,,ii  #aag? ,,congress  #a/ ,session    
,s4 #ajjb  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,m>* #be1 #bjba ,mr4   
,casey 7= himself1 ,ms4 ,baldw91 & ,ms4 
,/ab5[7 introduc$ ! foll[+ bill2 :i* 0  
read twice & ref]r$ to ! ,committee on  
,heal?1 ,education1 ,labor1 & ,p5sions  
,a ,,bill  ,to prohibit false or        
mislead+ adv]tis+ = heal? insurance     
cov]age1 require w>n+s & report+ )      
respect to noncompreh5sive heal? plans1 
enc\rage enrollm5t 9 heal? plans1 & =   
o!r purposes4  #a4 ,%ort title2 table ( 
cont5ts  7a7 ,%ort title ,?is ,act may  
be cit$ z ! ,junk ,plan ,acc\ntability &
 ,disclosure ,act ( #bjba4  7b7 ,table (
 cont5ts ,! table ( cont5ts = ?is ,act  
is z foll[s3  ,sec4 #a4 ,%ort title2    
table ( cont5ts4 ,,title                
,i--,prohibition ( false or mislead+    
onl9e adv]tis+ = heal? insurance cov]age
 ,sec4 #aja4 ,def9itions4 ,sec4 #ajb4   
,,ftc ov]sight ( onl9e heal? insurance  
adv]tisem5ts4 ,,title ,,ii--,w>n+s &    
report+ requirem5ts = noncompreh5sive   

heal? plans ,sec4 #bja4 ,def9itions4    
,sec4 #bjb4 ,requirem5ts = notice reg>d+
 b5efits4 ,sec4 #bjc4 ,report+          
requirem5ts4 ,sec4 #bjd4 ,en=cem5t4     
,sec4 #bje4 ,regulations4 ,,title       
,,iii--,enc\rag+ enrollm5t 9 heal? plans
 ,sec4 #cja4 ,s5se ( ,congress4 ,sec4   
#cjb4 ,requir+ ,m>ketplace outrea*1     
educational activities1 & annual        
enrollm5t t>gets4 ,sec4 #cjc4 ,report on
 effects ( website ma9t5ance dur+ op5   
enrollm5t4 ,sec4 #cjd4 ,promot+ consum] 
outrea* & education4 ,sec4 #cje4        
,improv+ transp>5cy & acc\ntability 9 ! 
,m>ketplace4 ,sec4 #cjf4 ,improv+       
aw>5ess ( heal? cov]age options4 ,sec4  
#cjg4 ,promot+ ,/ate innovations to exp&
 cov]age4  ,i ,prohibition ( false or   
mislead+ onl9e adv]tis+ = heal?         
insurance cov]age  #aja4 ,def9itions ,9 
?is title3 7#a7 ,commission ,! t]m      
,commission means ! ,f$]al ,trade       
,commission4  7#b7 ,heal? insurance     
cov]age ,! t]m heal? insurance cov]age  
means b5efits consi/+ ( m$ical c>e      

7provid$ directly1 ?r\gh insurance or   
reimbursem5t1 or o!rwise & includ+ items
 & s]vices paid = z m$ical c>e1 b       
exclud+ any gr\p heal? plan7 t are (f]$ 
to individuals1 includ+-- 7,a7 a plan   
(f]$ ?r\gh an association2  7,b7        
%ort-t]m limit$ duration insurance2     
7,c7 a policy = su* b5efits t is n (f]$ 
by a heal? insurance issu] 7z su* t]m is
 def9$ 9 section #bgia7;b77#b7 ( !      
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;gg-#ia7;b77#b772 &  7,d7 
o!r heal? c>e arrangem5ts t are n heal? 
plans4  7#c7 ,non-,,aca compliant heal? 
insurance cov]age ,! t]m non-,,aca      
compliant heal? insurance cov]age has ! 
mean+ giv5 su* t]m 9 p>agraph 7#c7 (    
section #acba7;c7 ( ! ,pati5t           
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjda7;c77 7z add$ by section
 #cjb74  7#d7 ,onl9e plat=m ,! t]m onl9e
 plat=m means any public-fac+ website1  
web application1 or digital application1
 includ+ a se>* eng9e or social network4
  7#e7 ,qualifi$ heal? plan ,! t]m      

qualifi$ heal? plan has ! mean+ giv5 su*
 t]m 9 section #acja7;a7 ( ! ,pati5t    
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjba7;a774  #ajb4 ,,ftc     
ov]sight ( onl9e heal? insurance        
adv]tisem5ts  7a7 ,prohibitions = onl9e 
private heal? insurance adv]tisem5t     
7#a7 ,9 g5]al ,subject to p>agraph 7#c71
 a p]son may n po/1 publi%1 or o!rwise  
display on ! int]net a deceptive        
adv]tisem5t = heal? insurance cov]age4  
7#b7 ,deceptive ,an onl9e adv]tisem5t = 
heal? insurance cov]age %all be consid]$
 deceptive if x--  7,a7 is likely to    
mislead1 or has ! effect ( mislead+1 a  
reasonable individual to believe t su*  
adv]tisem5t is made by1 ?r\gh1 or on    
behalf (-- 7i7 ,heal?c>e4gov2  7ii7 a   
,/ate or ,f$]al ,am]ican ,heal? ,b5efit 
,ex*ange describ$ 9 sections #acaa &    
#acba ( ! ,pati5t ,protection &         
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjca1 #ahjda72 or  7iii7 any o!r      
,f$]al1 ,/ate1 or local gov]nm5t entity2
  7,b7 is likely to mislead1 or has !   

effect ( mislead+1 a reasonable         
individual ab\t-- 7i7 ! relative co/ (  
enroll+ 9 non-,,aca compliant heal?     
insurance cov]age z comp>$ to ! co/ (   
enroll+ 9 a qualifi$ heal? plan2  7ii7 !
 relative actu>ial value ( non-,,aca    
compliant heal? insurance cov]age z     
comp>$ to a qualifi$ heal? plan2 or     
7iii7 ! relative scope ( b5efits (      
non-,,aca compliant heal? insurance     
cov]age z comp>$ to a qualifi$ heal?    
plan2  7,c7 is likely to mislead1 or has
 ! effect ( mislead+1 a reasonable      
individual to believe t ! heal?         
insurance cov]age adv]tis$-- 7i7        
complies ) ! requirem5ts = qualifi$     
heal? plans "u ! ,pati5t ,protection &  
,af=dable ,c>e ,act 7,public ,law       
#aaa-adh71 al?\gh ! heal? insurance     
cov]age does n meet su* requirem5ts2 or 
7ii7 provides cov]age = b5efits t are n 
cov]$ by su* heal? insurance cov]age2 or
  7,d7 is likely to mislead1 or has !   
effect ( mislead+1 a reasonable         
individual reg>d+ ! scope1 co/1 or      

duration ( cov]age ( ! heal? insurance  
cov]age be+ adv]tis$4  7#c7 ,liability (
 onl9e plat=ms ,if a p]son :o is        
unrelat$ to ! op]ator ( an onl9e plat=m 
pays or arranges to po/1 publi%1 or     
o!rwise display an adv]tisem5t t        
violates p>agraph 7#a7 on ! onl9e       
plat=m-- 7,a7 su* p]son %all be deem$ to
 h committ$ ! violation ( su* p>agraph2 
&  7,b7 ! op]ator ( ! onl9e plat=m %all 
n be liable = a violation ( su*         
p>agraph4  7b7 ,en=cem5t by !           
,commission  7#a7 ,unfair or deceptive  
acts or practice ,a violation ( ?is     
section or a regulation promulgat$ "u   
?is section %all be treat$ z a violation
 ( a rule def9+ an unfair or deceptive  
act or practice "u section              
#ah7;a77#a77;,b7 ( ! ,f$]al ,trade      
,commission ,act 7#ae ,u4,s4,c4         
#eg;a7a77#a77;,b774  7#b7 ,p[]s ( !     
,f$]al ,trade ,commission  7,a7 ,9 g5]al
 ,except z provid$ 9 subp>agraph 7,c71 !
 ,commission %all en=ce ?is section 9 ! 
same mann]1 by ! same means1 & ) ! same 

jurisdiction1 p[]s1 & duties z ?\gh all 
applicable t]ms & provisions ( ! ,f$]al 
,trade ,commission ,act 7#ae ,u4,s4,c4  
#da et seq47 7 incorporat$ into & made a
 "p ( ?is section4  7,b7 ,privileges &  
immunities ,any p]son :o violates ?is   
section or a regulation promulgat$ "u   
?is section %all be subject to !        
p5alties & entitl$ to ! privileges &    
immunities provid$ 9 ! ,f$]al ,trade    
,commission ,act 7#ae ,u4,s4,c4 #da et  
seq474  7,c7 ,nonpr(it organizations &  
insurance ,not)/&+ section #d or #f ( ! 
,f$]al ,trade ,commission ,act 7#ae     
,u4,s4,c4 #dd1 #df71 section #b (       
,mc,carran-,f]guson ,act 7#ae ,u4,s4,c4 
#ajab71 or any o!r jurisdictional       
limitation ( ! ,commission1 !           
,commission %all also en=ce ?is section 
& ! regulations promulgat$ "u ?is       
section1 9 ! same mann] provid$ 9       
subp>agraphs 7,a7 & 7,b7 ( ?is p>agraph1
 ) respect to-- 7i7 organizations n     
organiz$ to c>ry on bus9ess = _! own    
pr(it or t ( _! memb]s2 &  7ii7 !       

bus9ess ( insurance1 & p]sons engag$ 9  
su* bus9ess4  7,d7 ,cont9u$             
applicability ( ,/ate law  7i7 ,9 g5]al 
,?is section %all only sup]s$e a ,/ate  
law to ! ext5t t ?is section is         
inconsi/5t ) o!rwise applicable ,/ate   
law4  7ii7 ,cl>ification ,a ,/ate law t 
provides additional protections to      
consum]s ?an ^? protections provid$ 9   
?is ,act %all n be consid]$ inconsi/5t )
 ?is ,act = purposes ( clause 7i74  7#c7
 ,rulemak+ ,! ,commission %all          
promulgate 9 accordance ) section #eec (
 title #e1 ,unit$ ,/ates ,code1 su*     
rules z may be necess>y to c>ry out ?is 
,act4  7#d7 ,au?ority pres]v$ ,no?+ 9   
?is ,act %all be con/ru$ to limit !     
au?ority ( ! ,commission "u any o!r     
provision ( law4  7c7 ,,gao /udy &      
report  7#a7 ,/udy ,! ,comptroll] ,g5]al
 ( ! ,unit$ ,/ates %all conduct a /udy  
on ! effectiv5ess ( ! ,commission's     
ov]sight ( onl9e adv]tisem5ts = heal?   
insurance cov]age pursuant to ?is       
section dur+ ! p]iod :i* beg9s on ! date

 ( enactm5t ( ?is ,act & ends #c ye>s   
!reaft]4 ,su* /udy %all include !       
foll[+3  7,a7 ,! numb] ( en=cem5t       
actions dur+ su* p]iod tak5 by !        
,commission relat$ to ! ov]sight ( onl9e
 adv]tisem5ts = heal? insurance cov]age 
"u ?is section4  7,b7 ,a description ( !
 outcome ( any su* en=cem5t action4     
7,c7 ,a description ( any b>ri] to !    
,commission's en=cem5t au?ority "u ?is  
section 9 relation to su* adv]tisem5ts4 
7,d7 ,a description ( h[ ! ,commission's
 ov]sight ( onl9e adv]tisem5ts = heal?  
insurance cov]age has protect$ consum]s1
 includ+ ?r\gh means o!r ?an en=cem5t   
actions4  7#b7 ,report ,n lat] ?an #d   
ye>s aft] ! date ( enactm5t ( ?is ,act1 
! ,comptroll] ,g5]al ( ! ,unit$ ,/ates  
%all submit to ,congress a report       
conta9+ ! results ( ! /udy conduct$ "u  
p>agraph 7#a71 toge!r ) recomm5dations =
 su* legislation & adm9i/rative action z
 ! ,comptroll] ,g5]al det]m9es          
appropriate4  ,,ii ,w>n+s & report+     
requirem5ts = noncompreh5sive heal?     

plans  #bja4 ,def9itions ,9 ?is title3  
7#a7 ,applicable heal? plan ,! t]m      
applicable heal? plan-- 7,a7 means      
7except z provid$ 9 subp>agraph 7,b77-- 
7i7 heal? insurance cov]age 9 !         
individual m>ket provid+ except$        
b5efits1 exclud+-- 7,i7 automobile      
liability insurance describ$ 9 p>agraph 
7#a77;,c7 ( section #bgia7;c7 ( !       
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;gg-#ia7;c772  7,,ii7     
automobile m$ical paym5t insurance      
describ$ 9 p>agraph 7#a77;,e7 ( su*     
section2  7,,iii7 limit$ scope d5tal or 
vision b5efits describ$ 9 p>agraph      
7#b77;,a7 ( su* section2  7,,iv7 work]s'
 comp5sation1 or simil> insurance1      
describ$ 9 p>agraph 7#a77;,d7 ( su*     
section2  7,v7 cov]age = on-site m$ical 
cl9ics describ$ 9 p>agraph 7#a77;,g7 (  
su* section2 or  7,,vi7 m$ic>e          
supplem5tal heal? insurance 7z def9$ "u 
section #ahhb7;g77#a7 ( ! ,social       
,security ,act7 or cov]age supplem5tal  
to ! cov]age provid$ "u *apt] #ee (     

title #aj1 ,unit$ ,/ates ,code2  7ii7   
/ud5t heal? insurance cov]age1 z def9$ 9
 section #adg4ade7;a7 ( title #de1 ,code
 ( ,f$]al ,regulations 7or a successor  
regulation72  7iii7 %ort-t]m limit$     
duration insurance1 z def9$ 9 section   
#add4ajc ( title #de1 ,code ( ,f$]al    
,regulations 7or a successor            
regulation72  7iv7 any heal? c>e        
arrangem5t = b5efits or paym5ts = m$ical
 c>e (f]$ to individuals ?r\gh an       
association2 &  7v7 any o!r heal? c>e   
arrangem5t = b5efits or paym5ts = m$ical
 c>e 7o!r ?an "u a ,f$]al heal? c>e     
program7 t is n heal? insurance cov]age1
 or a gr\p heal? plan1 = purposes (     
title ,,xxvii ( ! ,public ,heal? ,s]vice
 ,act 7#db ,u4,s4,c4 #cjj;gg et seq471  
"p #g ( subtitle ,b ( title ,i ( !      
,employee ,retirem5t ,income ,security  
,act ( #aigd 7#bi ,u4,s4,c4 #aaha et    
seq471 or *apt] #ajj ( ! ,int]nal       
,rev5ue ,code ( #aihf1 includ+ su* an   
arrangem5t (f]$ by a ,/ate f>m bureau or
 a heal? c>e %>+ m9i/ry2 &  7,b7 does n 

include--  7i7 any gr\p heal? plan2     
7ii7 any gr&fa!r$ heal? plan2 &  7iii7  
any heal? insurance cov]age to :i* !    
transitional policy1 describ$ 9 ! lett] 
issu$ on ,novemb] #ad1 #bjac1 by !      
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices to  
insurance commission]s1 or an ext5sion (
 su* policy1 applies4  7#b7 ,applicable 
,/ate au?ority2 except$ b5efits2        
,ex*ange ,! t]ms applicable ,/ate       
au?ority1 except$ b5efits1 & ,ex*ange h 
! mean+s giv5 su* t]ms 9 section #bgia (
 ! ,public ,heal? ,s]vice ,act 7#db     
,u4,s4,c4 #cjj;gg-#ia74  7#c7 ,f$]al    
heal? c>e program ,! t]m ,f$]al heal?   
c>e program has ! mean+ giv5 su* t]m "u 
section #aabh;,b7f7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#acbj;a-#g;b7f771 except t su* t]m      
includes ! heal? insurance program "u   
*apt] #hi ( title #e1 ,unit$ ,/ates     
,code4  7#d7 ,gr&fa!r$ heal? plan ,! t]m
 gr&fa!r$ heal? plan has ! mean+ giv5   
su* t]m 9 section #abea7;e7 ( ! ,pati5t 
,protection & ,af=dable ,c>e ,act 7#db  

,u4,s4,c4 #ahjaa7;e774  7#e7 ,gr\p heal?
 plan ,! t]m gr\p heal? plan has ! mean+
 giv5 su* t]m 9 section #bgia ( !       
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;gg-#ia74  7#f7 ,heal? c>e
 %>+ m9i/ry ,! t]m heal? c>e %>+ m9i/ry 
has ! mean+ giv5 su* t]m 9 section      
#ejjj;,a7d77#b77;,b77ii7 ( ! ,int]nal   
,rev5ue ,code ( #aihf4  7#g7 ,heal?     
insurance cov]age2 heal? insurance      
issu]2 individual m>ket ,! t]ms heal?   
insurance cov]age1 heal? insurance      
issu]1 & individual m>ket h ! mean+s    
giv5 su* t]ms 9 section #bgia ( !       
,public ,heal? ,s]vice ,act4  7#h7      
,non-,,aca compliant heal? insurance    
cov]age ,! t]m non-,,aca compliant heal?
 insurance cov]age has ! mean+ giv5 su* 
t]m 9 p>agraph 7#c7 ( section #acba7;c7 
( ! ,pati5t ,protection & ,af=dable ,c>e
 ,act 7#db ,u4,s4,c4 #ahjda7;c77 7z add$
 by section #cjb71 except t su* t]m %all
 n include any ,f$]al heal? c>e program4
  7#i7 ,pla9 language ,! t]m pla9       
language has ! mean+ giv5 ! t]m pla9    

writ+ 9 section #c ( ! ,pla9 ,writ+ ,act
 ( #bjaj 7#e ,u4,s4,c4 #cja note74      
7#aj7 ,secret>y ,! t]m ,secret>y means !
 ,secret>y ( ,heal? & ,human ,s]vices4  
#bjb4 ,requirem5ts = notice reg>d+      
b5efits  7a7 ,9 g5]al ,ea* applicable   
heal? plan %all (f] to consum]s1 prior  
to enrollm5t1 enrollm5t mat]ial t       
includes-- 7#a7 a pla9 language         
explanation ( ! b5efits includ$ 9 su*   
plan1 includ+ ?r\gh =ms t are culturally
 & l+ui/ically appropriate = su*        
consum]s2 &  7#b7 a w>n+ page reg>d+ su*
 b5efits 9 accordance ) subsection 7b74 
7b7 ,w>n+ page  7#a7 ,9 g5]al ,! w>n+   
page requir$ "u subsection 7a77#b7 %all 
include--  7,a7 a cle> /atem5t indicat+ 
t ! applicable heal? plan is n a        
compreh5sive heal? plan because x is n  
requir$ to comply ) c]ta9 requirem5ts "u
 ! ,pati5t ,protection & ,af=dable ,c>e 
,act 7,public ,law #aaa-adh7 & title    
,,xxvii ( ! ,public ,heal? ,s]vice ,act 
7#db ,u4,s4,c4 #cjj;gg et seq472  7,b7 a
 /atem5t enc\rag+ ! consum] to review ! 

plan docum5ts c>efully to ensure !      
individual is aw>e (--  7i7 any         
exclusions or limitations reg>d+ cov]age
 ( preexi/+ conditions or heal? b5efits 
7su* z hospitalization1 em]g5cy s]vices1
 mat]nity c>e1 prev5tive c>e1           
prescription drugs1 & m5tal heal? &     
sub/ance use disord] s]vices72 &  7ii7  
any lifetime or annual doll> limits on  
heal? b5efits2  7,c7 a /atem5t notify+ !
 consum] t1 if ! plan expires or !      
individual loses eligibility = ! plan1 !
 individual may h to wait until ! beg9n+
 ( an op5 enrollm5t p]iod to enroll 9   
ano!r plan2  7,d7 a /atem5t notify+ !   
consum] ( ! option to enroll 9 a        
qualifi$ heal? plan1 :i* is g5]ally a m 
compreh5sive heal? plan1 ?r\gh !        
,ex*ange op]at+ 9 ! ,/ate1 includ+--    
7i7 a /atem5t t mo/ consum]s :o enroll 9
 a qualifi$ heal? plan receive help pay+
 = _! mon?ly premiums2  7ii7 a /atem5t t
 special enrollm5t p]iods are available 
?r\gh ! ,ex*ange2  7iii7 a l9k to       
,heal?c>e4gov 7or a successor website7  

or ano!r website = ! ,ex*ange op]at+ 9 !
 ,/ate2 &  7iv7 ! phone numb] = !       
,ex*ange op]at+ 9 ! ,/ate2 &  7,e7 a l9e
 = ! signature ( ! consum] to ackn[l$ge 
t ! consum] has read & und]/&s !        
provisions 9 ! w>n+ page1 & = ! date on 
:i* su* signature is provid$4  7#b7     
,accessibility  7,a7 ,9 g5]al ,! w>n+   
page requir$ "u subsection 7a77#b7 %all 
be--  7i7 locat$ at ! beg9n+ ( !        
enrollm5t mat]ial1  7ii7 accessible to p
 ) disabilities1 includ+ a physical1    
cognitive1 or s5sory disability1 includ+
 accessibility to su* p ?r\gh ! use (   
comput]s & o!r te*nology = receiv+      
consum] in=mation2 &  7iii7 writt5 9    
pla9 language t is easily und]/ood by   
individuals ) an intellectual or o!r    
cognitive or process+ disability4  7,b7 
,multiple languages ,an applicable heal?
 plan %all make ! w>n+ page requir$ "u  
subsection 7a77#b7 available 9 ! top #ae
 languages spok5 by individuals ) limit$
 ,engli% pr(ici5cy 9 ! ,/ate 9 :i* !    
plan is (f]$4  7,c7 ,re/riction on      

promot+ enrollm5t 9 non-,,aca compliant 
heal? insurance cov]age ,! w>n+ page    
requir$ "u subsection 7a77#b7 %all n    
include any provision-- 7i7 promot+     
enrollm5t 9 any non-,,aca compliant     
heal? insurance cov]age2 or  7ii7       
direct+ consum]s to a s\rce t c\ld      
enroll ! consum] 9 any non-,,aca        
compliant heal? insurance cov]age4  7#c7
 ,additional ,/ate requirem5ts ,a ,/ate 
may require applicable heal? plans to   
include in=mation1 9 addition to !      
in=mation requir$ "u ?is section1 9 !   
w>n+ page requir$ "u subsection 7a77#b71
 except t any su* additional in=mation  
%all n--  7,a7 replace ! in=mation      
requir$ "u ?is section2  7,b7 promote   
enrollm5t 9 any non-,,aca compliant     
heal? insurance cov]age2  7,c7 direct   
consum]s to a s\rce t c\ld enroll !     
consum] 9 any non-,,aca compliant heal? 
insurance cov]age2 or  7,d7 o!rwise     
conflict ) a requirem5t "u ?is section4 
7c7 ,records ( signatures  7#a7 ,9 g5]al
 ,an adm9i/rator ( an applicable heal?  

plan %all ma9ta9 a record ( ! signature 
( a consum] obta9$ "u subsection        
7b77#a77;,e7 :ile ! consum] is enroll$ 9
 ! plan & =1 at a m9imum1 #b ye>s aft] !
 consum] is no long] enroll$ 9 su* plan4
 ,! ,secret>y may1 ?r\gh regulations "u 
section #bje1 require an applicable     
heal? plan to ma9ta9 su* record = a     
p]iod long] ?an #b ye>s aft] ! consum]  
is no long] enroll$ 9 ! plan4  7#b7     
,reimbursem5t  7,a7 ,9 g5]al ,9 ! case t
 a consum] claims1 )9 ! p]iod & 9       
accordance ) ! proc$ures describ$ 9     
subp>agraph 7,c71 t an applicable heal? 
plan did n cov] a heal? b5efit :ile !   
consum] 0 enroll$ 9 su* plan & !        
adm9i/rator ( su* plan is n able to     
provide pro( ( ! record requir$ "u      
p>agraph 7#a7 ) respect to t consum]1 ! 
plan %all reimburse ! consum]1 9 an     
am\nt det]m9$ "u subp>agraph 7,b71 = su*
 b5efit4  7,b7 ,am\nt  7i7 ,9 g5]al     
,except z provid$ "u clause 7ii71 su*   
reimbursem5t %all be equal to 7! great] 
(7-- 7,i7 ! am\nt ! applicable second   

l[e/ co/ silv] plan 7z def9$ 9 section  
#cf;,b7b77#c77;,b7 ( ! ,int]nal ,rev5ue 
,code ( #aihf71 available 9 ! ,ex*ange  
op]at+ 9 ! ,/ate 9 :i* ! consum] resid$ 
at ! "t ( enrollm5t1 w\ld h paid = !    
heal? b5efit if ! consum] 7 enroll$ 9   
su* plan & ! heal? b5efit 0 provid$     
9-network2 or  7,,ii7 if applicable1 an 
am\nt det]m9$ by ! ,/ate 9 :i* ! consum]
 resides at ! "t ( enrollm5t4  7ii7     
,cov]age requir$ by plan docum5ts ,9 !  
case describ$ 9 subp>agraph 7,a71 if !  
,secret>y or applicable ,/ate au?ority  
det]m9es t ! applicable heal? plan 0    
requir$ to provide cov]age ( ! heal?    
b5efit claim$ by ! consum] bas$ on      
/atem5ts includ$ 9 ! plan docum5ts1 !   
applicable heal? plan %all reimburse !  
consum] 9 an am\nt det]m9$ 9 accordance 
) su* plan docum5ts4  7,c7 ,claims ,!   
,secret>y %all1 ?r\gh regulations "u    
section #bje1 e/abli% proc$ures = ! fil+
 ( claims "u subp>agraph 7,a71 includ+  
by sett+ ! p]iod dur+ :i* a claim "u su*
 subp>agraph %all be fil$4 ,su* p]iod   

%all be n less ?an #b ye>s aft] !       
consum] is no long] enroll$ 9 ! plan4   
7#c7 ,liability "u o!r applicable laws  
,! ability ( an applicable heal? plan to
 produce pro( ( a record requir$ "u     
p>agraph 7#a7 %all n %ield ! plan1      
includ+ any adm9i/rator1 insurance      
brok]1 or op]ator ( ! plan1 f liability 
"u o!r applicable ,/ate or ,f$]al law = 
any deceptive practice t ! plan1 includ+
 any su* adm9i/rator1 insurance brok]1  
or op]ator1 engag$ 9 :ile enroll+ a     
consum] 9 ! plan4  #bjc4 ,report+       
requirem5ts  7a7 ,9 g5]al ,n lat] ?an   
,novemb] #a ( ! fir/ cal5d> ye> foll[+ !
 date ( enactm5t ( ?is ,act1 & ,novemb] 
#a ( ea* ye> !reaft]1 an applicable     
heal? plan %all submit to ! ,secret>y a 
report conta9+ ea* ( ! foll[+ 7) respect
 to ! plan ye> cov]$ by ! report+       
p]iod73 7#a7 ,! total enrollm5t 9 !     
applicable heal? plan4  7#b7  7,a7 ,a   
/atem5t ( :e!r ! applicable heal? plan  
us$ an insurance brok]4  7,b7 ,if su*   
plan us$ an insurance brok]1 an         

indication ( ! numb] ( consum]s :o 7    
enroll$ 9 ! plan ?r\gh an insurance     
brok]4  7#c7 ,! total am\nt ( claims    
submitt$ = paym5t to ! applicable heal? 
plan4  7#d7 ,! total am\nt ( claims d5i$
 by ! applicable heal? plan4  7#e7      
,in=mation on any m>ket+ mat]ials !     
applicable heal? plan us$ to enroll     
consum]s 9 ! plan1 includ+-- 7,a7 an    
indication ( :e!r ! plan us$ any onl9e  
adv]tisem5ts2 &  7,b7 a copy ( any      
m>ket+ mat]ial us$1 includ+ any onl9e   
adv]tisem5t4  7#f7 ,any o!r in=mation   
reg>d+ enrollm5t1 cov]age1 or adv]tis+ !
 ,secret>y det]m9es appropriate ?r\gh   
regulations issu$ "u section #bje4  7b7 
,exemptions ,an applicable heal? plan   
%all be exempt f ! requirem5t "u        
subsection 7a7 if-- 7#a7 ! plan is      
requir$ "u ! law ( ea* ,/ate 9 :i* !    
plan is (f]$ to submit all in=mation    
requir$ "u subsection 7a7 to !          
applicable ,/ate au?ority 9 ea* su*     
,/ate2 &  7#b7 ! applicable ,/ate       
au?ority 9 ea* su* ,/ate reviews su*    

in=mation & has a process = address+ any
 su* in=mation t is mislead+ or         
incorrect4  7c7 ,transmittal to ,/ates  
,n lat] ?an #b mon?s aft] receiv+ a     
report "u subsection 7a7 f an applicable
 heal? plan1 ! ,secret>y %all transmit !
 report to ! applicable ,/ate au?ority (
 ea* ,/ate 9 :i* ! plan is (f]$4  7d7   
,public availability  7#a7 ,9 g5]al ,!  
,secret>y %all make all in=mation       
submitt$ "u subsection 7a7 available to 
! public ?r\gh a publicly accessible    
website4  7#b7 ,publiciz+ website ,!    
,secret>y %all publicize ! website "u   
p>agraph 7#a71 includ+ ?r\gh agreem5ts )
 applicable ,/ate au?orities & national 
& ,/ate organizations repres5t+         
consum]s4  #bjd4 ,en=cem5t ,! ,secret>y 
%all h ! au?ority to en=ce ! requirem5ts
 "u section #bjb 7except ! additional   
,/ate requirem5ts "u subsection 7b77#c7 
( su* section7 & section #bjc aga9/ an  
applicable heal? plan 9 ! same mann] z !
 ,secret>y may "u section #bgbc7;b7 7)\t
 reg>d to ! limitation "u p>agraph      

7#a77;,a7 ( su* section7 en=ce a        
requirem5t "u p>ts ,a & ,d ( title      
,,xxvii ( ! ,public ,heal? ,s]vice ,act 
7#db ,u4,s4,c4 #cjj;gg et seq47 aga9/ a 
heal? insurance issu] t violates a      
provision ( su* "p1 includ+ ?r\gh civil 
money p5alties & proc$ures =            
adm9i/rative & judicial review "u       
section #bgbc7;b77#b7 ( su* ,act 7#db   
,u4,s4,c4 #cjj;gg-#bb7;b77#b774  #bje4  
,regulations  7a7 ,9 g5]al ,! ,secret>y 
may issue regulations to c>ry out ?is   
title1 includ+--  7#a7 regulations to   
e/abli% en=cem5t proc$ures au?oriz$ "u  
section #bjd2 &  7#b7 subject to        
subsection 7b71 regulations = e/abli%+  
requirem5ts = ! w>n+ page requir$ "u    
section #bjb7;a77#b7 t are 9 addition to
 ! requirem5ts provid$ "u section #bjb4 
7b7 ,limitation on requirem5ts = w>n+   
page ,a requirem5t 9 a regulation       
describ$ 9 subsection 7a77#b7 %all n--  
7#a7 use any language to promote        
enrollm5t 9 any non-,,aca compliant     
heal? insurance cov]age2  7#b7 direct   

consum]s to a s\rce t c\ld enroll !     
consum] 9 any non-,,aca compliant heal? 
insurance cov]age2 or  7#c7 o!rwise     
conflict ) a requirem5t "u ?is title4   
,,iii ,enc\rag+ enrollm5t 9 heal? plans 
#cja4 ,s5se ( ,congress ,x is ! s5se (  
,congress t-- 7#a7 :5 individuals se>* =
 phrases relat$ to heal? insurance1     
int]net se>* eng9es1 includ+ ,google1   
,b+1 & ,yahoo1 %\ld display an answ] box
 t directs individuals to--  7,a7       
,heal?c>e4gov & ! associat$ toll free   
numb]1 #a-hjj-cah-beif1 ) respect to    
se>*es orig9at+ 9 ,/ates 9 :i* a ,f$]al 
,ex*ange is op]at+2 &  7,b7 a l9k &     
phone numb] = ! appropriate ,/ate-bas$  
,ex*ange1 ) respect to se>*es orig9at+ 9
 ,/ates 9 :i* a ,/ate ,ex*ange is       
op]at+2 &  7#b7 ! answ] box relat$ to   
,heal?c>e4,gov 9 response to a se>*     
describ$ 9 p>agraph 7#a7 %\ld be plac$ 9
 position z]o1 above all o!r cont5t1    
includ+ adv]tisem5ts4  #cjb4 ,requir+   
,m>ketplace outrea*1 educational        
activities1 & annual enrollm5t t>gets   

7a7 ,9 g5]al ,section #acba7;c7 ( !     
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahjda7;c77 is am5d$
 by add+ at ! end ! foll[+3  7#c7       
,outrea* & educational activities  7,a7 
,9 g5]al ,9 ! case ( an ,ex*ange        
e/abli%$ or op]at$ by ! ,secret>y )9 a  
,/ate pursuant to ?is subsection1 !     
,secret>y %all c>ry out outrea* &       
educational activities = purposes (     
in=m+ individuals ab\t qualifi$ heal?   
plans (f]$ ?r\gh ! ,ex*ange1 includ+ by 
in=m+ su* individuals ( ! availability (
 cov]age "u su* plans & f9ancial        
assi/ance = cov]age "u su* plans4 ,su*  
outrea* & educational activities %all be
 provid$ 9 a mann] t is culturally &    
l+ui/ically appropriate to ! ne$s ( !   
populations be+ s]v$ by ! ,ex*ange      
7includ+ h>d-to-rea* populations1 su* z 
racial & sexual m9orities1 limit$       
,engli% pr(ici5t populations1           
individuals 9 rural areas1 vet]ans1 & "y
 adults7 & %all be provid$ to           
populations resid+ 9 high heal? disp>ity

 areas 7z def9$ 9 subp>agraph 7,e77 s]v$
 by ! ,ex*ange1 9 addition to o!r       
populations s]v$ by ! ,ex*ange4  7,b7   
,limitation on use ( funds ,no funds    
appropriat$ "u ?is p>agraph %all be us$ 
= exp5ditures = promot+ non-,,aca       
compliant heal? insurance cov]age4  7,c7
 ,non-,,aca compliant heal? insurance   
cov]age ,= purposes ( subp>agraph 7,b73 
7i7 ,! t]m non-,,aca compliant heal?    
insurance cov]age means--  7,i7 heal?   
insurance cov]age1 or a gr\p heal? plan1
 t is n a qualifi$ heal? plan2 &  7,,ii7
 o!r heal? c>e arrangem5ts t are n heal?
 plans4  7ii7 ,su* t]m includes !       
foll[+3 7,i7 ,an association heal? plan4
  7,,ii7 ,%ort-t]m limit$ duration      
insurance 7z def9$ 9 section #add4ajc ( 
title #de1 ,code ( ,f$]al ,regulations  
7or a successor regulation774  7,d7     
,fund+ ,out ( any funds 9 ! ,treasury n 
o!rwise appropriat$1 !re are h]eby      
appropriat$ = fiscal ye> #bjbc & ea*    
subsequ5t fiscal ye>1 #ajj1jjj1jjj to   
c>ry out ?is p>agraph4 ,funds           

appropriat$ "u ?is subp>agraph %all     
rema9 available until exp5d$4  7,e7     
,high heal? disp>ity area def9$ ,=      
purposes ( subp>agraph 7,a71 ! t]m high 
heal? disp>ity area means a contigu\s   
geographic area t-- 7i7 is locat$ 9 "o  
c5sus tract or ,,zip code2  7ii7 has    
measurable & docum5t$ racial1 e?nic1 or 
geographic heal? disp>ities2  7iii7 has 
a l[-income population1 z demon/rat$    
by--  7,i7 av]age income bel[ #ach p]c5t
 ( ! ,f$]al pov]ty l9e2 or  7,,ii7 a    
rate ( p>ticipation 9 ! special         
supplem5tal nutrition program "u section
 #ag ( ! ,*ild ,nutrition ,act ( #aiff  
7#db ,u4,s4,c4 #aghf7 t is high] ?an !  
national av]age rate ( p>ticipation 9   
su* program2  7iv7 has poor heal?       
outcomes1 z demon/rat$ by-- 7,i7 l[]    
life expectancy ?an ! national av]age2  
or  7,,ii7 a high] p]c5tage ( in/ances (
 l[ bir? weight ?an ! national av]age2 &
  7v7 is "p ( a ,metropolitan ,/ati/ical
 ,area id5tifi$ by ! ,(fice ( ,managem5t
 & ,budget4  7#d7 ,annual enrollm5t     

t>gets ,= plan ye> #bjbb & ea* subsequ5t
 plan ye>1 9 ! case ( an ,ex*ange       
e/abli%$ or op]at$ by ! ,secret>y )9 a  
,/ate pursuant to ?is subsection1 !     
,secret>y %all e/abli% annual enrollm5t 
t>gets = su* ,ex*ange = su* ye>4  4  7b7
 ,grants = ,/ate ,ex*anges ,section     
#acaa ( ! ,pati5t ,protection &         
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjca7 is am5d$ by add+ at ! end !     
foll[+3  7l7 ,op5 enrollm5t outrea*     
grants  7#a7 ,9 g5]al ,! ,secret>y %all 
aw>d grants to ,/ates t h e/abli%$ an   
,ex*ange pursuant to ?is section1 =     
purposes ( assi/+ su* ,/ates 9 conduct+ 
op5 enrollm5t outrea* ) respect to      
qualifi$ heal? plans4  7#b7             
,applications ,a ,/ate desir+ a grant "u
 ?is subsection %all submit an          
application to ! ,secret>y at su* "t1 9 
su* mann]1 & conta9+ su* in=mation z !  
,secret>y may require1 includ+ a plan   
demon/rat+ h[ ! ,/ate w use ! grant     
funds to c>ry out outrea* & educational 
activities consi/5t ) ! requirem5ts "u  

section #acba7;c77#c74  7#c7 ,aw>ds     
7,a7 ,9 g5]al ,! ,secret>y %all aw>d    
grants "u ?is subsection z foll[s3 7i7  
,! ,secret>y %all aw>d an initial r\nd (
 grants to ea* qualify+ ,/ate 9 ! am\nt 
( #a1jjj1jjj4  7ii7 ,if am\nts rema9    
available "u ?is subsection aft] aw>ds  
are made "u clause 7i71 ! ,secret>y %all
 aw>d eligible ,/ates t receiv$ an aw>d 
"u clause 7i7 an am\nt det]m9$          
appropriate by ! ,secret>y bas$ on--    
7,i7 ! ,/ate's total population2  7,,ii7
 ! p]c5tage ( ! ,/ate's population t is 
un9sur$2  7,,iii7 ! p]c5tage ( ! ,/ate's
 population t is difficult to insure2 & 
7,,iv7 su* o!r factors z ! ,secret>y    
det]m9es appropriate4  7,b7 ,available  
until exp5d$ ,) respect to a ,/ate      
receiv+ a grant "u ?is subsection1 !    
grant funds %all rema9 available until  
exp5d$4  7,c7 ,mat*+ requirem5t  7i7 ,9 
g5]al ,subject to clause 7iii71 z a     
condition = receiv+ a grant "u ?is      
section1 a ,/ate %all be requir$ to     
exp5d non-,f$]al funds1 at m9imum1 9 an 

am\nt equal to ! less] (-- 7,i7 #be     
p]c5t ( ! am\nt receiv$ "u ! grant = !  
purpose describ$ 9 p>agraph 7#a72 or    
7,,ii7 #a1jjj1jjj4  7ii7 ,previ\s       
allocations ,a ,/ate may apply fund+    
allocat$ to ! purpose describ$ 9        
p>agraph 7#a7 prior to receipt ( ! grant
 to satisfy ! requirem5t ( clause 7i74  
7iii7 ,waiv] ,! ,secret>y may waive !   
requirem5t "u clause 7i7 9 response to--
 7,i7 a public heal? em]g5cy or a       
disa/]2 or  7,,ii7 an economic recession
 or o!r economic h>d%ip t results 9 an  
increase 9 un9sur$ individuals4  7#d7   
,limitation on use ( funds ,no funds    
appropriat$ "u ?is subsection %all be   
us$ = exp5ditures = promot+ non-,,aca   
compliant heal? insurance cov]age 7z su*
 t]m is def9$ 9 section                 
#acba7;c77#c77;,c774  7#e7 ,application 
to ,m$icaid & ,,*ip outrea* & enrollm5t 
grants ,funds receiv$ by a ,/ate "u a   
grant aw>d$ "u ?is subsection-- 7,a7    
%all n be tak5 into consid]ation by !   
,secret>y :5 det]m9+ :e!r to aw>d !     

,/ate a grant "u section #baac ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acigmm72 &  7,b7 may n be us$ by !     
,/ate to satisfy ! ma9t5ance ( ef=t     
requirem5t "u subsection 7e7 ( su*      
section4  7#f7 ,fund+ ,to c>ry out ?is  
subsection1 !re are appropriat$1 out (  
am\nts 9 ! ,treasury n o!rwise          
appropriat$1 #ej1jjj1jjj = fiscal ye>   
#bjbc & ea* subsequ5t fiscal ye>4  4    
7c7 ,/udy & report ,n lat] ?an #cj days 
aft] ! date ( ! enactm5t ( ?is ,act1 !  
,secret>y ( ,heal? & ,human ,s]vices    
%all release to ,congress all aggregat$ 
docum5ts relat+ to /udies & data sets t 
7 creat$ on or aft] ,janu>y #a1 #bjad1 &
 relat$ to m>ket+ & outrea* ) respect to
 qualifi$ heal? plans (f]$ ?r\gh        
,ex*anges "u title ,i ( ! ,pati5t       
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjja et seq474  #cjc4       
,report on effects ( website ma9t5ance  
dur+ op5 enrollm5t ,n lat] ?an #a ye>   
aft] ! date ( ! enactm5t ( ?is ,act1 !  
,comptroll] ,g5]al ( ! ,unit$ ,/ates    

%all submit to ,congress a report exam9+
 :e!r ! ,dep>tm5t ( ,heal? & ,human     
,s]vices has be5 conduct+ ma9t5ance on !
 website commonly ref]r$ to z           
,health,care4gov dur+ annual op5        
enrollm5t p]iods 7z describ$ 9 section  
#acaa7;c77#f77;,b7 ( ! ,pati5t          
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjca7;c77#f77;,b77 9 su* a  
mann] s z to m9imize any disruption to !
 use ( su* website result+ f su*        
ma9t5ance4  #cjd4 ,promot+ consum]      
outrea* & education  7a7 ,9 g5]al       
,section #acaa7;i7 ( ! ,pati5t          
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #ahjca7;i77 is am5d$-- 7#a7 9 
p>agraph 7#b71 by add+ at ! end ! foll[+
 new subp>agraph3  7,c7 ,selection (    
recipi5ts ,9 ! case ( an ,ex*ange       
e/abli%$ & op]at$ by ! ,secret>y )9 a   
,/ate pursuant to section #acba7;c71 9  
aw>d+ grants "u p>agraph 7#a71 !        
,ex*ange %all-- 7i7 select entities to  
receive su* grants bas$ on an entity's  
demon/rat$ capacity to c>ry out ea* ( ! 

duties specifi$ 9 p>agraph 7#c72  7ii7 n
 take into acc\nt :e!r or n ! entity has
 demon/rat$ h[ ! entity w provide       
in=mation to individuals relat+ to gr\p 
heal? plans (f]$ by a gr\p or           
association ( employ]s describ$ 9       
section #beaj4c-e7;b7 ( title #bi1 ,code
 ( ,f$]al ,regulations 7or any successor
 regulation71 or %ort-t]m limit$        
duration insurance 7z def9$ 9 section   
#add4ajc ( title #de1 ,code ( ,f$]al    
,regulations 7or a successor            
regulation772 &  7iii7 ensure t1 ea*    
ye>1 ! ,ex*ange aw>ds su* a grant to--  
7,i7 at lea/ "o entity describ$ 9 ?is   
p>agraph t is a community &             
consum]-focus$ nonpr(it gr\p2 &  7,,ii7 
at lea/ "o entity describ$ 9 subp>agraph
 7,b71 :i* may include ano!r community &
 consum]-focus$ nonpr(it gr\p 9 addition
 to any su* gr\p aw>d$ a grant pursuant 
to subclause 7,i74  ,9 aw>d+ su* grants1
 an ,ex*ange may consid] an entity's    
record ) respect to wa/e1 fraud1 & abuse
 = purposes ( ma9ta9+ ! integrity ( su* 

,ex*ange4  2  7#b7 9 p>agraph 7#c7--    
7,a7 by am5d+ subp>agraph 7,c7 to read z
 foll[s3  7,c7 facilitate enrollm5t1    
includ+ ) respect to individuals )      
limit$ ,engli% pr(ici5cy & individuals )
 *ronic illnesses1 9 qualifi$ heal?     
plans1 ,/ate ,m$icaid plans "u title    
,,xix ( ! ,social ,security ,act1 &     
,/ate *ild heal? plans "u title ,,xxi ( 
su* ,act2  2  7,b7 9 subp>agraph 7,d71  
by /rik+ & at ! end2  7,c7 9 subp>agraph
 7,e71 by /rik+ ! p]iod at ! end &      
ins]t+ 2 &2  7,d7 by ins]t+ aft]        
subp>agraph 7,e7 ! foll[+ new           
subp>agraph3  7,f7 provide ref]rals to  
community-bas$ organizations t address  
social ne$s relat$ to heal? outcomes4  2
 &  7,e7 by add+ at ! end ! foll[+ flu% 
left s5t5ce3  ,! duties specifi$ 9 !    
prec$+ s5t5ce may be c>ri$ out by su* a 
navigator at any "t dur+ a ye>4 2  7#c7 
9 p>agraph 7#d77;,a7-- 7,a7 9 ! matt]   
prec$+ clause 7i71 by /rik+ n2  7,b7 9  
clause 7i7-- 7i7 by ins]t+ n be=e be2 & 
7ii7 by /rik+ 2 or & ins]t+ a semicolon2

  7,c7 9 clause 7ii7--  7i7 by ins]t+ n 
be=e receive2 &  7ii7 by /rik+ ! p]iod &
 ins]t+ a semicolon2 &  7,d7 by add+ at 
! end ! foll[+3  7iii7 ma9ta9 physical  
pres5ce 9 ! ,/ate ( ! ,ex*ange s z to   
all[ 9-p]son assi/ance to consum]s2 &   
7iv7 receive opioid specific education &
 tra9+ t ensures ! navigator c be/      
educate individuals on qualifi$ heal?   
plans (f]$ ?r\gh an ,ex*ange1           
specifically cov]age "u su* plans =     
opioid heal? c>e treatm5t4  2 &  7#d7 9 
p>agraph 7#f7--  7,a7 by /rik+          
,fund+4--,grants "u & ins]t+ ,fund+4--  
7,a7 ,/ate ,ex*anges ,grants "u  2 &    
7,b7 by add+ at ! end ! foll[+ new      
subp>agraph3  7,b7 ,f$]al ,ex*anges ,=  
purposes ( c>ry+ out ?is subsection1 )  
respect to an ,ex*ange e/abli%$ & op]at$
 by ! ,secret>y )9 a ,/ate pursuant to  
section #acba7;c71 ! ,secret>y %all     
obligate #ajj1jjj1jjj out ( am\nts      
collect$ ?r\gh ! us] fees on p>ticipat+ 
heal? insurance issu]s pursuant to      
section #aef4ej ( title #de1 ,code (    

,f$]al ,regulations 7or any successor   
regulations71 = fiscal ye> #bjbb & ea*  
subsequ5t fiscal ye>4 ,su* am\nt = a    
fiscal ye> %all rema9 available until   
exp5d$4  4  7b7 ,effective date ,!      
am5dm5ts made by ?is section %all apply 
) respect to plan ye>s beg9n+ on or aft]
 ,janu>y #a1 #bjbb4  #cje4 ,improv+     
transp>5cy & acc\ntability 9 !          
,m>ketplace  7a7 ,op5 enrollm5t reports 
,= plan ye> #bjbb & ea* subsequ5t ye>1 !
 ,secret>y ( ,heal? & ,human ,s]vices   
7ref]r$ to 9 ?is section z ! ,secret>y71
 9 coord9ation ) ! ,secret>y ( !        
,treasury & ! ,secret>y ( ,labor1 %all  
issue biweekly public reports dur+ !    
annual op5 enrollm5t p]iod on ! p]=mance
 ( ! f$]ally facilitat$ ,ex*ange op]at$ 
pursuant to section #acba7;c7 ( !       
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahjda7;c774 ,ea*   
su* report %all include a summ>y1       
includ+ in=mation on a ,/ate-by-,/ate   
basis :]e available1 (-- 7#a7 ! numb] ( 
unique website visits2  7#b7 ! numb] (  

individuals :o create an acc\nt2  7#c7 !
 numb] ( calls to ! call c5t]2  7#d7 !  
av]age wait "t = call]s contact+ ! call 
c5t]2  7#e7 ) respect to applications = 
enrollm5t--  7,a7 ! numb] ( su*         
applications submitt$2  7,b7 ! total    
numb] ( individuals on submitt$         
applications = enrollm5t2  7,c7 ! numb] 
( individuals on su* submitt$           
applications :o are det]m9$ eligible =  
enrollm5t 9 a qualifi$ heal? plan2  7,d7
 ! numb] ( individuals on su* submitt$  
applications :o are det]m9$ or assess$  
eligible = ! ,m$icaid program "u title  
,,xix ( ! ,social ,security ,act 7#db   
,u4,s4,c4 #acif et seq472  7,e7 ! numb] 
( individuals on su* submitt$           
applications :o are det]m9$ or assess$  
eligible = ! ,/ate ,*ildr5's ,heal?     
,insurance ,program "u title ,,xxi ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acig;aa et seq472  7,f7 ! numb] (      
individuals on su* submitt$ applications
 :o are det]m9$ eligible = a premium    
assi/ance cr$it "u section #cf;,b ( !   

,int]nal ,rev5ue ,code ( #aihf2  7,g7 ,!
 numb] ( individuals on su* submitt$    
applications :o are det]m9$ eligible =  
co/-%>+ r$uction "u section #adjb ( !   
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahjga72 &  7,h7 a  
breakd[n ( ! data describ$ 9            
subp>agraphs 7,a7 ?r\gh 7,g7 by age1    
sex1 race & pref]r$ language1 :]e su*   
in=mation is available2  7#f7 ! numb] ( 
individuals :o enroll 9 a qualifi$ heal?
 plan2 &  7#g7 ! p]c5tage ( individuals 
:o enroll 9 a qualifi$ heal? plan ?r\gh 
ea* (--  7,a7 ! website2  7,b7 ! call   
c5t]2  7,c7 navigators2  7,d7 ag5ts &   
brok]s2  7,e7 ! enrollm5t assi/ant      
program2  7,f7 directly f issu]s or web 
brok]s2 &  7,g7 o!r means4  7b7 ,op5    
,enrollm5t ,aft] ,action ,report ,= plan
 ye> #bjbb & ea* subsequ5t ye>1 !       
,secret>y1 9 coord9ation ) ! ,secret>y (
 ! ,treasury & ! ,secret>y ( ,labor1    
%all publi% an aft] action report n lat]
 ?an #c mon?s aft] ! completion ( !     
annual op5 enrollm5t p]iod reg>d+ !     

p]=mance ( ! ,ex*ange describ$ 9        
subsection 7a7 = ! applicable plan ye>4 
,ea* su* report %all include a summ>y1  
includ+ in=mation on a ,/ate-by-,/ate   
basis :]e available1 (--  7#a7 ! op5    
enrollm5t data report$ "u subsection 7a7
 = ! entirety ( ! enrollm5t p]iod2 &    
7#b7 activities relat$ to pati5t        
navigators describ$ 9 section #acaa7;i7 
( ! ,pati5t ,protection & ,af=dable ,c>e
 ,act 7#db ,u4,s4,c4 #ahjca7;i771       
includ+--  7,a7 ! p]=mance objectives   
e/abli%$ by ! ,secret>y = su* pati5t    
navigators2  7,b7 ! numb] ( consum]s    
enroll$ by su* a pati5t navigator2  7,c7
 an assessm5t ( h[ su* pati5t navigators
 h met e/abli%$ p]=mance metrics1       
includ+ a detail$ li/ ( all pati5t      
navigators1 fund+ receiv$ by pati5t     
navigators1 & :e!r e/abli%$ p]=mance    
objectives ( pati5t navigators 7 met2 & 
7,d7 ) respect to ! p]=mance objectives 
describ$ 9 subp>agraph 7,a7--  7i7 :e!r 
su* objectives assess ! full scope (    
pati5t navigator responsibilities1      

includ+ g5]al education1 plan selection1
 & det]m9ation ( eligibility = tax      
cr$its1 co/-%>+ r$uctions1 or o!r       
cov]age2  7ii7 h[ ! ,secret>y work$ )   
pati5t navigators to e/abli% su*        
objectives2 &  7iii7 h[ ! ,secret>y     
adju/$ su* objectives = case complexity 
& o!r contextual factors4  7c7 ,report  
on adv]tis+ & consum] outrea* ,n lat]   
?an #c mon?s aft] ! completion ( !      
annual op5 enrollm5t p]iod = plan ye>   
#bjbb1 ! ,secret>y %all issue a report  
on adv]tis+ & outrea* to consum]s = !   
op5 enrollm5t p]iod = plan ye> #bjbb4   
,su* report %all include a description  
(--  7#a7 ! division ( sp5d+ on         
individual adv]tis+ plat=ms1 includ+    
television & radio adv]tisem5ts &       
digital m$ia1 to raise consum] aw>5ess (
 op5 enrollm5t2  7#b7 ! division ( sp5d+
 on individual outrea* plat=ms1 includ+ 
email & text messages1 to raise consum] 
aw>5ess ( op5 enrollm5t2 &  7#c7 :e!r ! 
,secret>y conduct$ t>get$ outrea* to    
specific demographic gr\ps & geographic 

areas4  7d7 ,promot+ transp>5cy &       
acc\ntability 9 ! adm9i/ration's        
exp5ditures ( ex*ange us] fees ,= plan  
ye> #bjbb & ea* subsequ5t plan ye>1 n   
lat] ?an ! date t is #c mon?s aft] ! end
 ( su* plan ye>1 ! ,secret>y ( ,heal? & 
,human ,s]vices %all submit to !        
appropriate committees ( ,congress &    
make available to ! public an annual    
report on ! exp5ditures by ! ,dep>tm5t (
 ,heal? & ,human ,s]vices ( us] fees    
collect$ pursuant to section #aef4ej (  
title #de1 ,code ( ,f$]al ,regulations  
7or any successor regulations74 ,ea* su*
 report = a plan ye> %all include a     
detail$ acc\nt+ ( ! am\nt ( su* us] fees
 collect$ dur+ su* plan ye> & ( ! am\nt 
( su* exp5ditures us$ dur+ su* plan ye> 
= ! f$]ally facilitat$ ,ex*ange op]at$  
pursuant to section #acba7;c7 ( !       
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahjda7;c77 on      
outrea* & enrollm5t activities1         
navigators1 ma9t5ance ( ,heal?c>e4gov1 &
 op]ation ( call c5t]s4  #cjf4 ,improv+ 

aw>5ess ( heal? cov]age options  7a7 ,9 
g5]al ,n lat] ?an #ij days aft] ! date (
 ! enactm5t ( ?is ,act1 ! ,secret>y (   
,labor1 9 consultation ) ! ,secret>y (  
,heal? & ,human ,s]vices1 %all update1 &
 make publicly available 9 a prom95t    
location on ! website ( ! ,dep>tm5t (   
,labor1 ! model ,consolidat$ ,omnibus   
,budget ,reconciliation ,act ( #aihe    
7ref]r$ to 9 ?is section z ,,cobra7     
cont9uation cov]age g5]al notice & !    
model ,,cobra cont9uation cov]age       
election notice develop$ by ! ,secret>y 
( ,labor = purposes ( facilitat+        
compliance ( gr\p heal? plans ) !       
notification requirem5ts "u section #fjf
 ( ! ,employee ,retirem5t ,income       
,security ,act ( #aigd 7#bi ,u4,s4,c4   
#aaff74 ,9 updat+ ea* su* notice1 !     
,secret>y ( ,labor %all include         
in=mation reg>d+ any ,ex*ange e/abli%$  
"u title ,i ( ! ,pati5t ,protection &   
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjja et seq47 ?r\gh :i* a qualifi$    
b5efici>y may be eligible to enroll 9 a 

qualifi$ heal? plan1 includ+-- 7#a7 !   
publicly accessible ,int]net website    
address = su* ,ex*ange2  7#b7 ! publicly
 accessible ,int]net website address = !
 ,f9d ,local ,help directory ma9ta9$ by 
! ,dep>tm5t ( ,heal? & ,human ,s]vices  
on ! heal?c>e4gov ,int]net website 7or a
 successor website72  7#c7 a cle>       
explanation t--  7,a7 an individual :o  
is eligible = cont9uation cov]age may   
also be eligible to enroll1 ) f9ancial  
assi/ance1 9 a qualifi$ heal? plan (f]$ 
?r\gh su* ,ex*ange1 b1 9 ! case t su*   
individual elects to enroll 9 su*       
cont9uation cov]age & subsequ5tly elects
 to t]m9ate su* cont9uation cov]age be=e
 ! p]iod ( su* cont9uation cov]age      
expires1 su* individual w n be eligible 
to enroll 9 a qualifi$ heal? plan (f]$  
?r\gh su* ,ex*ange dur+ a special       
enrollm5t p]iod2 &  7,b7 an individual  
:o elects to enroll 9 cont9uation       
cov]age w rema9 eligible to enroll 9 a  
qualifi$ heal? plan (f]$ ?r\gh su*      
,ex*ange dur+ an op5 enrollm5t p]iod &  

may be eligible = f9ancial assi/ance )  
respect to enroll+ 9 su* a qualifi$     
heal? plan2  7#d7 in=mation on consum]  
protections ) respect to enroll+ 9 a    
qualifi$ heal? plan (f]$ ?r\gh su*      
,ex*ange1 includ+ ! requirem5t = su* a  
qualifi$ heal? plan to provide cov]age =
 ess5tial heal? b5efits 7z def9$ 9      
section #acjb7;b7 ( su* ,act 7#db       
,u4,s4,c4 #ahjbb7;b77 & ! requirem5ts   
applicable to su* a qualifi$ heal? plan 
"u p>ts ,a & ,d ( title ,,xxvii ( !     
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;gg et seq472 &  7#e7     
in=mation on ! availability ( f9ancial  
assi/ance ) respect to enroll+ 9 a      
qualifi$ heal? plan1 includ+ ! maximum  
income limit = eligibility = a premium  
tax cr$it "u section #cf;,b ( ! ,int]nal
 ,rev5ue ,code ( #aihf4  7b7 ,"n (      
notices ,9 addition to updat+ ! model   
,,cobra cont9uation cov]age g5]al notice
 & ! model ,,cobra cont9uation cov]age  
election notice "u p>agraph 7#a71 !     
,secret>y ( ,labor %all r5ame ea* su*   

notice z ! model ,,cobra cont9uation    
cov]age & ,af=dable ,c>e ,act cov]age   
g5]al notice & ! model ,,cobra          
cont9uation cov]age & ,af=dable ,c>e    
,act cov]age election notice1           
respectively4  7c7 ,consum] te/+ ,prior 
to mak+ publicly available ! model      
,,cobra cont9uation cov]age g5]al notice
 & ! model ,,cobra cont9uation cov]age  
election notice updat$ "u p>agraph 7#a71
 ! ,secret>y ( ,labor %all provide an   
opportunity = consum] te/+ ( ea* su*    
notice1 z s updat$1 to ensure t ea* su* 
notice is cle> & und]/&able to ! av]age 
p>ticipant or b5efici>y ( a gr\p heal?  
plan4  7d7 ,def9itions ,9 ?is           
subsection3 7#a7 ,cont9uation cov]age ,!
 t]m cont9uation cov]age1 ) respect to a
 gr\p heal? plan1 has ! mean+ giv5 su*  
t]m 9 section #fjb ( ! ,employee        
,retirem5t ,income ,security ,act (     
#aigd 7#bi ,u4,s4,c4 #aafb74  7#b7 ,gr\p
 heal? plan ,! t]m gr\p heal? plan has !
 mean+ giv5 su* t]m 9 section #fjg ( su*
 ,act 7#bi ,u4,s4,c4 #aafg74  7#c7      

,qualifi$ b5efici>y ,! t]m qualifi$     
b5efici>y has ! mean+ giv5 su* t]m 9 su*
 section #fjg4  7#d7 ,qualifi$ heal?    
plan ,! t]m qualifi$ heal? plan has !   
mean+ giv5 su* t]m 9 section #acja ( !  
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahjba74  #cjg4     
,promot+ ,/ate innovations to exp&      
cov]age  7a7 ,9 g5]al ,subject to       
subsection 7d71 ! ,secret>y ( ,heal? &  
,human ,s]vices %all aw>d grants to     
eligible ,/ate ag5cies to enable su*    
,/ates to explore innovative solutions  
to promote great] enrollm5t 9 heal?     
insurance cov]age 9 ! individual & small
 gr\p m>kets1 includ+ activities        
describ$ 9 subsection 7c74  7b7         
,eligibility ,= purposes ( subsection   
7a71 eligible ,/ate ag5cies are         
,ex*anges e/abli%$ by a ,/ate "u title  
,i ( ! ,pati5t ,protection & ,af=dable  
,c>e ,act 7#db ,u4,s4,c4 #ahjja et seq47
 & ,/ate ag5cies ) prim>y responsibility
 ov] heal? & human s]vices = ! ,/ate    
involv$4  7c7 ,use ( funds ,= purposes (

 subsection 7a71 ! activities describ$ 9
 ?is subsection are ! foll[+3  7#a7     
,/ate ef=ts to /reaml9e heal? insurance 
enrollm5t proc$ures 9 ord] to r$uce     
burd5s on consum]s & facilitate great]  
enrollm5t 9 heal? insurance cov]age 9 ! 
individual & small gr\p m>kets1 includ+ 
automatic enrollm5t & re5rollm5t (1 or  
pre-populat$ applications =1 individuals
 )\t heal? insurance :o are eligible =  
tax cr$its "u section #cf;,b ( !        
,int]nal ,rev5ue ,code ( #aihf1 ) !     
ability to opt out ( su* enrollm5t4     
7#b7 ,/ate inve/m5t 9 te*nology to      
improve data %>+ & collection = !       
purposes ( facilitat+ great] enrollm5t 9
 heal? insurance cov]age 9 su* m>kets4  
7#c7 ,feasibility /udies to develop     
compreh5sive & coh]5t ,/ate plan =      
increas+ enrollm5t 9 ! individual &     
small gr\p m>ket4  7d7 ,fund+ ,=        
purposes ( c>ry+ out ?is section1 !re is
 h]eby appropriat$1 out ( any funds 9 ! 
,treasury n o!rwise appropriat$1        
#bjj1jjj1jjj = ea* ( ! fiscal ye>s #bjbb

 ?r\gh #bjbd4 ,su* am\nt %all rema9     
available until exp5d$4