1 z approv$ "u ,/ate law1 or     
prev5t+ a heal? insurance issu] f       
und]writ+ or f exclud+ or limit+ !      
cov]age on any individual1 subject to ! 
requirem5t ( section #bgda 7relat+ to   
gu>ante$ availability ( individual heal?

 insurance cov]age to c]ta9 individuals 
) prior gr\p cov]age74  7,c7 ,no        
assumption ( insurance risk by ,,ihp ,! 
,,ihp provides heal? b5efits cov]age    
only ?r\gh contracts ) heal? insurance  
issu]s & does n assume insurance risk ) 
respect to su* cov]age4  7#c7           
,geographic areas ,no?+ 9 ?is title %all
 be con/ru$ z prev5t+ ! e/abli%m5t &    
op]ation ( m ?an "o ,,ihp 9 a geographic
 area or z limit+ ! numb] ( ,i,h,ps t   
may op]ate 9 any area4  7#d7 ,provision 
( adm9i/rative s]vices to pur*as]s ,!   
,,ihp may provide adm9i/rative s]vices =
 memb]s4 ,su* s]vices may include       
acc\nt+1 bill+1 & enrollm5t in=mation4  
7b7 ,heal? b5efits cov]age requirem5ts  
7#a7 ,compliance ) consum] protection   
requirem5ts ,except z provid$ 9 section 
#cdjb1 any heal? b5efits cov]age (f]$   
?r\gh an ,,ihp-- 7,a7 %all be issu$ by a
 heal? insurance issu] t meets all      
applicable ,/ate /&>ds relat+ to consum]
 protection2  7,b7 %all be approv$ or   
o!rwise p]mitt$ to be (f]$ "u ,/ate law2

 &  7,c7 may n impose any exclusion ( a 
specific disease f su* cov]age4  7#b7   
,wellness bonuses = heal? promotion     
,no?+ 9 ?is title %all be con/ru$ z     
preclud+ a heal? insurance issu] (f]+   
heal? b5efits cov]age ?r\gh an ,,ihp f  
e/abli%+ premium disc\nts or rebates =  
memb]s or f modify+ o!rwise applicable  
copaym5ts or d$uctibles 9 return =      
adh]5ce to programs ( heal? promotion & 
disease prev5tion s long z su* programs 
are agre$ to 9 advance by ! ,,ihp &     
comply ) all o!r provisions ( ?is title 
& d n discrim9ate among simil>ly situat$
 memb]s4  7c7 ,memb]s2 heal? insurance  
issu]s  7#a7 ,memb]s  7,a7 ,9 g5]al ,"u 
rules e/abli%$ to c>ry out ?is title1 ) 
respect to an individual or small       
employ] :o is a memb] ( an ,,ihp1 !     
individual may enroll = heal? b5efits   
cov]age 7includ+ cov]age = dep5d5ts (   
su* individual7 or employ] may enroll   
employees = heal? b5efits cov]age       
7includ+ cov]age = dep5d5ts ( su*       
employees7 (f]$ by a heal? insurance    

issu] ?r\gh ! ,,ihp4  7,b7 ,rules =     
enrollm5t ,no?+ 9 ?is p>agraph %all     
preclude an ,,ihp f e/abli%+ rules (    
enrollm5t & re5rollm5t ( memb]s4 ,su*   
rules %all be appli$ consi/5tly to all  
memb]s )9 ! ,,ihp & %all n be bas$ 9 any
 mann] on heal? /atus-relat$ factors4   
7#b7 ,heal? insurance issu]s ,! contract
 betwe5 an ,,ihp & a heal? insurance    
issu] %all provide1 ) respect to a memb]
 enroll$ ) heal? b5efits cov]age (f]$ by
 ! issu] ?r\gh ! ,,ihp1 = ! paym5t to ! 
issu] ( ! premiums 7if any7 collect$ by 
! ,,ihp = heal? insurance cov]age (f]$  
by ! issu]4  #cdjb4 ,application ( c]ta9
 laws & requirem5ts  7a7 ,preemption (  
,/ate laws re/rict+ =mation ( ,i,h,ps   
,any ,/ate law or regulation relat+ to !
 composition or organization ( an ,,ihp 
is preempt$ to ! ext5t ! law or         
regulation is inconsi/5t ) ! provisions 
( ?is title4  7b7 ,preemption ( ,/ate   
requirem5ts relat+ to heal? b5efit      
cov]age  7#a7 ,b5efit requirem5ts  7,a7 
,9 g5]al ,subject to subp>agraph 7,b71  

,/ate laws are sup]s$$1 & %all n apply  
to heal? b5efits cov]age made available 
?r\gh an ,,ihp1 ins(> z su* laws impose 
b5efit requirem5ts = su* cov]age1       
includ+ 7b n limit$ to7 requirem5ts     
relat+ to cov]age ( specific provid]s1  
specific s]vices or conditions1 or !    
am\nt1 duration1 or scope ( b5efits4    
7,b7 ,exception = f$]ally impos$        
requirem5ts & = requirem5ts prohibit+   
disease-specific exclusions ,subp>agraph
 7,a7 %all n apply to a requirem5t to ! 
ext5t ! requirem5t-- 7i7 implem5ts title
 ,,xxvii or o!r ,f$]al law2 or  7ii7    
prohibits imposition ( an exclusion ( a 
specific disease f heal? b5efits        
cov]age4  7#b7 ,o!r requirem5ts prev5t+ 
(f]+ ( cov]age ?r\gh an ,,ihp ,/ate laws
 are sup]s$$1 & %all n apply to heal?   
b5efits cov]age made available ?r\gh an 
,,ihp1 ins(> z su* laws impose any o!r  
requirem5ts 7includ+ limitations on     
comp5sation arrangem5ts7 t1 directly or 
indirectly1 preclude 7or h ! effect (   
preclud+7 ! (f]+ ( su* cov]age ?r\gh an 

,,ihp1 if ! ,,ihp meets ! requirem5ts ( 
?is title4  7c7 ,preemption ( ,/ate     
premium rat+ requirem5ts ,/ate laws are 
sup]s$$1 & %all n apply to ! premiums   
impos$ = heal? b5efits cov]age made     
available ?r\gh an ,,ihp1 ins(> z su*   
laws impose re/rictions on ! v>iation ( 
premiums among su* cov]age (f]$ to      
memb]s ( ! ,,ihp4  #cdjc4 ,def9itions ,=
 purposes ( ?is title3 7#a7 ,dep5d5t ,! 
t]m dep5d5t1 z appli$ to heal? insurance
 cov]age (f]$ by a heal? insurance issu]
 lic5s$ 7or o!rwise regulat$7 9 a ,/ate1
 %all h ! mean+ appli$ to su* t]m )     
respect to su* cov]age "u ! laws ( !    
,/ate relat+ to su* cov]age & su* an    
issu]4 ,su* t]m may include ! sp\se &   
*ildr5 ( ! individual involv$4  7#b7    
,heal? b5efits cov]age ,! t]m heal?     
b5efits cov]age has ! mean+ giv5 ! t]m  
heal? insurance cov]age 9 section       
#bgia7;b77#a71 & does n include except$ 
b5efits 7z def9$ 9 section #bgia7;c774  
7#c7 ,heal? insurance issu] ,! t]m heal?
 insurance issu] has ! mean+ giv5 su*   

t]m 9 section #bgia7;b77#b74  7#d7      
,heal? /atus-relat$ factor ,! t]m heal? 
/atus-relat$ factor has ! mean+ giv5 su*
 t]m 9 section #bgia7;d77#i74  7#e7     
,memb] ,! t]m memb] means1 ) respect to 
an ,,ihp1 an individual or small employ]
 :o is a memb] ( ! legal entity describ$
 9 section #cdja7;a77#a7 to :i* ! ,,ihp 
is (f]+ cov]age4  7#f7 ,small employ] ,!
 t]m small employ] has ! mean+ giv5 su* 
t]m 9 section #gab7;c77#a77;,b7 ( !     
,employee ,retirem5t & ,income ,security
 ,act ( #aigd4  4  #e4 ,requirem5ts =   
individual heal? insurance  7a7 ,9 g5]al
 ,section #bgda ( ! ,public ,heal?      
,s]vice ,act 7#db ,u4,s4,c4             
#cjj;gg-#da71 z re/or$ & reviv$ by      
section #c ( ?is ,act1 is am5d$--  7#a7 
9 subsection 7a7-- 7,a7 9 ! head+1 by   
/rik+ to c]ta9 individuals ) prior gr\p 
cov]age2  7,b7 9 p>agraph 7#a71 by /rik+
 & section #bgdd2  7,c7 9 p>agraph      
7#a77;,b71 by ins]t+ unless su*         
exclusion complies ) p>agraph 7#b7 be=e 
! p]iod2 &  7,d7 by /rik+ p>agraph 7#b7 

& ins]t+ ! foll[+ new p>agraphs3  7#b7  
,limitation on preexi/+ condition       
exclusion p]iod  7,a7 ,limitation ,a    
heal? insurance issu] (f]+ heal?        
insurance cov]age 9 ! individual m>ket  
may n1 ) respect to an enrollee 9 su*   
cov]age1 impose any preexi/+ condition  
exclusion if su* enrollee has at lea/   
#ah mon?s ( cont9u\s cr$itable cov]age  
7z def9$ 9 section #bgja7;c77#a77       
imm$iately prec$+ ! enrollm5t date4     
7,b7 ,imposition ( exclusion ,not)/&+   
p>agraph 7#a77;,b71 a heal? insurance   
issu] (f]+ heal? insurance cov]age 9 !  
individual m>ket may1 ) respect to an   
enrollee 9 su* cov]age :o is n describ$ 
9 subp>agraph 7,a71 impose a preexi/+   
condition exclusion only if--  7i7 su*  
exclusion relates to a condition 7:e!r  
physical or m5tal71 reg>dless ( ! cause 
( ! condition1 = :i* m$ical advice1     
diagnosis1 c>e1 or treatm5t 0 recomm5d$ 
or receiv$ )9 ! #f-mon? p]iod end+ on ! 
enrollm5t date2  7ii7 su* exclusion     
ext5ds = a p]iod ( n m ?an #ah mon?s    

aft] ! enrollm5t date2 &  7iii7 ! p]iod 
( any su* preexi/+ condition exclusion  
is r$uc$ by ! aggregate ( ! p]iods (    
cr$itable cov]age 7if any1 z def9$ 9    
section #bgja7;c77#a77 applicable to !  
enrollee z ( ! enrollm5t date4  7,c7    
,premium sur*>ge ,not)/&+ p>agraph 7#f71
 ) respect to an enrollee describ$ 9    
subp>agraph 7,b71 a heal? insurance     
issu] may *>ge a premium = ! cov]age    
involv$ t does n exce$ #aej p]c5t ( !   
applicable /&>d rate1 = n to exce$ #bd  
mon?s 7or #cf mon?s if ! heal? insurance
 issu] does n impose any preexi/+       
condition exclusion ) respect to su*    
enrollee71 r$uc$ by ! aggregate ( !     
p]iods ( cr$itable cov]age 7if any1 z   
def9$ 9 section #bgja7;c77#a77          
applicable to ! enrollee z ( ! enrollm5t
 date4 ,= purposes ( ?is subsection1 !  
t]m applicable /&>d rate means ! /&>d   
premium rate t ! issu] *>ges = ! cov]age
 involv$ ) respect to an individual     
describ$ 9 subp>agraph 7,a7 ) ! same    
rat+ *>act]i/ics or rat+ factors z !    

enrollee describ$ 9 subp>agraph 7,b71   
provid$ t any v>iations 9 /&>d premium  
rates are bas$ on ! uni=m application ( 
rat+ *>act]i/ics or rat+ factors t are  
p]mitt$ by ,/ate law & are n o!rwise    
prohibit$ by p>agraph 7#f74  7#c7       
,exceptions ,not)/&+ p>agraph 7#b71 &   
subject to subp>agraph 7,d71 a heal?    
insurance issu] (f]+ heal? insurance    
cov]age 9 ! individual m>ket1 may n     
impose any ( ! foll[+ preexi/+ condition
 exclusions3  7,a7 ,exclusion n         
applicable to c]ta9 newborns ,9 ! case (
 an individual :o1 z ( ! la/ day ( !    
#cj-;day p]iod beg9n+ ) ! date ( bir?1  
is a dep5d5t ( an enrollee 9 su*        
cov]age4  7,b7 ,exclusion n applicable  
to c]ta9 adopt$ *ildr5 ,9 ! case ( a    
*ild :o is adopt$ or plac$ = adoption   
be=e atta9+ #ah ye>s ( age & :o1 z ( !  
la/ day ( ! #cj-;day p]iod beg9n+ on !  
date ( ! adoption or placem5t =         
adoption1 is a dep5d5t ( an enrollee 9  
su* cov]age4 ,! previ\s s5t5ce %all n   
apply to cov]age be=e ! date ( su*      

adoption or placem5t = adoption4  7,c7  
,exclusion n applicable to pregnancy    
,relat+ to pregnancy z a preexi/+       
condition4  7,d7 ,loss if break 9       
cov]age ,subp>agraphs 7,a7 & 7,b7 %all  
no long] apply to an individual aft] !  
end ( ! fir/ #fc-;day p]iod dur+ all (  
:i* ! individual 0 n cov]$ "u any       
cr$itable cov]age4  7#d7 ,op5 enrollm5t 
p]iods ,a heal? insurance issu] (f]+    
heal? insurance cov]age 9 ! individual  
m>ket may limit ! applicability ( !     
provisions ( p>agraph 7#a7 to s*$ul$ op5
 enrollm5t p]iods1 provid$ t--  7,a7 any
 su* op5 enrollm5t p]iod %all n be less 
?an #cj days2  7,b7 any p]iod betwe5    
s*$ul$ op5 enrollm5t p]iods %all n exce$
 #bd mon?s2 &  7,c7 su* limitation %all 
n apply to any individual :o qualifies =
 a special enrollm5t p]iod "u p>agraph  
7#e74  7#e7 ,special enrollm5t p]iods   
,subject to subp>agraphs 7,e7 & 7,f71 a 
heal? insurance issu] (f]+ heal?        
insurance cov]age 9 ! individual m>ket  
%all p]mit an individual :o is an       

eligible individual or a dep5d5t to     
enroll 9 cov]age dur+ a special         
enrollm5t p]iod if ! individual         
exp]i5ces any ( ! foll[+ qualify+ ev5ts3
  7,a7 ,= dep5d5t b5efici>ies ,!        
individual becomes1 by reason ( m>riage1
 bir?1 adoption or placem5t = adoption1 
a dep5d5t ( an individual enroll$ 9 a   
plan (f]$ by ! heal? insurance issu] &  
su* individual o!rwise qualifies1 "u !  
t]ms ( ! plan1 z eligible = cov]age z a 
dep5d5t ( su* enrollee4  7,b7 ,loss (   
gr\p cov]age ,! individual loses cov]age
 "u a gr\p heal? plan z a result (-- 7i7
 loss ( eligibility = ! cov]age 7includ+
 z a result ( legal sep>ation1 divorce1 
dea?1 atta9+ an age at :i* eligibility  
t]m9ates1 t]m9ation ( employm5t1 or     
r$uction 9 ! numb] ( h\rs ( employm5t72 
or  7ii7 t]m9ation ( ! cov]age by ! plan
 sponsor4  7,c7 ,loss ( individual      
cov]age ,! individual loses individual  
m>ket cov]age z a result (--  7i7       
discont9uation ( a plan z a result ( a  
heal? insurance issu] ceas+ to (f]      

cov]age 9 ! individual m>ket 9          
accordance ) section #bgdb7;c77#b7 7#db 
,u4,s4,c4 #cjj;gg-#db7;c77#b77 ( ?is    
title2  7ii7 expiration ( ,,cobra1 or   
o!r1 cont9uation cov]age2  7iii7 ceas+  
to qualify1 "u ! t]ms ( ! cov]age1 z a  
dep5d5t 7includ+ z a result ( legal     
sep>ation1 divorce1 dea?1 or atta9+ an  
age at :i* eligibility t]m9ates72 &     
7iv7 p]man5tly mov+ outside ! ,/ate 9   
:i* ! cov]age 0 issu$1 or 9 ! case ( a  
network plan1 outside ! plan's s]vice   
area4  7,d7 ,loss ( eligibility = a     
gov]nm5t cov]age program ,! individual  
loses cov]age by ceas+ to be eligible = 
cov]age "u any ( ! foll[+3 7i7 ,"p ,a or
 "p ,b ( title ,,xviii ( ! ,social      
,security ,act 7#db ,u4,s4,c4 #acie;c et
 seq42 #acie;j et seq474  7ii7 ,title   
,,xix ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acif et seq471 o!r ?an       
cov]age consi/+ solely ( b5efits "u     
section #aibh 7#db ,u4,s4,c4 #acifs74   
7iii7 ,title ,,xxi ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acig;aa et seq474 

7iv7 ,*apt] #ee ( title #aj4  7v7 ,*apt]
 #hi ( title #e4  7vi7 ,a ,/ate heal?   
b5efits risk pool4  7,e7 ,loss ( cov]age
 describ$ ,= purposes ( ?is p>agraph1   
loss ( cov]age %all n include any ( !   
foll[+3 7i7 ,volunt>y t]m9ation (       
cov]age by an individual1 except if su* 
t]m9ation is ! result ( circum/ances    
describ$ 9 subp>agraph 7,c77iv74  7ii7  
,t]m9ation ( cov]age by ! issu] or !    
plan sponsor ( ! cov]age = any reason   
describ$ 9 p>agraph 7#a7 or 7#b7 (      
section #bgdb7;b7 7#cjj;gg-#db7;b77 (   
?is title4  7iii7 ,loss ( any cov]age t 
consi/s solely ( cov]age ( except$      
b5efits 7z def9$ 9 section              
#cjj;gg-#ia7;c7 ( ?is title74  7,f7     
,limitation on special enrollm5t p]iod  
,any special enrollm5t p]iod %all n be  
less ?an #fj days & %all beg9 on ! date 
( ! qualify+ ev5t4  7#f7 ,/&>d premium  
rates ,) respect to ! premium rate *>g$ 
by a heal? insurance issu] = heal?      
insurance cov]age (f]$ 9 ! individual   
m>ket1 su* rate1 ) respect to ! p>ticul>

 plan or cov]age involv$1 %all n v>y    
bas$ on any ( ! foll[+ heal?            
/atus-relat$ factors 9 relation to an   
eligible individual or dep5d5t3  7,a7   
,heal? /atus4  7,b7 ,m$ical condition   
7includ+ bo? physical & m5tal           
illnesses74  7,c7 ,claims exp]i5ce4     
7,d7 ,receipt ( heal? c>e4  7,e7 ,m$ical
 hi/ory4  7,f7 ,g5etic in=mation4  7,g7 
,evid5ce ( insurability 7includ+        
conditions aris+ out ( acts ( dome/ic   
viol5ce74  7,h7 ,disability4  2  7#b7 by
 am5d+ subsection 7b7 to read z foll[s3 
7b7 ,def9itions ,= purposes ( ?is       
section3  7#a7 ,eligible individual ,!  
t]m eligible individual means an        
individual :o is eligible "u applicable 
,/ate law to pur*ase individual heal?   
insurance cov]age 9 ! ,/ate4  7#b7      
,dep5d5t ,! t]m dep5d5t means an        
individual :o1 "u ! t]ms ( ! cov]age &  
applicable ,/ate law1 qualifies to      
enroll 9 su* cov]age z a dep5d5t ( an   
individual describ$ 9 p>agraph 7#a74  2 
&  7#c7 by /rik+ subsection 7c7 &       

r$esignat+ subsection 7d7 & ! fir/      
subsection 7e7 z subsections 7c7 & 7d71 
respectively4  7b7 ,con=m+ am5dm5t      
,section #bgdd ( ! ,public ,heal?       
,s]vice ,act 7#db ,u4,s4,c4             
#cjj;gg-#dd71 z re/or$ & reviv$ by      
section #c ( ?is ,act1 is repeal$4  7c7 
,effective date ,subject to section     
#a7;c71 ! am5dm5ts made by ?is section  
%all apply ) respect to heal? insurance 
cov]age (f]$ = plan ye>s beg9n+ on or   
aft] ! ,k+ v4 ,burwell effective date4