,i  #aaeth ,,congress  #ast ,session    
,h4 ,r4 #dfbj  ,,in ,,the ,,house ,,of  
,,representatives  ,december #ab1       
#bjag,mrs4 ,noem 7for herself and ,ms4  
,sinema7 introduced the following bill2 
which was referred to the ,committee on 
,energy and ,commerce1 and in addition  
to the ,committee on ,ways and ,means1  
for a period to be subsequently         
determined by the ,speaker1 in each case
 for consideration of such provisions as
 fall within the jurisdiction of the    
committee concerned  ,a ,,bill  ,to     
amend the ,patient ,protection and      
,affordable ,care ,act to provide       
temporary relief from the annual fee    
imposed on health insurance providers4  
#a4 ,short title ,this ,act may be cited
 as the ,protecting ,families and ,small
 ,businesses ,act of #bjag4  #b4 ,relief
 from annual fee on health insurance    
providers  7a7 ,partial relief for #bjah
 for certain providers  7#a7 ,in general
 ,section #ijaj of the ,patient         
,protection and ,affordable ,care ,act  

is amended by adding at the end the     
following new subsection3  7k7 ,optional
 relief for #bjah  7#a7 ,in general ,in 
the case of a covered entity that meets 
the requirements of paragraph 7#b71 the 
fee described in subsection 7a77#a7     
shall be reduced by the sum of the      
premium rebates provided pursuant to    
paragraph 7#b74  7#b7 ,rebates for      
individuals ,a covered entity meets the 
requirements of this paragraph if such  
entity demonstrates to the satisfaction 
of the ,secretary of the ,treasury 7in  
consultation with the ,secretary of     
,health and ,human ,services1           
,administrator of the ,centers for      
,medicare and ,medicaid ,services1 and  
the ,national ,association of ,insurance
 ,commissioners1 as appropriate7 that   
such entity will provide--  7,a7 not    
later than ,april #cj1 #bjai1 to each   
individual enrolled in calendar year    
#bjah in a qualified rebate plan offered
 by such entity a premium rebate equal  
to the lesser of--  7i7 #b percent of   

the net premiums written for coverage   
under such plan for such individual for 
calendar year #bjah1 or  7ii7 the amount
 of the premiums described in           
subparagraph 7,a7 paid by such          
individual1 and  7,b7 for individuals   
who will receive a premium rebate       
described in subparagraph 7,a7 after    
,september #cj1 #bjah1 notice to such   
individuals by such date of such premium
 rebate4  7#c7 ,qualified rebate plan   
,for purposes of this subsection1 the   
term qualified rebate plan means1 with  
respect to a covered entity1 any        
combination1 as elected by the covered  
entity1 of the following categories of  
health plans3  7,a7 ,a health plan      
offered in the individual market4  7,b7 
,a health plan offered in the group     
market4  7,c7 ,a ,medicare ,advantage   
plan under part ,c of title ,,xviii of  
the ,social ,security ,act4  7,d7 ,a    
prescription drug plan offered under    
part ,d of such title ,,xviii4  7#d7    
,reduction in premiums treated as       

rebates ,for purposes of this           
subsection1 a reduction in premiums owed
 by an individual for a month shall be  
treated as a premium rebate paid to such
 individual on the first day of such    
month4  7l7 ,medicaid managed care plans
 reduction for #bjah ,in the case of a  
medicaid managed care organization 7as  
defined in section #aijc7m77#a77;,a7 of 
the ,social ,security ,act71 the fee    
described in subsection 7a77#a7 shall be
 reduced by an amount equal to #b       
percent of the net premiums written for 
coverage under a medicaid managed care  
plan 7under section #aijc7m7 or section 
#aicb of such ,act7 for calendar year   
#bjah4  4  7#b7 ,conforming amendment   
,paragraph 7#a7 of section #ijaj7;b7 of 
the ,patient ,protection and ,affordable
 ,care ,act is amended by striking the  
fee under this section and inserting the
 amount determined under this           
subsection4  7b7 ,relief for #bjai  7#a7
 ,in general ,section #ijaj7;j7 of the  
,patient ,protection and ,affordable    

,care ,act is amended by striking and at
 the end of paragraph 7#a71 by striking 
the period at the end of paragraph 7#b7 
and inserting 1 and ending before       
,january #a1 #bjai1 and1 and by adding  
at the end the following new paragraph3 
7#c7 beginning after ,december #ca1     
#bjai4  4  7c7 ,medical loss ratio      
,section #bgah of the ,public ,health   
,service ,act is amended by adding at   
the end the following new subsection3   
7f7 ,amounts expended for premium       
rebates not included ,no amount expended
 pursuant to subsections 7k7 or 7l7 of  
section #ijaj of the ,patient           
,protection and ,affordable ,care ,act  
shall be taken into account for purposes
 of this section4  4  7d7 ,effective    
date  7#a7 ,the amendments made by      
subsections 7a7 and 7b7 shall apply with
 respect to calendar years beginning    
after ,december #ca1 #bjag4  7#b7 ,the  
amendment made by subsection 7c7 shall  
apply with respect to plan years        
beginning after ,december #ca1 #bjag4