,i #aai? ,,congress #a/ ,session ,h4 ,r4 #feab ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,decemb] #i1 #bjbe,mr4 ,biggs ( ,arizona 7= himself1 ,mr4 ,ogles1 & ,mr4 ,clyde7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce1 & 9 addition to ! ,committees on ,ways & ,means1 ,education & ,work=ce1 & ! ,judici>y1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,a ,,bill ,to ,emp[] ,am]ican ,families ) ,direct ,control ,ov] ,heal?c>e ,doll>s1 ,codify ,presid5t ,trump's ,prov5 ,re=ms = ,flexibility & ,*oice1 ,prohibit ,taxpay] ,fund+ = ,abortion & ,g5d] ,transition ,proc$ures1 ,elim9ate ,wa/e & ,fraud 9 ! ,af=dable ,c>e ,act1 & ,reject ,ext5sions ( ,enhanc$ ,subsidies to ,insurance ,companies4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,putt+ ,pati5ts ,fir/ ,heal?c>e ,fre$om ,act #b4 ,table ( cont5ts ,! table ( cont5ts ( ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title4,sec4 #b4 ,table ( cont5ts4,title ,i--,putt+ pati5ts ov] heal? insurance companies,subtitle ,a--,m ,af=dable ,c>e ,act,sec4 #ajja4 ,%ort title4,sec4 #ajjb4 ,heal? fre$om waiv] program4,sec4 #ajjc4 ,trump heal? fre$om acc\nts4,subtitle ,b--,improv+ ,,hsa access1 utility1 & flexibility,sec4 #ajaa4 ,individuals entitl$ to "p ,a ( m$ic>e by reason ( age all[$ to contribute to heal? sav+s acc\nt4,sec4 #ajab4 ,all[ bo? sp\ses to make cat*-up contributions to ! same heal? sav+s acc\nt4,sec4 #ajac4 ,,fsa & ,,hra t]m9ations or conv]sions to fund ,h,s,as4,sec4 #ajad4 ,special rule = c]ta9 m$ical exp5ses incurr$ be=e e/abli%m5t ( heal? sav+s acc\nt4,sec4 #ajae4 ,contributions p]mitt$ if sp\se has heal? flexible sp5d+ arrangem5t4,sec4 #ajaf4 ,increase 9 heal? sav+s acc\nt contribution limitation = c]ta9 individuals4,sec4 #ajag4 ,heal? sav+s acc\nts us$ to pur*ase insurance4,subtitle ,c--,heal? c>e %>+ m9i/ries ,sec4 #ajah4 ,treatm5t ( heal? c>e %>+ m9i/ries4,sec4 #ajai4 ,heal? c>e %>+ m9i/ry fees treat$ z m$ical c>e4,sec4 #ajbj4 ,heal? c>e %>+ m9i/ries n treat$ z heal? insurance4,title ,,ii--,codify+ ,trump heal?c>e fre$om agenda,subtitle ,a--,association ,heal? ,plans ,act,sec4 #bjja4 ,%ort title4,sec4 #bjjb4 ,treatm5t ( gr\p or association ( employ]s4,sec4 #bjjc4 ,rules applicable to employee welf>e b5efit plans e/abli%$ & ma9ta9$ by a gr\p or association ( employ]s4,sec4 #bjjd4 ,rule ( con/ruction4,subtitle ,b--,,*oice ,arrangem5t ,act,sec4 #bjaa4 ,%ort title4,sec4 #bjab4 ,treatm5t ( heal? reimbursem5t arrangem5ts integrat$ ) individual m>ket cov]age4,sec4 #bjac4 ,p>ticipants 9 *oice arrangem5t eligible = pur*ase ( ex*ange insurance = pur*ase ( cafet]ia plan4,sec4 #bjad4 ,employ] cr$it = *oice arrangem5t4,subtitle ,c--,self-,insurance ,protection ,act,sec4 #bjba4 ,%ort title4,sec4 #bjbb4 ,f9d+s4,sec4 #bjbc4 ,c]ta9 m$ical /op-loss insurance obta9$ by c]ta9 plan sponsors ( gr\p heal? plans n includ$ "u ! def9ition ( heal? insurance cov]age4,sec4 #bjbd4 ,effect on o!r laws4,subtitle ,d--,small ,bus9ess ,flexibility ,act,sec4 #bjca4 ,%ort title4,sec4 #bjcb4 ,notification ( flexible heal? insurance b5efits4,subtitle ,e--,heal? ,cov]age ,*oice ,act,sec4 #bjda4 ,%ort title4,sec4 #bjdb4 ,def9ition ( %ort-t]m limit$ duration insurance4,subtitle ,f--,,impact ,act ( #bjbe,sec4 #bjea4 ,%ort title4,sec4 #bjeb4 ,exp&+ eligibility = cata/rophic plans4,subtitle ,g--,new ,heal? ,options ,act,sec4 #bjfa4 ,%ort title4,sec4 #bjfb4 ,creation ( a re9surance program = a new heal? insurance risk pool4,sec4 #bjfb4 ,promotion ( high-value c>e4,sec4 #bjfd4 ,disclosure ( l[] prices4,subtitle ,h--,fight+ wa/e fraud & abuse 9 ! unaf=dable c>e act,sec4 #bjga4 ,%ort title4,sec4 #bjgb4 ,address+ wa/e1 fraud1 & abuse 9 ! ,,aca ex*anges4,sec4 #bjgc4 ,fund+ co/-%>+ r$uction paym5ts4,title ,,iii--,end+ taxpay] fund+ = abortion & g5d] transition procedures,subtitle ,a--,no taxpay] fund+ = abortion & abortion insurance full disclosure act ( #bjbe,sec4 #cjjj4 ,applicability to entire act4,sec4 #cjja4 ,%ort title4,sec4 #cjjb4 ,prohibit+ taxpay] fund$ abortions4,sec4 #cjjc4 ,am5dm5t to table ( *apt]s4,sec4 #cjjd4 ,cl>ify+ application ( prohibition to premium cr$its & co/-%>+ r$uctions "u aca4,sec4 #cjje4 ,revision to notice requirem5ts reg>d+ disclosure ( ext5t ( heal? plan cov]age ( abortion & abortion premium sur*>ges4,subtitle ,b--,prohibit+ ,f$]al fund+ = g5d] transition procedures,sec4 #cjjf4 ,%ort title4,sec4 #cjjg4 ,prohibit+ ,f$]al fund+ = g5d] transition proc$ures4 ,i ,putt+ pati5ts ov] heal? insurance companies ,a ,m ,af=dable ,c>e ,act #ajja4 ,%ort title ,?is ,act may be cit$ z ! ,m ,af=dable ,c>e ,act4 #ajjb4 ,heal? fre$om waiv] program ,"p #d ( subtitle ,d ( title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjea et seq47 is am5d$ by add+ ! foll[+3 #acce4 ,heal? fre$om waiv] program 7a7 ,9 g5]al 7#a7 ,waiv] program ,! ,secret>y %all waive all or any requirem5ts describ$ 9 p>agraph 7#d71 z det]m9$ by ! applicable ,/ate1 = plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbf1 ) respect to heal? insurance cov]age )9 any ,/ate t submits a notification "u p>agraph 7#b71 provid$ t ! ,/ate ma9ta9s an invisible high-risk insurance pool or ano!r program design$ to mitigate risk to insurance premium co/s4 7#b7 ,notification ,a ,/ate entity describ$ 9 p>agraph 7#c7 desir+ a waiv] "u ?is section = any plan ye> beg9n+ on or aft] ,janu>y #a1 #bjbf1 %all notify ! ,secret>y ( its int5t to p>ticipate 9 ! waiv] program ) respect to all or any requirem5ts describ$ 9 p>agraph 7#d74 ,su* notification %all be fil$ at su* "t1 n lat] ?an #ij days be=e ! ,/ate int5ds to beg9 p>ticipation 9 ! waiv] program1 & 9 su* mann] z ! ,secret>y may require1 & conta9 su* in=mation z ! ,secret>y may require1 includ+ ! requirem5ts "u p>agraph 7#d7 t ! ,/ate int5ds to waiv] & evid5ce t ! ,/ate ma9ta9s a high-risk insurance pool4 7#c7 ,/ate submission ,a notification ) respect to a ,/ate may be submitt$ by-- 7,a7 ! gov]nor ( ! ,/ate2 or 7,b7 ! legislature ( ! ,/ate1 ^u a majority vote by ! ,/ate legislature4 7#d7 ,requirem5ts ,! requirem5ts describ$ 9 ?is p>agraph ) respect to heal? insurance cov]age )9 ! ,/ate are z foll[s3 7,a7 ,"p #a ( subtitle ,d4 7,b7 ,"p #b ( subtitle ,d4 7,c7 ,section #adjb4 7,d7 ,sections #cf;,b & #ejjj;,a ( ! ,int]nal ,rev5ue ,code ( #aihf4 7#e7 ,money foll[s ! p]son 7,a7 ,9 g5]al ,) respect to a ,/ate waiv] "u p>agraph 7#a71 "u :i*1 due to ! /ructure ( ! ,/ate plan1 individuals & small employ]s 9 ! ,/ate w\ld n qualify = ! premium tax cr$its1 co/-%>+ r$uctions1 or small bus9ess cr$its "u sec4 #cf;,b ( ! ,int]nal ,rev5ue ,code ( #aihf or "u "p ,i ( subtitle ,e = :i* !y w\ld o!rwise be eligible1 ! ,secret>y %all provide = an alt]native means by :i* ! aggregate am\nt ( su* cr$its or r$uctions t w\ld h be5 paid on behalf ( p>ticipants 9 ! ,ex*anges e/abli%$ "u ?is title _h ! ,/ate n receiv$ su* waiv]1 %all be paid into ! ,trump ,heal? ,fre$om ,acc\nts e/abli%$ "u section #bbc7;i7 ( ! ,int]nal ,rev5ue ,code ( #aihf ( eligible resid5ts ( ! ,/ate4 7,b7 ,paym5ts to trump heal? fre$om acc\nts ,! ,secret>y %all pay into ! ,trump ,heal? ,fre$om ,acc\nts ( ea* eligible resid5t ( a ,/ate = :i* a waiv] is 9 effect = a play ye> ! am\nt equal to ! total am\nt = :i* ! resid5t w\ld h be5 eligible 9 premium tax cr$it am\nts "u section #cf;,b ( ! ,int]nal ,rev5ue ,code ( #aihf & co/-%>+ r$uction am\nts "u section #adjb = ! ye>1 _h ! ,/ate n _h su* waiv] 9 effect4 ,9 det]m9+ ! appropriate paym5t am\nt "u ?is subp>agraph1 ! ,secret>y %all calculate premium tax cr$it am\nts & co/-%>+ r$uction am\nts bas$ on ! national av]age annual premium am\nt = a silv] ti] b5*m>k plan among ,/ates t d n h su* waiv]s 9 effect = ! applicable ye>4 ,! ,secret>y %all make paym5ts into ! ,trump ,heal? ,fre$om ,acc\nts ( eligible resid5ts on a mon?ly basis1 qu>t]ly basis1 or 9 "o lump sum at ! beg9n+ ( ! ye>1 at ! option ( ea* eligible resid5t4 7#f7 ,coord9at$ waiv] process ,! ,secret>y %all develop a process = coord9at+ & consolidat+ ! ,/ate waiv] processes applicable "u ! provisions ( ?is section1 & ! exi/+ waiv] processes applicable "u section #accb1 & titles ,,xviii1 ,,xix1 & ,,xxi ( ! ,social ,security ,act1 & any o!r ,f$]al law relat+ to ! provision ( heal? c>e items or s]vices4 ,su* processes %all p]mit a ,/ate to submit a s+le application = a waiv] "u any or all ( su* provisions4 7#g7 ,ex*anges 7,a7 ,9 g5]al ,9 ! case ( a ,/ate 9 :i* a waiv] is 9 effect "u ?is section = a plan ye>-- 7i7 ! ,/ate may-- 7,i7 op]ate an ,ex*ange e/abli%$ z describ$ 9 section #acaa7;b72 or 7,,ii7 all[ "o or m private entities to run comm]cial plat=ms t sell heal? plans approv$ by ! ,/ate insurance commission]2 or 7ii7 if ! ,/ate does n op]ate an ,ex*ange z describ$ 9 clause 7i77,i7 or all[ = "o or m comm]cial plat=ms describ$ 9 clause 7i77,,ii71 ! ,secret>y %all op]ate a ,f$]al ,ex*ange1 z describ$ 9 section #acba7;c71 provid$ t any ,/ate laws reg>d+ ! availability ( heal? plans on1 & ! op]ation (1 su* ,ex*ange %all apply 9 lieu ( any provision "u "p #a or "p #b t su* ,/ate has waiv$4 7,b7 ,application program int]face ,! ,secret>y %all make available to any ,/ate t all[s = comm]cial plat=ms describ$ 9 subp>agraph 7,a77i77,,ii71 ! application program int]face us$ = op]at+ ,f$]al & ,/ate ,ex*anges1 = use by any private entity runn+ su* a plat=m "u ,/ate au?ority4 7#h7 ,def9itions ,9 ?is section3 7,a7 ,eligible resid5t ,! t]m eligible resid5t means1 ) respect to a ,/ate = :i* a waiv] is 9 effect "u ?is section1 a resid5t :o-- 7i7 9 ! abs5ce ( su* a waiv] 9 ! ,/ate1 w\ld be eligible = a premium tax cr$it "u section #cf;,b ( ! ,int]nal ,rev5ue ,code ( #aihf or a co/-%>+ r$uction "u section #adjb1 if ! resid5t enroll$ 9 a qualifi$ heal? plan (f]$ on ! ,ex*ange ( su* ,/ate2 & 7ii7 enrolls 9 a plan (f]$ on ! ,ex*ange describ$ 9 p>agraph 7#g7 = ! applicable plan ye>4 7,b7 ,secret>y ,! t]m ,secret>y means-- 7i7 ! ,secret>y ( ,heal? & ,human ,s]vices ) respect to waiv]s relat+ to ! provisions describ$ 9 subp>agraph 7,a7 ?r\gh 7,c7 ( p>agraph 7#d72 & 7ii7 ! ,secret>y ( ! ,treasury ) respect to waiv]s relat+ to ! provisions describ$ 9 p>agraph 7#d77;,d74 7b7 ,waiv] p]iod ,ea* waiv] "u ?is section %all be 9 effect beg9n+ on ,janu>y #a ( ! plan ye> = :i* a timely notice is submitt$ by ! ,/ate "u subsection 7a77#b71 & cont9u+ until ! entity ( ! ,/ate describ$ 9 subp>agraph 7,a7 or 7,b7 ( subsection 7a77#c7 t submitt$ ! notification "u subsection 7a77#b7 submits to ! ,secret>y a notification ( int5t to discont9ue p>ticipation 9 ! waiv] program "u ?is section4 7c7 ,limitation ,! ,secret>y may n p]mit a waiv] "u ?is section ( any ,f$]al law or requirem5t t is n )9 ! au?ority ( ! ,secret>y4 7d7 ,availability ( plans 7#a7 ,9 g5]al ,any heal? insurance cov]age (f]$ 9 a ,/ate = :i* a waiv] "u ?is section is 9 effect1 & au?oriz$ by ! insurance commission] ( ! ,/ate1 %all be made available on1 z applicable1 ! ,f$]al or ,/ate ,ex*ange or comm]cial plat=ms describ$ 9 subsection 7a77#g71 ( all ,/ates = :i* su* a waiv] is 9 effect1 subject to ! laws ( ea* su* ,/ate4 7#b7 ,*ild-only plans ,9 any ,/ate = :i* a waiv] "u ?is section is 9 effect1 a heal? insurance issu] may (f] a plan 9 :i* ! only individuals eligible to enroll are individuals :o1 z ( ! beg9n+ ( a plan ye>1 h n atta9$ ! age ( #ba4 7e7 ,regulations ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ! ,m ,af=dable ,c>e ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices1 9 coord9ation ) ! ,secret>y ( ! ,treasury1 %all promulgate regulations to c>ry out ?is section4 7f7 ,rule ( con/ruction reg>d+ consum] protections1 includ+ ! pre-,exi/+ condition protection ,no?+ 9 ?is section %all be con/ru$ to all[ a ,/ate to waive ! requirem5ts ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act1 includ+ sections #bgja1 #bgjb1 #bgjc1 #bgjd1 #bgje1 #bgjf1 #bgaa1 #bgab1 & #bgah ( su* ,act4 4 #ajjc4 ,trump heal? fre$om acc\nts 7a7 ,9 g5]al ,section #bbc ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new subsection3 7i7 ,trump heal? fre$om acc\nts ,= purposes ( ?is section-- 7#a7 ,9 g5]al ,9 ! case ( a ,trump ,heal? ,fre$om ,acc\nt1 ?is section %all be appli$ z provid$ 9 p>agraphs 7#c7 ?r\gh 7#h74 7#b7 ,trump heal? fre$om acc\nt ,! t]m ,trump ,heal? ,fre$om ,acc\nt means a heal? sav+s acc\nt 7det]m9$ z provid$ 9 ?is subsection7 e/abli%$ by or on behalf ( an individual resid+ 9 a ,/ate = :i* a waiv] "u section #acce ( ! ,pati5t ,protection & ,af=dable ,c>e ,act is 9 effect :i* receives deposits ( am\nts transf]r$ to ! individual pursuant to section #acce7;a77#e7 ( su* ,act4 7#c7 ,eligible individual ,any individual cov]$ "u a heal? plan au?oriz$ to be made available on an ,ex*ange by section #acce7;d7 ( su* ,act %all be treat$ z an eligible individual4 7#d7 ,treatm5t ( transf]r$ contributions ,am\nts transf]r$ to a ,trump ,heal? ,fre$om ,acc\nt pursuant to section #acce7;a77#e7 ( su* ,act %all n be tak5 into acc\nt 9 det]m9+ ! d$uction all[$ by subsection 7a74 7#e7 ,acc\nt mu/ be only hsa ( individual 7,a7 ,9 g5]al ,an individual :o has a ,trump ,heal? ,fre$om ,acc\nt %all n be treat$ z an eligible individual ) respect to any heal? sav+s acc\nt o!r ?an su* ,trump ,heal? ,fre$om ,acc\nt4 7,b7 ,rollov] ( exi/+ acc\nt p]mitt$ ,an individual on ^: behalf a ,trump ,heal? ,fre$om ,acc\nt is e/abli%$ may roll ov] ! balance ( any o!r heal? sav+s acc\nt ( ! individual to su* ,trump ,heal? ,fre$om ,acc\nt accord+ to ! rule ( subsection 7f77#e74 7#f7 ,no rollov]s p]mitt$ ,except z provid$ 9 p>agraph 7#f77;,b71 subsection 7f77#e7 %all n apply & no am\nt %all be contribut$ f a ,trump ,heal? ,fre$om ,acc\nt to any heal? sav+ acc\nt o!r ?an a ,trump ,heal? ,fre$om ,acc\nt4 7#g7 ,re/riction on use ( am\nts ,no am\nts 9 a ,trump ,heal? ,fre$om ,acc\nt may be us$-- 7,a7 to pay premiums = a heal? plan t cov]s-- 7i7 g5d] transition proc$ures2 or 7ii7 abortion2 or 7,b7 pay = any s]vice describ$ 9 clause 7i7 or 7ii7 or subp>agraph 7,a74 7#h7 ,def9itions ,= purposes ( p>agraph 7#h7-- 7,a7 ,g5d] transition proc$ure 7i7 ,9 g5]al ,! t]m g5d] transition proc$ure means any hormonal or surgical int]v5tion = ! purpose ( g5d] transition1 includ+-- 7,i7 gonadotrop9-releas+ hormone 7,,gnrh7 agoni/s or o!r pub]ty-block+ or suppress+ drugs to /op or delay normal pub]ty2 7,,ii7 te/o/]one1 e/rog51 proge/]one1 or o!r &rog5s to an individual at doses t are sup]physiologic to :at w\ld normally be produc$ endog5\sly 9 a heal?y individual ( ! same age & sex2 7,,iii7 ca/ration2 7,,iv7 or*iectomy2 7,v7 scrotopla/y2 7,,vi7 implantation ( erection or te/icul> pro/heses2 7,,vii7 vasectomy2 7,,viii7 hy/]ectomy2 7,,ix7 oophorectomy2 7,x7 ov>iectomy2 7,,xi7 recon/ruction ( ! fix$ "p ( ! ure?ra ) or )\t a metoidiopla/y or a phallopla/y2 7,,xii7 metoidiopla/y2 7,,xiii7 p5ectomy2 7,,xiv7 phallopla/y2 7,,xv7 vag9opla/y2 7,,xvi7 clitoropla/y2 7,,xvii7 vag9ectomy2 7,,xviii7 vulvopla/y2 7,,xix7 r$uction ?yro*ondropla/y2 7,,xx7 *ondrol>yngopla/y2 7,,xxi7 ma/ectomy2 7,,xxii7 tubal ligation2 7,,xxiii7 /]ilization2 7,,xxiv7 any pla/ic1 cosmetic1 or ae/hetic surg]y t fem9izes or mascul9izes ! facial or o!r physiological features ( an individual2 7,,xxv7 any placem5t ( *e/ implants to create fem99e brea/s2 7,,xxvi7 any placem5t ( fat or artificial implants 9 ! gluteal region2 7,,xxvii7 augm5tation mammopla/y2 7,,xxviii7 liposuction2 7,,xxix7 lip(ill+2 7,,xxx7 voice surg]y2 7,,xxxi7 hair recon/ruction2 7,,xxxii7 pectoral implants2 & 7,,xxxiii7 ! removal ( any o!rwise heal?y or non-diseas$ body "p or tissue4 7ii7 ,exclusions ,! t]m g5d] transition proc$ure does n include ! foll[+ :5 furni%$ to an individual by a heal? c>e provid] ) ! cons5t ( su* individual or1 if applicable1 su* individual's p>5ts or legal gu>dian3 7,i7 ,s]vices to individuals born ) a m$ically v]ifiable disord] ( sex developm5t1 includ+ an individual ) ext]nal sex *>act]i/ics t are irresolvably ambigu\s su* z an individual born ) #df ,,xx *romosomes ) virilization1 & individual born ) #df ,,xy *romosomes ) und]virilization1 or an individual born hav+ bo? ov>ian & te/icul> tissue4 7,,ii7 ,s]vice provid$ :5 a physician has o!rwise diagnos$ a disord] ( sexual developm5t 9 :i* ! physician has det]m9$ ?r\gh g5etic or bio*emical te/+ t ! individual does n h normal sex *romosome /ructure1 sex /]oid hormone production1 or sex /]oid hormone action = a heal?y individual ( ! same sex & age4 7,,iii7 ,! treatm5t ( any infection1 injury1 disease1 or disord] t has be5 caus$ by or exac]bat$ by ! p]=mance ( g5d] transition proc$ures1 :e!r or n ! g5d] transition proc$ure 0 p]=m$ 9 accordance ) ,/ate & ,f$]al law or :e!r or n fund+ = ! g5d] transition proc$ure is p]missible "u ?is section4 7,,iv7 ,any proc$ure und]tak5 because ! individual suff]s f a physical disord]1 physical injury1 or physical illness 7b n m5tal1 behavioral1 or emotional di/ress or a m5tal1 behavioral1 or emotional disord]7 t w\ld1 z c]tifi$ by a physician1 place ! individual 9 imm95t dang] ( dea? or impairm5t ( major bodily function1 unless ! proc$ure is p]=m$4 7,v7 ,pub]ty suppression or block+ prescription drugs = ! purpose ( normaliz+ pub]ty = a m9or exp]i5c+ precoci\s pub]ty4 7,,vi7 ,male circumcision4 7,b7 ,g5d] transition ,! t]m g5d] transition means ! process 9 :i* an individual goes f id5tify+ ) or pres5t+ z 8 or h] sex to id5tify+ ) or pres5t+ a self-proclaim$ id5tity t does n correspond ) or is diff]5t f 8 or h] sex & may be accompani$ ) social1 legal1 or physical *anges4 7,c7 ,sex ,! t]m sex1 :5 ref]r+ to an individual's sex1 means to ref] to ei!r male or female1 z biologically det]m9$4 7,d7 ,female ,! t]m female1 :5 us$ to ref] to a natural p]son1 means an individual :o naturally has1 _h1 w h1 or w\ld h1 b = a cong5ital anomaly1 hi/oric accid5t1 or int5tional or un9t5tional disruption1 ! reproductive sy/em t at "s po9t produces1 transports1 & utilizes eggs = f]tilization4 7,e7 ,male ,! t]m male1 :5 us$ to ref] to a natural p]son1 means an individual :o naturally has1 _h1 w h1 or w\ld h1 b = a cong5ital anomaly1 hi/orical accid5t1 or int5tional or un9t5tional disruption1 ! reproductive sy/em t at "s po9t produces1 transports1 & utilizes sp]m = f]tilization4 7b7 ,effective date ,! am5dm5t made by ?is section %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjbe4 4 ,b ,improv+ ,,hsa access1 utility1 & flexibility #ajaa4 ,individuals entitl$ to "p a ( m$ic>e by reason ( age all[$ to contribute to heal? sav+s acc\nt 7a7 ,9 g5]al ,section #bbc7;c77#a77;,b7 is am5d$ by /rik+ & at ! end ( clause 7ii71 by /rik+ ! p]iod at ! end ( clause 7iii7 & ins]t+ 1 &1 & by add+ at ! end ! foll[+ new clause3 7iv7 entitlem5t to hospital insurance b5efits "u "p ,a ( title ,,xviii ( ! ,social ,security ,act by reason ( section #bbf7;a7 ( su* ,act4 4 7b7 ,treatm5t ( heal? insurance pur*as$ f acc\nt ,section #bbc7;d77#b77;,c77iv7 is am5d$ by ins]t+ & :o is n an eligible individual aft] :o has atta9$ ! age specifi$ 9 section #ahaa ( ! ,social ,security ,act4 7c7 ,coord9ation ) p5alty on di/ributions n us$ = qualifi$ m$ical exp5ses ,section #bbc7;f77#d77;,c7 is am5d$ by /rik+ ,subp>agraph 7,a7 & ins]t+ ,except 9 ! case ( an eligible individual1 subp>agraph 7,a74 7d7 ,con=m+ am5dm5t ,section #bbc7;b77#g7 is am5d$ by ins]t+ 7o!r ?an an entitlem5t to b5efits describ$ 9 subsection 7c77#a77;,b77iv77 aft] ,social ,security ,act4 7e7 ,effective date ,! am5dm5ts made by ?is section %all apply to mon?s beg9n+ aft] ,decemb] #ca1 #bjbe4 #ajab4 ,all[ bo? sp\ses to make cat*-up contributions to ! same heal? sav+s acc\nt 7a7 ,9 g5]al ,section #bbc7;b77#e7 is am5d$ to read z foll[s3 7#e7 ,special rule = m>ri$ individuals ) family cov]age 7,a7 ,9 g5]al ,9 ! case ( individuals :o are m>ri$ to ea* o!r1 if bo? sp\ses are eligible individuals & ei!r sp\se has family cov]age "u a high d$uctible heal? plan z ( ! fir/ day ( any mon?-- 7i7 ! limitation "u p>agraph 7#a7 %all be appli$ by n tak+ into acc\nt any o!r high d$uctible heal? plan cov]age ( ei!r sp\se 7& if su* sp\ses bo? h family cov]age "u sep>ate high d$uctible heal? plans1 only "o su* cov]age %all be tak5 into acc\nt71 7ii7 su* limitation 7aft] application ( clause 7i77 %all be r$uc$ by ! aggregate am\nt paid to ,ar*] ,m,s,as ( su* sp\ses = ! taxable ye>1 & 7iii7 su* limitation 7aft] application ( clauses 7i7 & 7ii77 %all be divid$ equally betwe5 su* sp\ses unless !y agree on a diff]5t division4 7,b7 ,treatm5t ( additional contribution am\nts ,if bo? sp\ses ref]r$ to 9 subp>agraph 7,a7 h atta9$ age #ee be=e ! close ( ! taxable ye>1 ! limitation ref]r$ to 9 subp>agraph 7,a77iii7 :i* is subject to division betwe5 ! sp\ses %all include ! additional contribution am\nts det]m9$ "u p>agraph 7#c7 = bo? sp\ses4 ,9 any o!r case1 any additional contribution am\nt det]m9$ "u p>agraph 7#c7 %all n be tak5 into acc\nt "u subp>agraph 7,a77iii7 & %all n be subject to division betwe5 ! sp\ses4 4 7b7 ,effective date ,! am5dm5ts made by ?is section %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjbe4 #ajac4 ,,fsa & ,,hra t]m9ations or conv]sions to fund hsas 7a7 ,9 g5]al ,section #ajf7;e77#b7 is am5d$ to read z foll[s3 7#b7 ,qualifi$ hsa di/ribution ,= purposes ( ?is subsection-- 7,a7 ,9 g5]al ,! t]m qualifi$ ,,hsa di/ribution means1 ) respect to any employee1 a di/ribution f a heal? flexible sp5d+ arrangem5t or heal? reimbursem5t arrangem5t ( su* employee contribut$ directly to a heal? sav+s acc\nt ( su* employee if-- 7i7 su* di/ribution is made 9 connection ) su* employee e/abli%+ cov]age "u a high d$uctible heal? plan 7z def9$ 9 section #bbc7;c77#b77 if dur+ ! #d-ye> p]iod prec$+ ! date ! employee s e/abli%es cov]age ! employee 0 n cov]$ "u su* a high d$uctible heal? plan1 & 7ii7 su* arrangem5t is describ$ 9 section #bbc7;c77#a77;,b77v7 ) respect to any portion ( ! plan ye> rema9+ aft] su* di/ribution is made1 if su* employee rema9s enroll$ 9 su* arrangem5t4 7,b7 ,doll> limitation ,! aggregate am\nt ( di/ributions f heal? flexible sp5d+ arrangem5ts & heal? reimbursem5t arrangem5ts ( any employee :i* may be treat$ z qualifi$ ,,hsa di/ributions 9 connection ) an e/abli%m5t ( cov]age describ$ 9 subp>agraph 7,a77i7 %all n exce$ ! doll> am\nt 9 effect "u section #abe7;i77#a7 7twice su* am\nt 9 ! case ( cov]age :i* is describ$ 9 section #bbc7;b77#b77;,b774 4 7b7 ,p>tial r$uction ( limitation on d$uctible ,,hsa contributions ,section #bbc7;b77#d7 is am5d$ by /rik+ & at ! end ( subp>agraph 7,b71 by /rik+ ! p]iod at ! end ( subp>agraph 7,c7 & ins]t+ 1 &1 & by ins]t+ aft] subp>agraph 7,c7 ! foll[+ new subp>agraph3 7,d7 s mu* ( any qualifi$ ,,hsa di/ribution 7z def9$ 9 section #ajf7;e77#b77 made to a heal? sav+s acc\nt ( su* individual dur+ ! taxable ye> z does n exce$ ! aggregate increases 9 ! balance ( ! arrangem5t f :i* su* di/ribution is made :i* occur dur+ ! portion ( ! plan ye> :i* prec$es su* di/ribution 7o!r ?an any balance c>ri$ ov] to su* plan ye> & det]m9$ )\t reg>d to any decrease 9 su* balance dur+ su* portion ( ! plan ye>74 4 7c7 ,conv]sion to ,,hsa-,compatible arrangem5t = rema9d] ( plan ye> ,section #bbc7;c77#a77;,b71 z am5d$ by ?is prec$+ provisions ( ?is ,act1 is am5d$ by /rik+ & at ! end ( clause 7iii71 by /rik+ ! p]iod at ! end ( clause 7iv7 & ins]t+ 1 &1 & by add+ at ! end ! foll[+ new clause3 7v7 cov]age "u a heal? flexible sp5d+ arrangem5t or heal? reimbursem5t arrangem5t = ! portion ( ! plan ye> aft] a qualifi$ ,,hsa di/ribution 7z def9$ 9 section #ajf7;e77#b7 det]m9$ )\t reg>d to subp>agraph 7,a77ii7 !re(7 is made1 if ! t]ms ( su* arrangem5t :i* apply = su* portion ( ! plan ye> are su* t1 if su* t]ms appli$ = ! entire plan ye>1 !n su* arrangem5t w\ld n be tak5 into acc\nt "u subp>agraph 7,a77ii7 ( ?is p>agraph = su* plan ye>4 4 7d7 ,inclusion ( qualifi$ ,,hsa di/ributions on ,w-#b 7#a7 ,9 g5]al ,section #fjea7;a71 z am5d$ by ! prec$+ provisions ( ?is ,act1 is am5d$ by /rik+ & at ! end ( p>agraph 7#ai71 by /rik+ ! p]iod at ! end ( p>agraph 7#bj7 & ins]t+ 1 &1 & by ins]t+ aft] p>agraph 7#bj7 ! foll[+ new p>agraph3 7#ba7 ! am\nt ( any qualifi$ ,,hsa di/ribution 7z def9$ 9 section #ajf7;e77#b77 ) respect to su* employee4 4 7#b7 ,con=m+ am5dm5t ,section #fjea7;a77#ab7 is am5d$ by ins]t+ 7o!r ?an any qualifi$ ,,hsa di/ribution1 z def9$ 9 section #ajf7;e77#b77 be=e ! comma at ! end4 7e7 ,effective date ,! am5dm5ts made by ?is section %all apply to di/ributions made aft] ,decemb] #ca1 #bjbe4 #ajad4 ,special rule = c]ta9 m$ical exp5ses incurr$ be=e e/abli%m5t ( heal? sav+s acc\nt 7a7 ,9 g5]al ,section #bbc7;d77#b71 z am5d$ by ! prec$+ provisions ( ?is ,act1 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,f7 ,treatm5t ( c]ta9 m$ical exp5ses incurr$ be=e e/abli%m5t ( acc\nt ,if a heal? sav+s acc\nt is e/abli%$ dur+ ! #fj-;day p]iod beg9n+ on ! date t cov]age ( ! acc\nt b5efici>y "u a high d$uctible heal? plan beg9s1 !n1 solely = purposes ( det]m9+ :e!r an am\nt paid is us$ = a qualifi$ m$ical exp5se1 su* acc\nt %all be treat$ z hav+ be5 e/abli%$ on ! date t su* cov]age beg9s4 4 7b7 ,effective date ,! am5dm5t made by ?is section %all apply ) respect to cov]age beg9n+ aft] ,decemb] #ca1 #bjbe4 #ajae4 ,contributions p]mitt$ if sp\se has heal? flexible sp5d+ arrangem5t 7a7 ,contributions p]mitt$ if sp\se has a heal? flexible sp5d+ arrangem5t ,section #bbc7;c77#a77;,b71 z am5d$ by ?is prec$+ provisions ( ?is ,act1 is am5d$ by /rik+ & at ! end ( clause 7iv71 by /rik+ ! p]iod at ! end ( clause 7v7 & ins]t+ 1 &1 & by add+ at ! end ! foll[+ new clause3 7vi7 cov]age "u a heal? flexible sp5d+ arrangem5t ( ! sp\se ( ! individual = any plan ye> ( su* arrangem5t if ! aggregate reimbursem5ts "u su* arrangem5t = su* ye> d n exce$ ! aggregate exp5ses :i* w\ld be eligible = reimbursem5t "u su* arrangem5t if su* exp5ses 7 det]m9$ )\t reg>d to any exp5ses paid or incurr$ ) respect to su* individual4 4 7b7 ,effective date ,! am5dm5t made by ?is section %all apply to plan ye>s beg9n+ aft] ,decemb] #ca1 #bjbe4 #ajaf4 ,increase 9 heal? sav+s acc\nt contribution limitation = c]ta9 individuals 7a7 ,increase 7#a7 ,9 g5]al ,section #bbc7;b7 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#i7 ,increase 9 limitation = c]ta9 taxpay]s 7,a7 ,9 g5]al ,! applicable limitation "u subp>agraphs 7,a7 & 7,b7 ( p>agraph 7#b7 %all be increas$ by #d1cjj & #h1eej1 respectively4 7,b7 ,limitation bas$ on modifi$ adju/$ gross income ,! am\nt ( ! increase "u subp>agraph 7,a7 7det]m9$ )\t reg>d to ?is subp>agraph7 %all be r$uc$ 7b n bel[ z]o7 by ! am\nt :i* be>s ! same ratio to ! am\nt ( su* increase 7z s det]m9$7 z-- 7i7 ! excess 7if any7 (-- 7,i7 ! taxpay]'s adju/$ gross income = su* taxable ye>1 ov] 7,,ii7 #ge1jjj 7#aej1jjj 9 ! case ( a jo9t return1 if ! eligible individual has family cov]age71 be>s to 7ii7 #be1jjj 7#ej1jjj 9 ! case ( a jo9t return1 if ! eligible individual has family cov]age74 ,= purposes ( ! prec$+ s5t5ce1 adju/$ gross income %all be det]m9$ 9 ! same mann] z "u section #bai7;g77#c77;,a71 except det]m9$ )\t reg>d to any d$uction all[$ "u ?is section4 4 7#b7 ,only to apply to employee contributions ,section #ajf7;d77#a7 is am5d$ by ins]t+ & section #bbc7;b77#i7 aft] det]m9$ )\t reg>d to ?is subsection4 7b7 ,inflation adju/m5t ,section #bbc7;g71 z am5d$ by ! prec$+ provisions ( ?is ,act1 is am5d$-- 7#a7 by ins]t+ 1 7b77#i77;,a71 7b77#i77;,b77i77,,ii71 be=e & 7c77#b77;,a7 ea* place x appe>s1 7#b7 by /rik+ clauses 7ii7 & 7ii7 9 p>agraph 7#a77;,b77i7 & ins]t+ clauses 7ii71 7iii71 & 7iv71 7#c7 by /rik+ & at ! end ( p>agraph 7#a77;,b77ii71 7#d7 by /rik+ ! p]iod at ! end ( p>agraph 7#a77;,b77iii7 & ins]t+ 1 &1 & 7#e7 by ins]t+ aft] p>agraph 7#a77;,b77iii7 ! foll[+ new clause3 7iv7 9 ! case ( ! doll> am\nts 9 subsections 7b77#i77;,a7 & 7b77#i77;,b77i77,,ii71 cal5d> ye> #bjbe 4 7c7 ,effective date 7#a7 ,subsection 7a7 ,! am5dm5ts made by subsection 7a7 %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjbe4 7#b7 ,subsection 7b7 ,! am5dm5ts made by subsection 7b7 %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjbf4 #ajag4 ,heal? sav+s acc\nts us$ to pur*ase insurance 7a7 ,9 g5]al ,section #bbc7;d77#b7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$-- 7#a7 by /rik+ subp>agraphs 7,b7 & 7,c71 & 7#b7 by r$esignat+ subp>agraph 7,d7 z subp>agraph 7,c74 7b7 ,effective date ,! am5dm5t made by ?is section %all apply to plan ye>s beg9n+ aft] ,decemb] #ca1 #bjbe4 ,c ,heal? c>e %>+ m9i/ries #ajah4 ,treatm5t ( heal? c>e %>+ m9i/ries 7a7 ,inclusion z m$ical exp5ses ,p>agraph 7#b7 ( section #bbc7;c7 ( ! ,int]nal ,rev5ue ,code ( #aihf1 z r$esignat$ & am5d$ by ! prec$+ provisions ( ?is ,act1 is fur!r am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,d7 ,inclusion ( heal? c>e %>+ m9i/ries ,! t]m qualifi$ m$ical exp5ses %all include am\nts paid by a memb] ( a heal? c>e %>+ m9i/ry 7z def9$ 9 section #ejjj;,a7d77#b77;,b77ii7 )\t reg>d to subclause 7,,iv7 !re(7 =-- 7i7 ! %>+ ( m$ical exp5ses among memb]s1 & 7ii7 adm9i/rative fees ( ! m9i/ry4 4 7b7 ,effective date ,! am5dm5ts made by ?is section %all apply to taxable ye>s beg9n+ aft] ! date ( enactm5t ( ?is ,act4 #ajai4 ,heal? c>e %>+ m9i/ry fees treat$ z m$ical c>e 7a7 ,9 g5]al ,section #bac7;d7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#ab7 ,heal? c>e %>+ m9i/ries ,= purposes ( ?is section1 ! t]m m$ical c>e %all include am\nts paid by a memb] ( a heal? c>e %>+ m9i/ry 7z def9$ 9 section #ejjj;,a7d77#b77;,b77ii7 )\t reg>d to subclause 7,,iv7 !re(7 =-- 7,a7 ! %>+ ( m$ical exp5ses among memb]s1 & 7,b7 adm9i/rative fees ( ! m9i/ry4 4 7b7 ,effective date ,! am5dm5t made by ?is section %all apply to taxable ye>s beg9n+ aft] ! date ( ! enactm5t ( ?is ,act4 #ajbj4 ,heal? c>e %>+ m9i/ries n treat$ z heal? insurance 7a7 ,9 g5]al ,section #bbc7;c7 ( ! ,int]nal ,rev5ue ,code ( #aihf1 z r$esignat$ & am5d$ by ! prec$+ provisions ( ?is ,act1 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#e7 ,heal? c>e %>+ m9i/ries n treat$ z heal? insurance ,a heal? c>e %>+ m9i/ry 7z def9$ 9 section #ejjj;,a7d77#b77;,b77ii7 )\t reg>d to subclause 7,,iv7 !re(7 %all n be treat$ z heal? plan or insurance = purposes ( ?is title4 4 7b7 ,effective date ,! am5dm5ts made by ?is section %all apply to taxable ye>s beg9n+ aft] ! date ( enactm5t ( ?is ,act4 ,,ii ,codify+ ,trump heal?c>e fre$om ag5da ,a ,association ,heal? ,plan ,act #bjja4 ,%ort title ,?is ,act may be cit$ ! ,association ,heal? ,plan ,act4 #bjjb4 ,treatm5t ( gr\p or association ( employ]s 7a7 ,9 g5]al ,section #c7e7 ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd 7#bi ,u4,s4,c4 #ajjb7e77 is am5d$-- 7#a7 by /rik+ ,! t]m & ins]t+ 7,a7 ,! t]m2 & 7#b7 by add+ at ! end ! foll[+3 7,b7 ,= purposes ( subp>agraph 7,a71 a gr\p or association ( employ]s %all be treat$ z an employ]1 reg>dless ( :e!r ! employ]s compos+ su* gr\p or association are 9 ! same indu/ry1 trade1 or pr(ession1 if su* gr\p or association-- 7i7 7,i7 has e/abli%$ & ma9ta9s an employee welf>e b5efit plan t is a gr\p heal? plan 7z def9$ 9 section #gcc7;a77#a772 7,,ii7 provides cov]age "u su* plan to at lea/ #ea employees aft] all ( ! employees employ$ by all ( ! employ] memb]s ( su* gr\p or association h be5 aggregat$ & c\nt$ toge!r z describ$ 9 subp>agraph 7,d72 7,,iii7 has be5 actively 9 exi/5ce = at lea/ #b ye>s2 7,,iv7 has be5 =m$ & ma9ta9$ 9 good fai? = purposes o!r ?an provid+ m$ical c>e 7z def9$ 9 section #gcc7;a77#b77 ?r\gh ! pur*ase ( insurance or o!rwise2 7,v7 does n condition memb]%ip 9 ! gr\p or association on any heal? /atus-relat$ factor 7z describ$ 9 section #gjb7;a77#a77 relat+ to any individual2 7,,vi7 makes cov]age "u su* plan available to all employ] memb]s ( su* gr\p or association reg>dless ( any heal? /atus-relat$ factor 7z describ$ 9 section #gjb7;a77#a77 relat+ to su* employ] memb]s2 7,,vii7 does n provide cov]age "u su* plan to any individual o!r ?an an employee ( an employ] memb] ( su* gr\p or association2 7,,viii7 has e/abli%$ a gov]n+ bo>d ) by-laws or o!r simil> indications ( =mality to manage & op]ate su* plan 9 bo? =m & sub/ance1 ( :i* at lea/ #ge p]c5t ( ! bo>d memb]s %all be made up ( employ] memb]s ( su* gr\p or association p>ticipat+ 9 ! plan t are duly elect$ by ea* p>ticipat+ employ] memb] ca/+ #a vote dur+ a s*$ul$ election2 7,,ix7 is n a heal? insurance issu] 7z def9$ 9 section #gcc7;b77#b771 & is n own$ or controll$ by su* a heal? insurance issu] or by a subsidi>y or affiliate ( su* a heal? insurance issu]1 o!r ?an to ! ext5t su* a heal? insurance issu] may p>ticipate 9 ! gr\p or association z a memb]2 7ii7 is /ructur$ 9 good fai? ) any set ( crit]ia to qualify = su* treatm5t 9 any advisory op9ion issu$ prior to ! date ( enactm5t ( ! ,association ,heal? ,plans ,act2 or 7iii7 meets any o!r set ( crit]ia to qualify = su* treatm5t t ! ,secret>y by regulation may provide4 7,c7 7i7 ,= purposes ( subp>agraph 7,b71 a self-employ$ individual %all be treat$ z-- 7,i7 an employ] :o may become a memb] ( a gr\p or association ( employ]s2 7,,ii7 an employee :o may p>ticipate 9 an employee welf>e b5efit plan e/abli%$ & ma9ta9$ by su* gr\p or association2 & 7,,iii7 a p>ticipant ( su* plan subject to ! eligibility det]m9ation & monitor+ requirem5ts set =? 9 clause 7iii74 7ii7 ,= purposes ( ?is subp>agraph1 ! t]m self-employ$ individual means an individual :o-- 7,i7 does n h any common law employees2 7,,ii7 has a bona fide own]%ip "r 9 a trade or bus9ess1 reg>dless ( :e!r su* trade or bus9ess is incorporat$ or un9corporat$2 7,,iii7 e>ns wages 7z def9$ 9 section #caba7;a7 ( ! ,int]nal ,rev5ue ,code ( #aihf7 or self-employm5t income 7z def9$ 9 section #adjb7;b7 ( su* ,code7 f su* trade or bus9ess2 & 7,,iv7 works at lea/ #aj h\rs a week or #dj h\rs p] mon? provid+ p]sonal s]vices to su* trade or bus9ess4 7iii7 ,! bo>d ( a gr\p or association ( employ]s %all-- 7,i7 initially det]m9e :e!r an individual meets ! requirem5ts "u clause 7ii7 to be consid]$ to a self-employ$ individual = ! purposes ( be+ treat$ z an-- 7aa7 employ] memb] ( su* gr\p or association 79 accordance ) clause 7i77,i772 & 7bb7 employee :o may p>ticipate 9 ! employee welf>e b5efit plan e/abli%$ & ma9ta9$ by su* gr\p or association 79 accordance ) clause 7i77,,ii772 7,,ii7 ?r\gh reasonable monitor+ proc$ures1 p]iodically det]m9e :e!r ! individual cont9ues to meet su* requirem5ts2 & 7,,iii7 if ! bo>d det]m9es t an individual no long] meets su* requirem5ts1 n make su* plan cov]age available to su* individual 7or dep5d5ts !re(7 = any plan ye> foll[+ ! plan ye> dur+ :i* ! bo>d makes su* det]m9ation4 ,if1 subsequ5t to a det]m9ation t an individual no long] meets su* requirem5ts1 su* individual furni%es evid5ce ( satisfy+ su* requirem5ts1 su* individual 7& dep5d5ts !re(7 %all be eligible to receive plan cov]age4 7,d7 ,= purposes ( subp>agraph 7,b71 all ( ! employees 7includ+ self-employ$ individuals7 employ$ by all ( ! employ] memb]s 7includ+ self-employ$ individuals7 ( a gr\p or association ( employ]s %all be-- 7i7 treat$ z p>ticipants 9 a s+le plan multiple employ] welf>e arrangem5t2 & 7ii7 aggregat$ & c\nt$ toge!r = purposes ( any regulation ( an employee welf>e b5efit plan e/abli%$ & ma9ta9$ by su* gr\p or association4 4 7b7 ,det]m9ation ( employ] or jo9t employ] /atus ,! provision ( employee welf>e b5efit plan cov]age by a gr\p or association ( employ]s %all n be con/ru$ z evid5ce = e/abli%+ an employ] or jo9t employ] relation%ip "u any ,f$]al or ,/ate law4 #bjjc4 ,rules applicable to employee welf>e b5efit plans e/abli%$ & ma9ta9$ by a gr\p or association ( employ]s ,"p #g ( subtitle ,b ( title ,i ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd 7#bi ,u4,s4,c4 #aaha1 et seq47 is am5d$ by add+ at ! end ! foll[+3 #gcf4 ,rules applicable to employee welf>e b5efit plans e/abli%$ & ma9ta9$ by a gr\p or association ( employ]s 7a7 ,premium rates = a gr\p or association ( employ]s 7#a7 7,a7 ,9 ! case ( an employee welf>e b5efit plan e/abli%$ & ma9ta9$ by a gr\p or association ( employ]s describ$ 9 section #c7e77;,b71 su* plan may1 to ! ext5t n prohibit$ "u ,/ate law-- 7i7 e/abli% base premium rates =m$ on an actu>ially s\nd1 modifi$ community rat+ me?odology t consid]s ! pool+ ( all plan p>ticipant claims2 & 7ii7 utilize ! specific risk pr(ile ( ea* employ] memb] ( su* gr\p or association to det]m9e contribution rates = ea* su* employ] memb]'s %>e ( a premium by actu>ially adju/+ above or bel[ ! e/abli%$ base premium rates4 7,b7 ,= purposes ( p>agraph 7#a71 ! t]m employ] memb] means-- 7i7 an employ] :o is a memb] ( su* gr\p or association ( employ]s & employs at lea/ #a common law employee2 or 7ii7 a gr\p made up solely ( self-employ$ individuals1 )9 :i* all ( ! self-employ$ individual memb]s ( su* gr\p or association are aggregat$ toge!r z a s+le employ] memb] gr\p1 provid$ ! gr\p includes at lea/ #bj self-employ$ individual memb]s4 7#b7 ,9 ! ev5t a gr\p or association is made up solely ( self-employ$ individuals 7& no employ]s ) at lea/ #a common law employee are memb]s ( su* gr\p or association71 ! employee welf>e b5efit plan e/abli%$ by su* gr\p or association %all-- 7,a7 treat all self-employ$ individuals :o are memb]s ( su* gr\p or association z a s+le risk pool2 7,b7 pool all plan p>ticipant claims2 & 7,c7 *>ge ea* plan p>ticipant ! same premium rate4 7b7 ,discrim9ation & pre-,exi/+ condition protections ,an employee welf>e b5efit plan e/abli%$ & ma9ta9$ by a gr\p or association ( employ]s describ$ 9 section #c7e77;,b7 %all be prohibit$ f-- 7#a7 e/abli%+ any rule = eligibility 7includ+ cont9u$ eligibility7 ( any individual 7includ+ an employee ( an employ] memb] or a self-employ$ individual1 or a dep5d5t ( su* employee or self-employ$ individual7 to enroll = b5efits "u ! t]ms ( ! plan t discrim9ates bas$ on any heal? /atus-relat$ factor t relates to su* individual 7consi/5t ) ! rules "u section #gjb7;a77#a772 7#b7 requir+ an individual 7includ+ an employee ( an employ] memb] or a self-employ$ individual1 or a dep5d5t ( su* employee or self-employ$ individual71 z a condition ( enrollm5t or cont9u$ enrollm5t "u ! plan1 to pay a premium or contribution t is great] ?an ! premium or contribution = a simil>ly situat$ individual enroll$ 9 ! plan bas$ on any heal? /atus-relat$ factor t relates to su* individual 7consi/5t ) ! rules "u section #gjb7;b77#a772 & 7#c7 d5y+ cov]age "u su* plan on ! basis ( a pre-exi/+ condition 7consi/5t ) ! rules "u section #bgjd ( ! ,public ,heal? ,s]vice ,act74 4 #bjjd4 ,rule ( con/ruction ,no?+ 9 ?is ,act %all be con/ru$ to exempt a gr\p heal? plan :i* is an employee welf>e b5efit plan (f]$ ?r\gh a gr\p or association ( employ]s f ! requirem5ts ( "p #g ( subtitle ,b ( title ,i ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd 7#bi ,u4,s4,c4 #aaha et4 seq471 includ+ ! provisions ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act z incorporat$ by ref]5ce into ?is ,act ?r\gh section #gae4 ,b ,,*oice ,arrangem5t ,act #bjaa4 ,%ort title ,?is ,act may be cit$ z ! ,,*oice ,arrangem5t ,act4 #bjab4 ,treatm5t ( heal? reimbursem5t arrangem5ts integrat$ ) individual m>ket cov]age 7a7 ,9 g5]al ,section #ihae7;b7 is am5d$-- 7#a7 ,by /rik+ 8exception ,not)/&+ subsection 7a70 & ins]t+ ! foll[+3 ,exceptions4-- 7#a7 ,self-insur$ gr\p heal? plans ,not)/&+ subsection 7a7 7#b7 by add+ at ! end ! foll[+ new p>agraph3 7#b7 ,cu/om heal? option & individual c>e exp5se arrangem5ts 7,a7 ,9 g5]al ,= purposes ( ?is sub*apt]1 a cu/om heal? option & individual c>e exp5se arrangem5t %all be treat$ z meet+ ! requirem5ts ( section #ihjb & sections #bgje1 #bgaa1 #bgac1 & #bgae ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act4 7,b7 ,cu/om heal? option & individual c>e exp5se arrangem5ts def9$ ,= purposes ( ?is section1 ! t]m cu/om heal? option & individual c>e exp5se arrangem5t means a heal? reimbursem5t arrangem5t-- 7i7 :i* is an employ]-provid$ gr\p heal? plan fund$ solely by employ] contributions to provide paym5ts or reimbursem5ts = m$ical c>e subject to a maximum fix$ doll> am\nt = a p]iod1 7ii7 "u :i* su* paym5ts or reimbursem5ts may only be made = m$ical c>e provid$ dur+ p]iods dur+ :i* ! individual is cov]$-- 7,i7 "u individual heal? insurance cov]age 7o!r ?an cov]age t consi/s solely ( except$ b5efits71 or 7,,ii7 "u "p ,a & ,b ( title ,,xviii ( ! ,social ,security ,act or "p ,c ( su* title1 7iii7 :i* meets ! nondiscrim9ation requirem5ts ( subp>agraph 7,c71 7iv7 :i* meets ! sub/antiation requirem5ts ( subp>agraph 7,d71 & 7v7 :i* meets ! notice requirem5ts ( subp>agraph 7,e74 7,c7 ,nondiscrim9ation 7i7 ,9 g5]al ,an arrangem5t meets ! requirem5ts ( ?is subp>agraph if an employ] (f]+ su* arrangem5t to an employee )9 a specifi$ class ( employee-- 7,i7 (f]s su* arrangem5t to all employees )9 su* specifi$ class on ! same t]ms1 & 7,,ii7 does n (f] any o!r gr\p heal? plan 7o!r ?an an acc\nt-bas$ gr\p heal? plan or a gr\p heal? plan t consi/s solely ( except$ b5efits7 to any employees )9 su* specifi$ class4 ,9 ! case ( an employ] :o (f]s a gr\p heal? plan provid$ ?r\gh heal? insurance cov]age 9 ! small gr\p m>ket 7t is subject to section #bgja ( ! ,public ,heal? ,s]vice ,act7 to all employees )9 su* specifi$ class1 subclause 7,,ii7 %all n apply to su* gr\p heal? plan4 7ii7 ,specifi$ class ( employee ,= purposes ( ?is subp>agraph1 any ( ! foll[+ may be designat$ z a specifi$ class ( employee3 7,i7 ,full-"t employees4 7,,ii7 ,"p-"t employees4 7,,iii7 ,sal>i$ employees4 7,,iv7 ,non-sal>i$ employees4 7,v7 ,employees ^: prim>y site ( employm5t is 9 ! same rat+ area4 7,,vi7 ,employees :o are includ$ 9 a unit ( employees cov]$ "u a collective b>ga9+ agreem5t to :i* ! employ] is subject 7det]m9$ "u rules simil> to ! rules ( section #aje7;h774 7,,vii7 ,employees :o h n met a gr\p heal? plan1 or heal? insurance issu] (f]+ gr\p heal? insurance cov]age1 wait+ p]iod requirem5t t satisfies section #bgjh ( ! ,public ,heal? ,s]vice ,act4 7,,viii7 ,seasonal employees4 7,,ix7 ,employees :o are nonresid5t ali5s & :o receive no e>n$ income 7)9 ! mean+ ( section #iaa7;d77#b77 f ! employ] :i* con/itutes income f s\rces )9 ! ,unit$ ,/ates 7)9 ! mean+ ( section #hfa7;a77#c774 7,x7 ,su* o!r classes ( employees z ! ,secret>y may designate4 ,an employ] may designate 79 su* mann] z is prescrib$ by ! ,secret>y7 two or m ( ! classes describ$ 9 ! prec$+ subclauses z ! specifi$ class ( employees to :i* ! arrangem5t is (f]$ = purposes ( apply+ ?is subp>agraph4 7iii7 ,special rule = new hires ,an employ] may designate prospectively s mu* ( a specifi$ class ( employees z are hir$ aft] a date set by ! employ]4 ,su* subclass ( employees %all be treat$ z ! specifi$ class = purposes ( apply+ clause 7i74 7iv7 ,rules = det]m9+ type ( employee ,= purposes = clause 7ii71 any det]m9ation ( full-"t1 "p-"t1 or seasonal employm5t /atus %all be made "u rules simil> to ! rules ( section #aje7;h7 or #dihj;,h1 :i*ev] ! employ] elects = ! plan ye>4 ,su* election %all apply ) respect to all employees ( ! employ] = ! plan ye>4 7v7 ,p]mitt$ v>iation ,= purposes ( clause 7i77,i71 an arrangem5t %all n fail to be treat$ z provid$ on ! same t]ms )9 a specifi$ class m]ely because ! maximum doll> am\nt ( paym5ts & reimbursem5ts :i* may be made "u ! t]ms ( ! arrangem5t = ! ye> ) respect to ea* employee )9 su* class-- 7,i7 increases z additional dep5d5ts ( ! employee are cov]$ "u ! arrangem5t1 & 7,,ii7 increases ) respect to a p>ticipant z ! age ( ! p>ticipant increases1 b n 9 excess ( an am\nt equal to #cjj p]c5t ( ! l[e/ maximum doll> am\nt ) respect to su* a p>ticipant det]m9$ )\t reg>d to age4 7,d7 ,sub/antiation requirem5ts ,an arrangem5t meets ! requirem5ts ( ?is subp>agraph if ! arrangem5t has reasonable proc$ures to sub/antiate-- 7i7 t ! p>ticipant & any dep5d5ts are1 or w be1 enroll$ 9 cov]age describ$ 9 subp>agraph 7,b77ii7 z ( ! beg9n+ ( ! plan ye> ( ! arrangem5t 7or z ( ! beg9n+ ( cov]age "u ! arrangem5t 9 ! case ( an employee :o fir/ becomes eligible to p>ticipate 9 ! arrangem5t aft] ! date notice is giv5 ) respect to ! plan "u subp>agraph 7,e7 7det]m9$ )\t reg>d to clause 7iii7 !re(771 & 7ii7 any reque/s made = paym5t or reimbursem5t ( m$ical c>e "u ! arrangem5t & t ! p>ticipant & any dep5d5ts rema9 s enroll$4 7,e7 ,notice 7i7 ,9 g5]al ,except z provid$ 9 clause 7iii71 an arrangem5t meets ! requirem5ts ( ?is subp>agraph if1 "u ! arrangem5t1 ea* employee eligible to p>ticipate is1 n lat] ?an #fj days be=e ! beg9n+ ( ! plan ye>1 giv5 writt5 notice ( ! employee's rights & obligations "u ! arrangem5t :i*-- 7,i7 is suffici5tly accurate & compreh5sive to apprise ! employee ( su* rights & obligations1 & 7,,ii7 is writt5 9 a mann] calculat$ to be und]/ood by ! av]age employee eligible to p>ticipate4 7ii7 ,notice requirem5ts ,su* notice %all include su* in=mation z ! ,secret>y may by regulation prescribe4 7iii7 ,notice deadl9e = c]ta9 employees ,9 ! case ( an employee-- 7,i7 :o fir/ becomes eligible to p>ticipate 9 ! arrangem5t aft] ! date notice is giv5 ) respect to ! plan "u clause 7i7 7det]m9$ )\t reg>d to ?is clause71 or 7,,ii7 ^: employ] is fir/ e/abli%$ few] ?an #abj days be=e ! beg9n+ ( ! fir/ plan ye> ( ! arrangem5t1 ! requirem5ts ( ?is subp>agraph %all be treat$ z met if ! notice requir$ "u clause 7i7 is provid$ n lat] ?an ! date ! arrangem5t may take effect ) respect to su* employee4 4 7b7 ,inclusion ( ,,*oice arrangem5t p]mitt$ b5efits on ,w-#b 7#a7 ,9 g5]al ,section #fjea7;a71 z am5d$ by ! prec$+ provisions ( ?is ,act1 is am5d$ by /rik+ & at ! end ( p>agraph 7#ah71 by /rik+ ! p]iod at ! end ( p>agraph 7#ai7 & ins]t+ 1 &1 & by ins]t+ aft] p>agraph 7#ai7 ! foll[+ new p>agraph3 7#bj7 ! total am\nt ( p]mitt$ b5efits = enroll$ individuals "u a cu/om heal? option & individual c>e exp5se arrangem5t 7z def9$ 9 section #ihae7;b77#b77 ) respect to su* employee4 4 7c7 ,treatm5t ( curr5t rules relat+ to c]ta9 arrangem5ts 7#a7 ,no inf]5ce ,to ! ext5t n inconsi/5t ) ! am5dm5ts made by ?is section-- 7,a7 no inf]5ce %all be made f su* am5dm5ts ) respect to ! rules prescrib$ 9 ! ,f$]al ,regi/] on ,june #bj1 #bjai 7#hd ,f$4 ,reg4 #bhhhh71 relat+ to heal? reimbursem5t arrangem5ts & o!r acc\nt-bas$ gr\p heal? plans1 & 7,b7 any ref]5ce to cu/om heal? option & individual c>e exp5se arrangem5ts %all = purposes ( su* rules be treat$ z includ+ a ref]5ce to individual cov]age heal? reimbursem5t arrangem5ts4 7#b7 ,o!r con=m+ ( rules ,! ,secret>y ( ! ,treasury1 ! ,secret>y ( ,heal? & ,human ,s]vices1 & ! ,secret>y ( ,labor %all modify su* rules z may be necess>y to con=m to ! am5dm5ts made by ?is section4 7d7 ,effective date ,! am5dm5ts made by ?is section %all apply to plan ye>s beg9n+ aft] ,decemb] #ca1 #bjbe4 #bjac4 ,p>ticipants 9 *oice arrangem5t eligible = pur*ase ( ex*ange insurance = pur*ase ( cafet]ia plan 7a7 ,9 g5]al ,section #abe7;f77#c7 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,c7 ,exception = p>ticipants 9 *oice arrangem5t ,subp>agraph 7,a7 %all n apply 9 ! case ( an employee p>ticipat+ 9 a cu/om heal? option & individual c>e exp5se arrangem5t 7)9 ! mean+ ( section #ihae7;b77#b77 (f]$ by ! employee's employ]4 4 7b7 ,effective date ,! am5dm5t made by ?is section %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjbe4 #bjad4 ,employ] cr$it = *oice arrangem5t 7a7 ,9 g5]al ,subp>t ,d ( "p ,,iv ( sub*apt] ,a ( *apt] #a is am5d$ by add+ at ! end ! foll[+ new section3 #de;,,bb4 ,employ] cr$it = *oice arrangem5t 7a7 ,9 g5]al ,= purposes ( section #ch1 9 ! case ( an eligible employ]1 ! ,,*oice arrangem5t cr$it det]m9$ "u ?is section = any taxable ye> is an am\nt1 ) respect to ea* employee enroll$ dur+ ! cr$it p]iod 9 a ,,*oice arrangem5t ma9ta9$ by ! employ]1 equal to-- 7#a7 #ajj multipli$ by ! numb] ( mon?s = :i* ! employee is s enroll$ dur+ ! fir/ ye> 9 ! cr$it p]iod1 & 7#b7 "o-half ( ! doll> am\nt 9 effect "u p>agraph 7#a7 = ! taxable ye>1 multipli$ by ! numb] ( mon?s = :i* ! employee is s enroll$ dur+ ! second ye> ( ! cr$it p]iod4 7b7 ,arrangem5t mu/ con/itute m9imum ess5tial cov]age ,an employee %all n be tak5 into acc\nt "u subsection 7a7 unless su* employee's eligibility = ! ,,*oice arrangem5t 7det]m9$ )\t reg>d to ! employee be+ enroll$7 w\ld cause ! employee to be treat$ "u section #cf;,b7c77#b7 z be+ eligible = m9imum ess5tial cov]age consi/+ ( an eligible employ]-sponsor$ plan 7z def9$ 9 section #ejjj;,a7f77#b774 7c7 ,def9itions ,= purposes ( ?is section-- 7#a7 ,,*oice arrangem5t ,! t]m ,,*oice arrangem5t means a cu/om heal? option & individual c>e exp5se arrangem5t 7z def9$ 9 section #ihae7;b77#b77;,b774 7#b7 ,cr$it p]iod ,! cr$it p]iod ) respect to an eligible employ] is ! fir/ #b "o-ye> p]iods beg9n+ ) ! mon? dur+ :i* ! employ] fir/ e/abli%es a ,,*oice arrangem5t on behalf ( employees ( ! employ]4 7#c7 ,eligible employ] ,! t]m eligible employ] means1 ) respect to any taxable ye> beg9n+ 9 a cal5d> ye>1 an employ] :o is n an applicable l>ge employ] = ! cal5d> ye> "u section #dihj;,h4 7d7 ,inflation adju/m5t 7#a7 ,9 g5]al ,9 ! case ( any taxable ye> beg9n+ 9 a cal5d> ye> aft] #bjbf1 ! doll> am\nt 9 subsection 7a7 %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* su* taxable ye> beg9s by sub/itut+ cal5d> ye> #bjbe = cal5d> ye> #bjaf 9 subp>agraph 7,a77ii7 !re(4 7#b7 ,r\nd+ ,if any am\nt aft] adju/m5t "u p>agraph 7#a7 is n a multiple ( #aj1 su* am\nt %all be r\nd$ to ! next l[] multiple ( #aj4 4 7b7 ,cr$it made "p ( g5]al bus9ess cr$it ,section #ch7;b7 is am5d$ by /rik+ plus at ! end ( p>agraph 7#dj71 by /rik+ ! p]iod at ! end ( p>agraph 7#da7 & ins]t+ 1 plus1 & by add+ at ! end ! foll[+ new p>agraph3 7#db7 ! ,,*oice arrangem5t cr$it det]m9$ "u section #de;,,bb7a74 4 7c7 ,cr$it all[$ aga9/ alt]native m9imum tax ,section #ch7;c77#d77;,b7 is am5d$-- 7#a7 by r$esignat+ clauses 7x71 7xi71 & 7xii7 z clauses 7xi71 7xii71 & 7xiii71 respectively1 & 7#b7 by ins]t+ aft] clause 7ix7 ! foll[+ new clause3 7x7 ! cr$it det]m9$ "u section #de;,,bb1 4 7d7 ,cl]ical am5dm5t ,! table ( sections = subp>t ,d ( "p ,,iv ( sub*apt] ,a ( *apt] #a is am5d$ by add+ at ! end ! foll[+ new item3 7e7 ,effective date ,! am5dm5ts made by ?is section %all apply to taxable ye>s beg9n+ aft] ,decemb] #ca1 #bjbe4 ,c ,self-,insurance ,protection ,act #bjba4 ,%ort title ,?is ,act may be cit$ z ! ,self-,insurance ,protection ,act4 #bjbb4 ,f9d+s ,congress f9ds ! foll[+3 7#a7 ,small & l>ge employ]s (f] heal? b5efit plan cov]age to employees 9 self-fund$ arrangem5ts us+ company assets or a fund1 or by pay+ premiums to pur*ase fully-insur$ cov]age f a heal? insurance company4 7#b7 ,employ]s t self-fund heal? b5efit plans w (t5 pur*ase /op-loss insurance z a f9ancial risk managem5t tool to protect aga9/ excess or unexpect$ cata/rophic heal? plan claims losses t arise above project$ co/s paid out ( company assets4 7#c7 ,/op-loss cov]age insures ! employ] sponsor+ ! heal? b5efit plan aga9/ un=ese5 heal? plan claims1 does n insure ! employee heal? b5efit plan itself1 & does n pay heal? c>e provid]s = m$ical s]vices provid$ to ! employees4 7#d7 ,employ]-sponsor$ heal? b5efit plans are regulat$ "u ! ,employee ,retirem5t ,income ,security ,act ( #aigd1 h[ev]1 ,/ates regulate ! availability & ! cov]age t]ms ( /op-loss insurance cov]age t employ]s pur*ase to protect company assets & to protect a fund aga9/ excess or unexpect$ claims losses4 7#e7 ,bo? l>ge & small employ]s t *oose to self-fund mu/ also be able to protect company assets or a fund aga9/ excess or unexpect$ claims losses & ,/ates mu/ reasonably regulate /op-loss insurance to assure its availability to bo? l>ge & small employ]s4 #bjbc4 ,c]ta9 m$ical /op-loss insurance obta9$ by c]ta9 plan sponsors ( gr\p heal? plans n includ$ "u ! def9ition ( heal? insurance cov]age ,section #gcc7;b77#a7 ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd 7#bi ,u4,s4,c4 #aaia;b7b77#a77 is am5d$ by add+ at ! end ! foll[+ s5t5ce3 ,su* t]m %all n include a /op-loss policy obta9$ by a self-insur$ gr\p heal? plan or a plan sponsor ( a gr\p heal? plan t self-insures ! heal? risks ( its plan p>ticipants to reimburse ! plan or sponsor = losses t ! plan or sponsor incurs 9 provid+ heal? or m$ical b5efits to su* plan p>ticipants 9 excess ( a pr$et]m9$ level set =? 9 ! /op-loss policy obta9$ by su* plan or sponsor44 #bjbd4 ,effect on o!r laws ,section #ead7;b7 ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd 7#bi ,u4,s4,c4 #aadd7;b77 is am5d$ by add+ at ! end ! foll[+3 7#aj7 ,! provisions ( ?is title 7includ+ "p #g relat+ to gr\p heal? plans7 %all preempt ,/ate laws ins(> z !y may n[ or h]eaft] prev5t an employee b5efit plan t is a gr\p heal? plan f insur+ aga9/ ! risk ( excess or unexpect$ heal? plan claims losses4 4 ,d ,small ,bus9ess ,flexibility ,act #bjca4 ,%ort title ,?is ,act may be cit$ z ! ,small ,bus9ess ,flexibility ,act4 #bjcb4 ,notification ( flexible heal? insurance b5efits 7a7 ,9 g5]al ,sub*apt] ,c ( *apt] #ajj ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new section3 #ihce4 ,notification ( flexible heal? insurance b5efits 7a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! date ( enactm5t ( ?is section1 ! ,secret>y %all notify employ]s ( ! availability ( tax-advantag$ flexible heal? insurance b5efits1 ) an initial focus on small bus9esses1 p>ticul>ly 9 rural areas 7z def9$ 9 section #acic7;a77#b774 7b7 ,def9itions ,9 ?is section3 7#a7 ,employ] ,! t]m employ] has ! mean+ giv5 su* t]m 9 section #c7e7 ( ! ,employee ,retirem5t ,income ,security ,act 7#bi ,u4,s4,c4 #ajjb7e774 7#b7 ,flexible heal? insurance b5efits ,! t]m flexible heal? insurance b5efits means-- 7,a7 an individual contribution heal? reimbursem5t arrangem5t 7z describ$ 9 ! rule entitl$ ,heal? ,reimbursem5t ,arrangem5ts & ,o!r ,acc\nt-,bas$ ,gr\p ,heal? ,plans 7#hd ,f$4 ,reg4 #bhhhh 7,june #bj1 #bjai7772 7,b7 a qualifi$ small employ] heal? reimbursem5t arrangem5t 7z def9$ 9 section #ihca7;d77#b772 & 7,c7 ! small employ] heal? insurance cr$it det]m9$ "u section #de,r4 4 7b7 ,cl]ical am5dm5t ,! table ( sections = sub*apt] ,c ( *apt] #ajj ( su* ,code is am5d$ by add+ at ! end ! foll[+ new item3 ,sec4 #ihce4 ,notification ( flexible heal? insurance b5efits 4 ,e ,heal? ,cov]age ,*oice ,act #bjda4 ,%ort title ,?is ,act may be cit$ z ! ,heal? ,cov]age ,*oice ,act4 #bjdb4 ,def9ition ( %ort-t]m limit$ duration insurance ,section #bgia7;b7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ia7;b77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#f7 ,%ort-t]m limit$ duration insurance ,! t]m %ort-t]m limit$ duration insurance means heal? insurance cov]age provid$ "u a contract ) a heal? insurance issu] t-- 7,a7 has an expiration date specifi$ 9 ! contract t is less ?an #ab mon?s aft] ! orig9al effective date ( ! contract2 & 7,b7 has a duration ( n m ?an #aj ye>s 7tak+ into acc\nt r5ewals or ext5sions7 aft] ! orig9al effective date ( ! contract4 4 ,f ,,impact ,act ( #bjbe #bjea4 ,%ort title ,?is ,act may be cit$ z ! ,improv$ ,m$ical ,pati5ts ,af=dable ,c>e ,today ,act ( #bjbe or ! ,,impact ,act ( #bjbe4 #bjeb4 ,exp&+ eligibility = cata/rophic plans 7a7 ,9 g5]al ,section #acjb7;e77#b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db4 ,u4,s4,c4 #ahjbb7;e77#b7 is am5d$-- 7#a7 9 subp>agraph 7,b77ii71 by /rik+ ! p]iod at ! end & ins]t+ 2 or2 & 7#b7 by add+ at ! end ! foll[+ new subp>agraph3 7,c7 ) respect to ! plan ye> involv$1 is det]m9$ to be ineligible 7or reasonably expects to be ineligible7 = ! premium tax cr$it "u section #cf;,b ( ! ,int]nal ,rev5ue ,code ( #aihf or = r$uc$ co/-%>+ "u section #adjb on ! basis ( ! individual's h\sehold income = su* ye>4 4 7b7 ,effective date ,! am5dm5ts made by ?is section %all apply ) respect to plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbf4 ,g ,new ,heal? ,options ,act #bjfa4 ,%ort title ,?is ,act may be cit$ z ! ,new ,heal? ,options ,act4 #bjfb4 ,creation ( a re9surance program = a new heal? insurance risk pool 7a7 ,9 g5]al ,"p ,v ( subtitle ,b ( title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjfa et seq47 is am5d$ by add+ at ! end ! foll[+ new section3 #acdd4 ,re9surance program = c]ta9 (f-ex*ange plans 7a7 ,9 g5]al ,!re is e/abli%$ a ,re9surance ,program1 to be adm9i/]$ by ! ,secret>y ( ,heal? & ,human ,s]vices1 to provide paym5ts to heal? insurance issu]s ) respect to claims = eligible individuals = ! purpose ( l[]+ premiums = su* individuals4 7b7 ,fund+ 7#a7 ,appropriation ,= ! purpose ( provid+ fund+ = ! ,re9surance ,program1 = ea* ye> dur+ ! p]iod beg9n+ on ,janu>y #a1 #bjbf1 & end+ on ,decemb] #ca1 #bjcj1 !re is appropriat$ out ( any monies 9 ! ,treasury n o!rwise obligat$ an am\nt equal to ! product ( #ej & ! aggregate numb] ( memb] mon?s = all eligible individuals enroll$ 9 a cov]$ plan dur+ su* ye>4 7#b7 ,limitation on appropriation ,9 no ye> %all ! appropriation = ! ,re9surance ,program au?oriz$ 9 p>agraph 7#a7 exce$ #f1jjj1jjj1jjj4 7#c7 ,use ( unexp5d$ funds ,appropriat$ am\nts rema9+ unexp5d$ at ! end ( any ye> may be us$ to make paym5ts "u ! ,re9surance ,program 9 any future ye>4 7#d7 ,limitation on use ( funds ,no funds receiv$ "u ! ,re9surance ,program may be us$ to pay = s]vices describ$ 9 section #acjc7;b77#a77;,b77i7 7z 9 effect on ! date ( ! enactm5t ( ?is section74 7c7 ,op]ation ( program 7#a7 ,9 g5]al ,! ,secret>y %all e/abli% p>amet]s = ! op]ation ( ! ,re9surance ,program consi/5t ) ?is section4 7#b7 ,deadl9e = initial op]ation ,n lat] ?an #abj days aft] ! date ( ! enactm5t1 ! ,secret>y %all e/abli% suffici5t p>amet]s to specify h[ ! ,program w op]ate = #bjbf4 7#c7 ,def9itions ,9 ?is section3 7,a7 ,cov]$ plan ,! t]m cov]$ plan means individual heal? insurance cov]age 7z su* t]m is def9$ 9 section #bgia ( ! ,public ,heal? ,s]vice ,act7-- 7i7 ) respect to :i* ! issu] ( su* cov]age has made ! election describ$ 9 section #acab7;c77#a77;,a72 & 7ii7 t does n provide cov]age = s]vices describ$ 9 section #acjc7;b77#a77;,b77i7 7z 9 effect on ! date ( ! enactm5t ( ?is section74 7,b7 ,eligible individual ,! t]m eligible individual means an individual enroll$ 9 a cov]$ plan4 7d7 ,atta*m5t doll> am\nt & paym5t proportion 7#a7 ,9 g5]al ,! ,secret>y %all annually e/abli% an atta*m5t po9t1 paym5t proportion1 & re9surance cap ) respect to claims = eligible individuals = paym5ts "u ! ,re9surance ,program1 consi/5t ) ! foll[+3 7,a7 ,! atta*m5t po9t = ! p]iod beg9n+ ,janu>y #a1 #bjbf1 & end+ ,decemb] #ca1 #bjbf1 %all be #aaj1jjj4 7,b7 ,! paym5t proportion = ! p]iod beg9n+ ,janu>y #a1 #bjbf1 & end+ ,decemb] #ca1 #bjbf1 %all be #ij p]c5t4 7,c7 ,! re9surance cap = ! p]iod beg9n+ ,janu>y #a1 #bjbf & end+ ,decemb] #ca1 #bjbf1 %all be #cjj1jjj4 7#b7 ,adju/m5t au?ority ,! ,secret>y may adju/ any am\nts describ$ 9 p>agraph 7#a7 z necess>y to ensure ! ,re9surance ,program does n make paym5t = a ye> 9 excess ( ! am\nt available = su* ye> "u subsection 7b74 4 7b7 ,election ,to opt out ( s+le risk pool 7#a7 ,9 g5]al ,section #acab7;c77#a7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjcb7;c77#a77 is am5d$-- 7,a7 by /rik+ ,a heal? insurance issu] & ins]t+ ! foll[+3 7,a7 ,9 g5]al ,a heal? insurance issu] 2 7,b7 9 subp>agraph 7,a71 z ins]t$ by p>agraph 7#a71 by ins]t+ & o!r ?an any heal? plan ) respect to :i* su* issu] has elect$ = ?is subp>agraph n to apply aft] gr&fa!r$ heal? plans2 & 7,c7 by add+ at ! end ! foll[+ new subp>agraph3 7,b7 ,treatm5t ( plans opt+ out ( s+le risk pool ,a heal? insurance issu] %all consid] all enrollees 9 all heal? plans (f]$ by su* issu] 9 ! individual m>ket ) respect to :i* su* issu] has made ! election describ$ 9 subp>agraph 7,a7 to be memb]s ( a s+le risk pool4 4 7#b7 ,prohibit+ s+le risk pool opt out = qualifi$ heal? plans ,section #acja7;a77#a77;,c7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjba7;a77#a77 is am5d$-- 7,a7 9 clause 7iii71 by /rik+ & at ! end2 7,b7 9 clause 7iv71 by /rik+ ! p]iod & ins]t+ 2 &2 & 7,c7 by add+ at ! end ! foll[+ new clause3 7v7 has n made ! election describ$ 9 section #acab7;c77#a77;,a7 ) respect to su* plan4 4 7#c7 ,effective date ,! am5dm5ts made by ?is subsection %all apply ) respect to plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbf4 7c7 ,remov+ age premium v>iation limitation = c]ta9 plans 7#a7 ,9 g5]al 7,a7 ,removal ( limitation = c]ta9 plans ,section #bgja7;a77#a77;,a77iii7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c #cjj;gg7a77#a77;,a77iii77 is am5d$ by ins]t+ or1 9 ! case ( su* cov]age ) respect to :i* ! issu] ( su* cov]age has made ! election describ$ 9 section #acab7;c77#a77;,a7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act1 by m ?an an actu>ially ju/ifi$ am\nt = adults be=e 2 &4 7,b7 ,effective date ,! am5dm5t made by subp>agraph 7,a7 %all apply ) respect to plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbf4 7#b7 ,ma9ta9+ age premium v>iation limitation = qualifi$ heal? plans ,section #acja7;a77#a7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjba7;a77#a771 z am5d$ by subsection 7b71 is fur!r am5d$-- 7,a7 9 subp>agraph 7,b71 by /rik+ & at ! end2 7,b7 9 subp>agraph 7,c77v71 by /rik+ ! p]iod & ins]t+ 2 &2 & 7,c7 by add+ at ! end ! foll[+ new subp>agraph3 7,d7 ) respect to ! premium rate *>g$ by su* plan1 if su* plan v>ies su* rate by age1 does n v>y su* rate by m ?an #c to #a = adults 7consi/5t ) section #bgjg7;c7 ( ! ,public ,heal? ,s]vice ,act74 4 7d7 ,treatm5t ( opt out plans 9 relation to individual heal? cov]age reimbursem5t arrangem5ts ,! ,secret>ies ( ,heal? & ,human ,s]vices1 ,labor1 & ! ,treasury %all n fail to treat any individual heal? insurance cov]age 7z def9$ 9 section #bgia ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ia77 z eligible = integration ) an individual heal? c>e reimbursem5t arrangem5t on ! basis t ! heal? insurance issu] 7z s def9$7 ( su* cov]age has made ! election describ$ 9 section #acab7;c77#a77;,a7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7z ins]t$ by subsection 7b774 #bjfb4 ,promotion ( high-value c>e 7a7 ,9 g5]al ,subp>t ,,ii ( "p ,a ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#aa et seq47 is am5d$ by add+ at ! end ! foll[+ new section3 #bgcj4 ,application ( c]ta9 out-(-network co/s to d$uctibles & out-(-pocket maximums 7a7 ,9 g5]al ,a gr\p heal? plan1 & a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age1 %all1 9 ! case t an individual enroll$ "u su* plan or cov]age is furni%$ items or s]vices by a heal? c>e provid] or heal? c>e facility t does n h 9 effect a contractual relation%ip ) su* plan or issu] = ! furni%+ ( su* items or s]vices & su* individual incurs any out-(-pockets co/s ) respect to su* items & s]vices1 at ! option ( su* individual1 apply su* co/s to any d$uctible or out-(-pocket maximum applicable to items & s]vices furni%$ by heal? c>e provid]s or heal? c>e facilities ) contracts 9 effect ) su* plan or issu] = ! furni%+ ( su* items or s]vices1 b only if ! foll[+ requirem5ts are met3 7#a7 ,! item or s]vice furni%$ by su* provid] or facility )\t a contract 9 effect ) su* plan or issu] is an item or s]vice = :i* b5efits are available "u su* plan or cov]age4 7#b7 ,! am\nt *>g$ by su* provid] or facility = su* item or s]vice is equal to or less ?an-- 7,a7 ! l[e/ am\nt recogniz$ by ! plan or cov]age z paym5t = su* item or s]vice out ( all heal? c>e provid]s & heal? c>e facilities ) a contract 9 effect ) su* plan or issu] to furni% su* item or s]vice 9 ! same rat+ area 7z def9$ = purposes ( section #bgja7 9 :i* ! item or s]vice describ$ 9 p>agraph 7#a7 0 furni%$2 or 7,b7 ! #be? p]c5tile ( *>ges = su* item or s]vice furni%$ 9 ! same ,/ate 9 :i* ! item or s]vice describ$ 9 p>agraph 7#a7 0 furni%$4 7b7 ,disclosure ( in=mation ,a gr\p heal? plan1 & a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age1 %all1 ) respect to ea* item or s]vice = :i* b5efits are available "u su* plan or cov]age1 make available ! l[e/ am\nt describ$ 9 subsection 7a77#b77;,a7 & ! #be? p]c5tile describ$ 9 subsection 7a77#b77;,b7 to all individuals enroll$ "u su* plan or cov]age4 4 7b7 ,effective date ,! am5dm5t made by subsection 7a7 %all apply to plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbf4 #bjfd4 ,disclosure ( l[] prices ,"p ,e ( title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#aca7 is am5d$ by add+ at ! end ! foll[+ new section3 #bgii;,b-#aj4 ,disclosure ( l[] prices 7a7 ,9 g5]al ,beg9n+ ,janu>y #a1 #bjbf1 ea* heal? c>e provid] & heal? c>e facility %all disclose to pati5ts & prospective pati5ts enroll$ 9 a gr\p heal? plan1 gr\p or individual heal? insurance cov]age1 or a ,f$]al heal? c>e program 7z def9$ 9 section #aabh;,b b includ+ ! program e/abli%$ "u *apt] #hi ( title #e1 ,unit$ ,/ates ,code7 be+ furni%$ or seek+ to be furni%$ an item or s]vice by su* provid] or facility = :i* b5efits are available "u su* plan1 cov]age1 or program1 z applicable1 :e!r ! am\nt ( co/ %>+ 7includ+ d$uctibles1 copaym5ts1 & co9surance7 t w\ld be incurr$ by su* individual = su* item or s]vice "u su* plan1 cov]age1 or program1 z applicable1 exce$s ! *>ge t w\ld apply = su* item or s]vice = an individual )\t b5efits "u any su* plan1 cov]age1 or program = su* item or s]vice4 7b7 ,additional en=cem5t ,9 addition to any o!r p5alty applicable ) respect to a violation ( subsection 7a71 an individual :o is h>m$ by a violation ( ?is section by a heal? c>e provid] or heal? c>e facility may br+ an action aga9/ su* provid] or facility 9 an appropriate di/rict c\rt ( ! ,unit$ ,/ates =-- 7#a7 appropriate injunctive relief2 & 7#b7 damages 9 an am\nt t is equal to ! am\nt provid$ = su* h>m 9 a civil action "u ! law ( ! ,/ate 9 :i* ! provid] or facility is locat$4 4 ,h ,fight+ wa/e fraud & abuse 9 ! unaf=dable c>e act #bjga4 ,%ort title ,?is ,act may be cit$ z ! ,fight+ ,wa/e ,fraud & ,abuse 9 ! ,unaf=dable ,c>e ,ex*anges ,act ( #bjbe4 #bjgb4 ,address+ wa/e1 fraud1 & abuse 9 ! ,,aca ex*anges 7a7 ,*anges to enrollm5t p]iods = enroll+ 9 ex*anges ,section #acaa ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjca7 is am5d$-- 7#a7 9 subsection 7c77#f7-- 7,a7 by /rik+ subp>agraph 7,a72 7,b7 by /rik+ ,! ,secret>y & ins]t+ ! foll[+3 7,a7 ,9 g5]al ,! ,secret>y 2 7,c7 by r$esignat+ subp>agraphs 7,b7 ?r\gh 7,d7 z clauses 7i7 ?r\gh 7iii7 respectively1 & adju/+ ! m>g9s accord+ly2 7,d7 9 clause 7i71 z s r$esignat$1 by /rik+ p]iods1 z det]m9$ by ! ,secret>y = cal5d> ye>s aft] ! initial enrollm5t p]iod2 & ins]t+ ! foll[+3 p]iods = plans (f]$ 9 ! individual m>ket-- 7,i7 = enrollm5t = plan ye>s beg9n+ be=e ,janu>y #a1 #bjbg1 z det]m9$ by ! ,secret>y2 & 7,,ii7 = enrollm5t = plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbg1 beg9n+ on ,novemb] #a1 & end+ on ,decemb] #ae ( ! prec$+ cal5d> ye>2 4 7,e7 9 clause 7ii71 z s r$esignat$1 by ins]t+ subject to subp>agraph 7,b71 be=e special enrollm5t p]iod specifi$2 & 7,f7 by add+ at ! end ! foll[+ new subp>agraph2 7,b7 ,prohibit$ special enrollm5t p]iod ,) respect to plans ye>s beg9n+ on or aft] ,janu>y #a1 #bjbg1 ! ,secret>y may n require an ,ex*ange to provide = a special enrollm5t p]iod = an individual on ! basis ( ! relation%ip ( ! income ( su* individual to ! pov]ty l9e1 o!r ?an a special enrollm5t p]iod bas$ on a *ange 9 circum/ances or ! occurr5ce ( a specific ev5t4 2 7#b7 9 subsection 7d71 by add+ at ! end ! foll[+ new p>agraphs3 7#h7 ,prohibit$ enrollm5t p]iods ,an ex*ange may n provide =1 ) respect to enrollm5t = plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbg-- 7,a7 an annual op5 enrollm5t p]iod o!r ?an ! p]iod describ$ 9 subp>agraph 7,a77i7 ( subsection 7c77#f72 or 7,b7 a special enrollm5t p]iod describ$ 9 subp>agraph 7,b7 ( su* subsection4 7#i7 ,v]ification ( eligibility = special enrollm5t p]iods 7,a7 ,9 g5]al ,) respect to enrollm5t = plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbg1 an ,ex*ange %all v]ify t ea* individual seek+ to enroll 9 a qualifi$ heal? plan (f]$ by ! ,ex*ange dur+ a special enrollm5t p]iod select$ "u p>agraph 7,b7 is eligible to enroll dur+ su* special enrollm5t p]iod prior to enroll+ su* individual 9 su* plan4 7,b7 ,select$ special enrollm5t p]iods ,= purposes ( subp>agraph 7,a71 an ,ex*ange %all select "o or m special enrollm5t p]iods = a plan ye> ) respect to :i* su* ,ex*ange %all conduct ! v]ification requir$ "u subp>agraph 7,a7 su* t ! ,ex*ange conducts su* v]ification = n less ?an #ge p]c5t ( all individuals enroll+ 9 a qualifi$ heal? plan (f]$ by ! ,ex*ange dur+ any special enrollm5t p]iod ) respect to su* plan ye>4 4 7b7 ,v]ify+ income = individuals enroll$ 9 a qualifi$ heal? plan ?r\gh an ex*ange 7#a7 ,9 g5]al ,section #adaa7;e77#d7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjha7;e77#d77 is am5d$-- 7,a7 by r$esignat+ subp>agraph 7,c7 z subp>agraph 7,e72 & 7,b7 by ins]t+ aft] subp>agraph 7,b7 ! foll[+ new subp>agraphs3 7,c7 ,requir+ v]ification ( income & family size :5 tax data is unavailable ,= plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbg1 = purposes ( subp>agraph 7,a71 9 ! case t ! ,ex*ange reque/s data f ! ,secret>y ( ! ,treasury reg>d+ an individual's h\sehold income & ! ,secret>y ( ! ,treasury does n return su* data1 su* in=mation may n be v]ifi$ solely on ! basis ( ! atte/ation ( su* individual ) respect to su* h\sehold income1 & ! ,ex*ange %all take ! actions describ$ 9 subp>agraph 7,a74 7,d7 ,requir+ v]ification ( income 9 ! case ( c]ta9 income discrepancies 7i7 ,9 g5]al ,subject to clause 7iii71 = plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbg1 = purposes ( subp>agraph 7,a71 9 ! case t a specifi$ income discrepancy describ$ 9 clause 7ii7 ( ?is subp>agraph exi/s ) respect to ! in=mation provid$ by an applicant "u subsection 7b77#c71 ! h\sehold income ( su* individual %all be treat$ z inconsi/5t ) in=mation 9 ! records ma9ta9$ by p]sons "u subsection 7c71 or z n v]ifi$ "u subsection 7d71 & ! ,ex*ange %all take ! actions describ$ 9 su* subp>agraph 7,a74 7ii7 ,specifi$ income discrepancy ,= purposes ( clause 7i71 a specifi$ income discrepancy exi/s ) respect to ! in=mation provid$ by an applicant "u subsection 7b77#c7 if-- 7,i7 ! applicant atte/s to a project$ annual h\sehold income t w\ld qualify su* applicant to be an applicable taxpay] "u section #cf;,b7c77#a77;,a7 ( ! ,int]nal ,rev5ue ,code ( #aihf ) respect to ! taxable ye> involv$2 7,,ii7 ! ,ex*ange receives data f ! ,secret>y ( ! ,treasury or o!r reliable1 ?ird p>ty data1 t indicates t ! h\sehold income ( su* applicant is less ?an ! h\sehold income t w\ld qualify su* applicant to be an applicable taxpay] "u su* section #cf;,b7c77#a77;,a7 ) respect to ! taxable ye> involv$2 7,,iii7 su* atte/$ project$ annual h\sehold income exce$s ! income reflect$ 9 ! data describ$ 9 subclause 7,,ii7 by a reasonable ?re%old e/abli%$ by ! ,ex*ange & approv$ by ! ,secret>y 7:i* %all be n less ?an #aj p]c5t1 & may also be a doll> am\nt72 & 7,,iv7 ! ,ex*ange has n assess$ or det]m9$ bas$ on ! data describ$ 9 subclause 7,,ii7 t ! h\sehold income ( ! applicant meets ! applicable income-bas$ eligibility /&>d = ! ,m$icaid program "u title ,,xix ( ! ,social ,security ,act or ! ,/ate *ildr5's heal? insurance program "u title ,,xxi ( su* ,act4 7iii7 ,exclusion ( c]ta9 individuals ineligible = m$icaid ,! subp>agraph %all n apply 9 ! case ( an applicant :o is an ali5 lawfully pres5t 9 ! ,unit$ ,/ates1 :o is n eligible = ! ,m$icaid program "u title ,,xix ( ! ,social ,security ,act by reason ( su* ali5 /atus4 4 7#b7 ,requir+ individuals on ^: behalf advance paym5ts ( ! premium tax cr$it are made to file & reconcile on an annual basis ,section #adab7;b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjhb7;b77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#c7 ,annual requirem5t to file & reconcile 7,a7 ,9 g5]al ,= plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbg1 9 ! case ( an individual ) respect to :om any advance paym5t ( ! premium tax cr$it all[able "u section #cf;,b ( ! ,int]nal ,rev5ue ,code ( #aihf 0 made "u ?is section to ! issu]s ( a qualifi$ heal? plan = ! relevant prior tax ye>1 an advance det]m9ation ( eligibility = su* premium tax cr$it may n be made "u ?is subsection ) respect to su* individual & su* plan ye> if ! ,ex*ange det]m9es1 bas$ on in=mation provid$ by ! ,secret>y ( ! ,treasury1 t su* individual-- 7i7 has n fil$ an income tax return1 z requir$ "u section #fjaa & #fjab ( su* code 7& implem5t+ regulations71 = ! relevant prior tax ye>2 or 7ii7 z necess>ily1 has n be5 reconcil$ 79 accordance ) subsection 7f7 ( su* section #cf;,b7 ! advance paym5t ( ! premium tax cr$it made ) respect to su* individual = su* relevant prior tax ye>4 7,b7 ,relevant prior tax ye> ,= purposes ( subp>agraph 7,a71 ! t]m relevant prior tax ye> means1 ) respect to ! advance det]m9ation ( eligibility made "u ?is subsection ) respect to an individual1 ! taxable ye> = :i* tax return data w\ld be us$ = purposes ( v]ify+ ! h\sehold income & family size ( su* individual 7z describ$ 9 section #adaa7;b77#c77;,a774 7,c7 ,prelim9>y atte/ation ,if an individual subject to subp>agraph 7,a7 atte/s t su* individual has fulfill$ ! requirem5ts to file an income tax return = ! relevant prior tax ye> &1 z necess>y1 to reconcile ! advance paym5t ( ! premium tax cr$it made ) respect to su* individual = su* relevant prior tax ye> 7z describ$ 9 clauses 7i7 & 7ii7 ( su* subp>agraph71 ! ,secret>y may make an initial advance det]m9ation ( eligibility ) respect to su* individual & may delay = a reasonable p]iod 7z det]m9$ by ! ,secret>y7 any det]m9ation bas$ on in=mation provid$ by ! ,secret>y ( ! ,treasury t su* individual has n fulfill$ su* requirem5ts4 7,d7 ,notice ,if ! ,secret>y det]m9es t an individual did n meet ! requirem5ts describ$ 9 subp>agraph 7,a7 ) respect to ! relevant prior tax ye> & notifies ! ,ex*ange ( su* det]m9ation1 ! ,ex*ange %all comply ) ! notification requirem5t describ$ 9 section #aee4cje7;f77#d77;i7 ( title #de1 ,code ( ,f$]al ,regulations 7z 9 effect ) respect to plan ye> #bjbe74 4 7#c7 ,remov+ automatic ext5sion ( p]iod to resolve income inconsi/5cies ,! ,secret>y ( ,heal? & ,human ,s]vices %all revise section #aee4cae7;f7 ( title #de1 ,code ( ,f$]al ,regulations1 to remove p>agraph 7#g7 ( su* section1 su* t1 ) respect to enrollm5t = plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbg1 9 ! case t an ,ex*ange e/abli%$ "u subtitle ,d ( title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjba et seq47 provides an individual apply+ = enrollm5t 9 a qualifi$ heal? plan ) a #ij-;day p]iod to resolve an inconsi/5cy 9 ! application ( su* individual pursuant to section #adaa7;e77#d77;,a77ii77,,ii7 ( su* ,act1 ! ,ex*ange may n provide = an automatic ext5sion to su* #ij-;day p]iod on ! basis t su* individual is requir$ to pres5t satisfactory docum5t>y evid5ce to v]ify h\sehold income4 7c7 ,revis+ rules ( all[able v>iation 9 actu>ial value ( heal? plans ,! ,secret>y ( ,heal? & ,human ,s]vices %all-- 7#a7 revise section #aef4adj7;c7 ( title #de1 ,code ( ,f$]al ,regulations1 to provide t1 = plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbg1 ! all[able v>iation 9 ! actu>ial value ( a heal? plan applicable "u su* section %all be ! all[able v>iation = su* plan applicable "u su* section = plan ye> #bjbb2 7#b7 revise sections #aef4bi7;b77#c7 ( title #de1 ,code ( ,f$]al ,regulations1 to provide t1 = plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbg1 ! requirem5t = a qualifi$ heal? plan issu] describ$ 9 su* section is t ! issu] ensures t ea* qualifi$ heal? plan complies ) b5efit design /&>ds1 z def9$ 9 section #aef4bj ( su* title2 & 7#c7 revise section #aef4djj ( title #de1 ,code ( ,f$]al ,regulations1 to provide t1 = plans ye>s beg9n+ on or aft] ,janu>y #a1 #bjbg1 ! t]m de m9imum v>iation = a silv] plan v>iation means a m9us #a p]c5tage po9t & plus #a p]c5tage po9t all[able actu>ial value v>iation4 7d7 ,updat+ premium adju/m5t p]c5tage me?odology ,section #acjb7;c77#d7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjbb7;c77#d77 is am5d$-- 7#a7 by /rik+ ,= purposes & ins]t+3 7,a7 ,9 g5]al ,= purposes 2 & 7#b7 by add+ at ! end ! foll[+ new subp>agraph3 7,b7 ,update to me?odology ,= cal5d> ye>s beg9n+ ) #bjbg1 ! premium adju/m5t p]c5tage "u ?is p>agraph = su* cal5d> ye> %all be det]m9$ consi/5t ) ! me?odology publi%$ 9 ! ,f$]al ,regi/] on ,april #be1 #bjai 7#hd ,f$4 ,reg4 #agecg ?r\gh #ageda74 4 7e7 ,elim9at+ ! fix$-,doll> & gross-,p]c5tage ?re%olds applicable to ex*ange enrollm5ts ,! ,secret>y ( ,heal? & ,human ,s]vices %all revise section #aee4djj7;g7 ( title #de1 ,code ( ,f$]al ,regulations to elim9ate1 = plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbg1 ! gross premium p]c5tage-base premium paym5t ?re%old policy describ$ 9 p>agraph 7#b7 ( su* section & ! fix$-doll> premium paym5t ?re%old policy describ$ 9 p>agraph 7#c7 ( su* section4 7f7 ,prohibit+ automatic re5rollm5t f bronze to silv] level qualifi$ heal? plans (f]$ by ex*anges ,! ,secret>y ( ,heal? & ,human ,s]vices %all revise section #aee4cce7;j7 ( title #de1 ,code ( ,f$]al ,regulations1 to remove p>agraph 7#d7 ( su* section t1 ) respect to re5rollm5ts = plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbg1 an ,ex*ange e/abli%$ "u subtitle ,d ( title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjba et seq47 may n re5roll an individual :o 0 enroll$ 9 a bronze level qualifi$ heal? plan 9 a silv] level qualifi$ heal? plan 7z su* t]ms are def9$ 9 section #acja7;a7 & describ$ 9 #acjb7;d7 ( su* ,act7 unless o!rwise p]mitt$ "u section #aee4cce7;j7 ( title #de1 ,code ( ,f$]al ,regulations1 z 9 effect on ! day be=e ! date ( ! enactm5t ( ?is section4 7g7 ,r$uc+ advance paym5ts ( premium tax cr$its = c]ta9 individuals re5roll$ 9 ex*anges ,section #adab ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjhb7 is am5d$-- 7#a7 9 subsection 7a77#c71 by ins]t+ 1 subject to subsection 7c77#b77;,c71 aft] qualifi$ heal? plans2 & 7#b7 9 subsection 7c77#b7-- 7,a7 9 subp>agraph 7,a71 by /rik+ ,! & ins]t+ ,subject to subp>agraph 7,c71 !2 & 7,b7 by add+ at ! end ! foll[+ subp>agraph3 7,c7 ,r$uction 9 advance paym5t = specifi$ re5roll$ individuals 7i7 ,9 g5]al ,! am\nt ( an advance paym5t made "u subp>agraph 7,a7 to r$uce ! premium payable = a qualifi$ heal? plan t provides cov]age to a specific re5roll$ individual = an applicable mon? %all be an am\nt equal to ! am\nt t w\ld o!rwise be made "u su* subp>agraph r$uc$ by #e 7or su* high] am\nt z ! ,secret>y det]m9es appropriate74 7ii7 ,def9itions ,9 ?is subp>agraph3 7,i7 ,applicable mon? ,! t]m applicable mon? means1 ) respect to a specifi$ re5roll$ individual1 any mon? dur+ a plan ye> beg9n+ on or aft] ,janu>y #a1 #bjbg 7or1 9 ! case ( an individual re5roll$ 9 a qualifi$ heal? plan by an ,ex*ange e/abli%$ pursuant to section #acba7;c71 ,janu>y #a1 #bjbg7 if1 prior to ! fir/ day ( su* mon?1 su* individual has fail$ to confirm or update su* in=mation z is necess>y to r$et]m9e ! eligibility ( su* individual = su* plan ye> pursuant to section #adaa7;f74 7,,ii7 ,specifi$ re5roll$ individual ,! t]m specifi$ re5roll$ individual means an individual :o is re5roll$ 9 a qualifi$ heal? plan & ) respect to :om ! advance paym5t made "u subp>agraph 7,a7 w\ld1 )\t application ( any r$uction "u ?is subp>agraph1 r$uce ! premium payable = a qualifi$ heal? plan t provides cov]age to su* an individual to #j4 4 7h7 ,prohibit+ cov]age ( g5d] transition proc$ures z an ess5tial heal? b5efit "u plans (f]$ by ex*anges 7#a7 ,9 g5]al ,section #acjb7;b77#b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjbb7;b77#b77 is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,c7 ,g5d] transition proc$ures ,= plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbg1 ! ess5tial heal? b5efits def9$ pursuant to p>agraph 7#a7 may n include items & s]vices furni%$ = a g5d] transition proc$ure4 4 7#b7 ,g5d] transition proc$ure def9$ ,section #acjd ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjbd7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7f7 ,g5d] transition proc$ure 7#a7 ,9 g5]al ,9 ?is title1 except z provid$ 9 p>agraph 7#b71 ! t]m g5d] transition proc$ure means1 ) respect to an individual1 any ( ! foll[+ :5 p]=m$ = ?is purpose ( int5tionally *ang+ ! body ( su* individual 7includ+ by disrupt+ ! body's developm5t1 inhibit+ its natural functions1 or modify+ its appe>ance7 to no long] correspond to ! individuals sex3 7,a7 ,p]=m+ any surg]y1 includ+-- 7i7 ca/ration2 7ii7 /]ilization2 7iii7 or*iectomy2 7iv7 scrotopla/y2 7v7 vasectomy2 7vi7 tubal ligation2 7vii7 hy/]ectomy2 7viii7 oophorectomy2 7ix7 ov>iectomy2 7x7 metoidiopla/y2 7xi7 clitoropla/y2 7xii7 recon/ruction ( ! fix$ "p ( ! ure?ra ) or )\t a metoidiopla/y or a phallopla/y2 7xiii7 p5ectomy2 7xiv7 phallopla/y2 7xv7 vag9opla/y2 7xvi7 vag9ectomy2 7xvii7 vulvopla/y2 7xviii7 r$uction ?yro*ondropla/y2 7xix7 *rondrol>yngopla/y2 7xx7 ma/ectomy2 & 7xxi7 any pla/ic1 cosmetic1 or ae/hetic surg]y t fem9izes or mascul9izes ! facial or o!r body features ( an individual4 7,b7 ,any placem5t ( *e/ implants to create fem99e brea/s or any placem5t ( erection or te/icul> pro/heses4 7,c7 ,any placem5t ( fat or artificial implants 9 ! gluteal region4 7,d7 ,adm9i/]+1 prescrib+1 or disp5s+ to an individual m$ications1 includ+-- 7i7 gonadotrop9-releas+ hormone 7,gn,r,h7 analogues or o!r pub]ty-block+ drugs to /op or delay normal pub]ty2 & 7ii7 te/o/]one1 e/rog51 or o!r &rog5s to an individual at doses t are sup]physiologic ?an w\ld normally be produc$ endog5\sly 9 a heal? individual ( ! same age & sex4 7#b7 ,exception ,p>agraph 7#a7 %all n apply to ! foll[+3 7,a7 ,pub]ty suppression or block+ prescription drugs = ! purpose ( normaliz+ pub]ty = an individual exp]i5c+ precoci\s pub]ty4 7,b7 ,m$ically necess>y proc$ures or treatm5ts to correct =-- 7i7 a m$ically v]ifiable disord] ( sex developm5t1 includ+-- 7,i7 #df1 ,,xx *romosomes ) virilization2 7,,ii7 #df1 ,,xy *romosomes ) und]virilization2 & 7,,iii7 bo? ov>ian & te/icul> tissue2 7ii7 sex *romosome /ructure1 sex /]oid hormone production1 or sex hormone action1 if det]m9$ to be abnormal by a physician ?r\gh g5etic or bio*emical te/+2 7iii7 infection1 disease1 injury1 or disord] caus$ or exac]bat$ by a previ\s proc$ure describ$ 9 p>agraph 7#a71 or a physical disord]1 physical injury1 or physical illness t w\ld1 z c]tifi$ by a physician1 place ! individual 9 imm95t dang] ( dea? or impairm5t ( a major bodily function unless ! proc$ure is p]=m$1 n includ+ proc$ures p]=m$ = ! alleviation ( m5tal di/ress2 or 7iv7 proc$ures to re/ore or recon/ruct ! body ( ! individual 9 ord] to correspond to ! individual's sex aft] "o or m previ\s proc$ures describ$ 9 p>agraph 7#a71 :i* may include ! removal ( a pseudo phallus or brea/ augm5tation4 7#c7 ,sex ,= purposes ( ?is subsection1 ! t]m sex means ei!r male or female1 z biologically det]m9$ & def9$ by subp>agraph 7,a7 & subp>agraph 7,b74 7,a7 ,female ,! t]m female means an individual :o naturally has1 _h1 w h1 or w\ld h1 b = a developm5tal or g5etic anomaly or hi/orical accid5t1 ! reproductive sy/ems t at "s po9t produces1 transports1 & utilizes eggs = f]tilization4 7,b7 ,male ,! t]m male means an individual :o naturally has1 _h1 w h1 or w\ld h1 b = a developm5tal or g5etic anomaly or hi/orical accid5t1 ! reproductive sy/em t at "s po9t produces1 transports1 & utilizes sp]m = f]tilization4 4 7i7 ,ensur+ appropriate application ( gu>ante$ issue requirem5ts 9 case ( non-,paym5t ( pa/ premiums 7#a7 ,9 g5]al ,section #bgjb ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#a7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7e7 ,nonpaym5t ( pa/ premiums 7#a7 ,9 g5]al ,a heal? insurance issu] (f]+ individual heal? cov]age may1 to ! ext5t all[$ "u ,/ate law1 d5y su* cov]age 9 ! case ( an individual :o owes any am\nt = premiums = individual heal? insurance cov]age (f]$ by su* issu] 7or by a heal? insurance issu] 9 ! same controll$ gr\p 7z def9$ 9 p>agraph 7#c77 z su* issu]7 9 :i* su* individual 0 previ\sly enroll$4 7#b7 ,attribution ( initial premium paym5t ow$ am\nt ,a heal? insurance issu$ (f]+ individual heal? insurance cov]age may1 9 ! case ( an individual describ$ 9 p>agraph 7#a7 & to ! ext5t all[$ "u ,/ate law1 attribute ! initial premium paym5t = su* cov]age applicable to su* individual to ! am\nt ow$ by su* individual = premiums = individual heal? insurance cov]age (f]$ by su* issu] 7or by a heal? insurance issu] 9 ! same controll$ gr\p z ! issu]7 9 :i* su* individual 0 previ\sly enroll$4 7#c7 ,controll$ gr\p def9$ ,= purposes ( ?is subsection1 ! t]m controll$ gr\p means a gr\p ( two or m p]sons t is treat$ z a s+le employ$ "u section #eb7;a71 #eb7;b71 #dad7m71 or #dad7o7 ( ! ,int]nal ,rev5ue ,code ( #aihf4 4 7#b7 ,effective date ,! am5dm5t made by p>agraph 7#a7 %all apply ) respect to plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbg4 #bjgc4 ,fund+ co/-%>+ r$uction paym5ts ,section #adjb ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjga7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7h7 ,fund+ 7#a7 ,9 g5]al ,!re are appropriat$ out ( any monies 9 ! ,treasury n o!rwise appropriat$ su* sums z may be necess>y = purposes ( mak+ paym5ts "u ?is section = plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbg4 7#b7 ,limitation 7,a7 ,9 g5]al ,! am\nts appropriat$ "u p>agraph 7#a7 may n be us$ = purposes ( mak+ paym5ts "u ?is section = a qualifi$ heal? plan t provides heal? b5efit cov]age t includes cov]age ( abortion4 7,b7 ,exception ,subp>agraph 7,a7 %all n apply to paym5ts = a qualifi$ heal? plan t provides cov]age ( abortion only if necess>y to save ! life ( ! "m or if ! pregnancy is a result ( an act ( rape or ince/4 4 ,,iii ,end+ taxpay] fund+ = abortion & g5d] transition proc$ures ,a ,no taxpay] fund+ = abortion & abortion insurance full disclosure act ( #bjbe #cjjj4 ,applicability to entire act 7a7 ,not)/&+ any o!r provision ( law1 ! prohibitions & limitations set =? 9 ?is title1 includ+ ! am5dm5ts made by ?is title1 %all apply to all funds au?oriz$ or appropriat$ "u ?is ,act1 includ+ "u title ,i1 title ,,ii1 & e subtitle !re(1 & to any tru/ fund to :i* su* funds are contribut$4 7b7 ,effective date ,?is section %all take effect on ! date ( ! enactm5t ( ?is ,act4 #cjja4 ,%ort title ,?is ,act may be cit$ z ! ,no ,taxpay] ,fund+ = ,abortion & ,abortion ,insurance ,full ,disclosure ,act ( #bjbe4 #cjjb4 ,prohibit+ taxpay] fund$ abortions ,title #a1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+ new *apt]3 #d ,prohibit+ taxpay] fund$ abortions #cja4 ,prohibition on fund+ = abortions ,no funds au?oriz$ or appropriat$ by ,f$]al law1 & none ( ! funds 9 any tru/ fund to :i* funds are au?oriz$ or appropriat$ by ,f$]al law1 %all be exp5d$ = any abortion4 #cjb4 ,prohibition on fund+ = heal? b5efits plans t cov] abortion ,none ( ! funds au?oriz$ or appropriat$ by ,f$]al law1 & none ( ! funds 9 any tru/ fund to :i* funds are au?oriz$ or appropriat$ by ,f$]al law1 %all be exp5d$ = heal? b5efits cov]age t includes cov]age ( abortion4 #cjc4 ,limitation on f$]al facilities & employees ,no heal? c>e s]vice furni%$-- 7#a7 by or 9 a heal? c>e facility own$ or op]at$ by ! ,f$]al ,gov]nm5t2 or 7#b7 by any physician or o!r individual employ$ by ! ,f$]al ,gov]nm5t to provide heal? c>e s]vices )9 ! scope ( ! physician's or individual's employm5t1 may include abortion4 #cjd4 ,con/ruction relat+ to sep>ate cov]age ,no?+ 9 ?is *apt] %all be con/ru$ z prohibit+ any individual1 entity1 or ,/ate or locality f pur*as+ sep>ate abortion cov]age or heal? b5efits cov]age t includes abortion s long z su* cov]age is paid = entirely us+ only funds n au?oriz$ or appropriat$ by ,f$]al law & su* cov]age %all n be pur*as$ us+ mat*+ funds requir$ = a f$]ally subsidiz$ program1 includ+ a ,/ate's or locality's contribution ( ,m$icaid mat*+ funds4 #cje4 ,con/ruction relat+ to ! use ( non-f$]al funds = heal? cov]age ,no?+ 9 ?is *apt] %all be con/ru$ z re/rict+ ! ability ( any non-,f$]al heal? b5efits cov]age provid] f (f]+ abortion cov]age1 or ! ability ( a ,/ate or locality to contract sep>ately ) su* a provid] = su* cov]age1 s long z only funds n au?oriz$ or appropriat$ by ,f$]al law are us$ & su* cov]age %all n be pur*as$ us+ mat*+ funds requir$ = a f$]ally subsidiz$ program1 includ+ a ,/ate's or locality's contribution ( ,m$icaid mat*+ funds4 #cjf4 ,non-preemption ( o!r f$]al laws ,no?+ 9 ?is *apt] %all repeal1 am5d1 or h any effect on any o!r ,f$]al law to ! ext5t su* law imposes any limitation on ! use ( funds = abortion or = heal? b5efits cov]age t includes cov]age ( abortion1 beyond ! limitations set =? 9 ?is *apt]4 #cjg4 ,con/ruction relat+ to complications aris+ f abortion ,no?+ 9 ?is *apt] %all be con/ru$ to apply to ! treatm5t ( any infection1 injury1 disease1 or disord] t has be5 caus$ by or exac]bat$ by ! p]=mance ( an abortion4 ,?is rule ( con/ruction %all be applicable )\t reg>d to :e!r ! abortion 0 p]=m$ 9 accord ) ,f$]al or ,/ate law1 & )\t reg>d to :e!r fund+ = ! abortion is p]missible "u section #cjh4 #cjh4 ,treatm5t ( abortions relat$ to rape1 ince/1 or pres]v+ ! life ( ! "m ,! limitations e/abli%$ 9 sections #cja1 #cjb1 & #cjc %all n apply to an abortion-- 7#a7 if ! pregnancy is ! result ( an act ( rape or ince/2 or 7#b7 9 ! case :]e a woman suff]s f a physical disord]1 physical injury1 or physical illness t w\ld1 z c]tifi$ by a physician1 place ! woman 9 dang] ( dea? unless an abortion is p]=m$1 includ+ a life-endang]+ physical condition caus$ by or aris+ f ! pregnancy itself4 #cji4 ,application to di/rict ( columbia ,9 ?is *apt]3 7#a7 ,any ref]5ce to funds appropriat$ by ,f$]al law %all be treat$ z includ+ any am\nts )9 ! budget ( ! ,di/rict ( ,columbia t h be5 approv$ by an ,act ( ,congress pursuant to section #ddf ( ! ,di/rict ( ,columbia ,home ,rule ,act 7or any applicable successor ,f$]al law74 7#b7 ,! t]m ,f$]al ,gov]nm5t includes ! ,gov]nm5t ( ! ,di/rict ( ,columbia4 4 #cjjc4 ,am5dm5t to table ( *apt]s ,! table ( *apt]s = title #a1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+ new item3 #d,prohibit+ taxpay] fund$ abortions #cja 4 #cjjd4 ,cl>ify+ application ( prohibition to premium cr$its & co/-%>+ r$uctions "u aca 7a7 ,9 g5]al 7#a7 ,disall[ance ( refundable cr$it & co/-%>+ r$uctions = cov]age "u qualifi$ heal? plan :i* provides cov]age = abortion 7,a7 ,9 g5]al ,subp>agraph 7,a7 ( section #cf;,b7c77#c7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by ins]t+ be=e ! p]iod at ! end ! foll[+3 or any heal? plan t includes cov]age = abortions 7o!r ?an any abortion or treatm5t describ$ 9 section #cjg or #cjh ( title #a1 ,unit$ ,/ates ,code74 7,b7 ,option to pur*ase or (f] sep>ate cov]age or plan ,p>agraph 7#c7 ( section #cf;,b7c7 ( su* ,code is am5d$ by add+ at ! end ! foll[+ new subp>agraph3 7,c7 ,sep>ate abortion cov]age or plan all[$ 7i7 ,option to pur*ase sep>ate cov]age or plan ,no?+ 9 subp>agraph 7,a7 %all be con/ru$ z prohibit+ any individual f pur*as+ sep>ate cov]age = abortions describ$ 9 su* subp>agraph1 or a heal? plan t includes su* abortions1 s long z no cr$it is all[$ "u ?is section ) respect to ! premiums = su* cov]age or plan4 7ii7 ,option to (f] cov]age or plan ,no?+ 9 subp>agraph 7,a7 %all re/rict any non-,f$]al heal? insurance issu] (f]+ a heal? plan f (f]+ sep>ate cov]age = abortions describ$ 9 su* subp>agraph1 or a plan t includes su* abortions1 s long z premiums = su* sep>ate cov]age or plan are n paid = ) any am\nt attributable to ! cr$it all[$ "u ?is section 7or ! am\nt ( any advance paym5t ( ! cr$it "u section #adab ( ! ,pati5t ,protection & ,af=dable ,c>e ,act74 4 7#b7 ,disall[ance ( small employ] heal? insurance exp5se cr$it = plan :i* includes cov]age = abortion ,subsection 7h7 ( section #de,r ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$-- 7,a7 by /rik+ ,any t]m & ins]t+ ! foll[+3 7#a7 ,9 g5]al ,any t]m 2 & 7,b7 by add+ at ! end ! foll[+ new p>agraph3 7#b7 ,exclusion ( heal? plans includ+ cov]age = abortion 7,a7 ,9 g5]al ,! t]m qualifi$ heal? plan does n include any heal? plan t includes cov]age = abortions 7o!r ?an any abortion or treatm5t describ$ 9 section #cjg or #cjh ( title #a1 ,unit$ ,/ates ,code74 7,b7 ,sep>ate abortion cov]age or plan all[$ 7i7 ,option to pur*ase sep>ate cov]age or plan ,no?+ 9 subp>agraph 7,a7 %all be con/ru$ z prohibit+ any employ] f pur*as+ = its employees sep>ate cov]age = abortions describ$ 9 su* subp>agraph1 or a heal? plan t includes su* abortions1 s long z no cr$it is all[$ "u ?is section ) respect to ! employ] contributions = su* cov]age or plan4 7ii7 ,option to (f] cov]age or plan ,no?+ 9 subp>agraph 7,a7 %all re/rict any non-,f$]al heal? insurance issu] (f]+ a heal? plan f (f]+ sep>ate cov]age = abortions describ$ 9 su* subp>agraph1 or a plan t includes su* abortions1 s long z su* sep>ate cov]age or plan is n paid = ) any employ] contribution eligible = ! cr$it all[$ "u ?is section4 4 7#c7 ,con=m+ aca am5dm5ts ,section #acjc7;b7 ( ,public ,law #aaa-adh 7#db ,u4,s4,c4 #ahjbc7;b77 is am5d$-- 7,a7 by /rik+ p>agraph 7#b72 7,b7 by /rik+ p>agraph 7#c71 z am5d$ by section #bjb7;a72 & 7,c7 by r$esignat+ p>agraph 7#d7 z p>agraph 7#b74 7b7 ,application to multi-,/ate plans ,p>agraph 7#f7 ( section #accd7;a7 ( ,public ,law #aaa-adh 7#db ,u4,s4,c4 #ahjed7;a77 is am5d$ to read z foll[s3 7#f7 ,cov]age consi/5t ) f$]al abortion policy ,9 ent]+ into contracts "u ?is subsection1 ! ,director %all ensure t no multi-,/ate qualifi$ heal? plan (f]$ 9 an ,ex*ange provides heal? b5efits cov]age = :i* ! exp5diture ( ,f$]al funds is prohibit$ "u *apt] #d ( title #a1 ,unit$ ,/ates ,code4 4 7c7 ,effective date ,! am5dm5ts made by subsection 7a7 %all apply to taxable ye>s end+ aft] ,decemb] #ca1 #bjbe1 b only ) respect to plan ye>s beg9n+ aft] su* date1 & ! am5dm5t made by subsection 7b7 %all apply to plan ye>s beg9n+ aft] su* date4 #cjje4 ,revision to notice requirem5ts reg>d+ disclosure ( ext5t ( heal? plan cov]age ( abortion & abortion premium sur*>ges 7a7 ,9 g5]al ,p>agraph 7#c7 ( section #acjc7;b7 ( ,public ,law #aaa-adh 7#db ,u4,s4,c4 #ahjbc7;b77 is am5d$ to read z foll[s3 7#c7 ,rules relat+ to notice 7,a7 ,9 g5]al ,! ext5t ( cov]age 7if any7 ( s]vices describ$ 9 p>agraph 7#a77;,b77i7 or 7#a77;,b77ii7 by a qualifi$ heal? plan %all be disclos$ to enrollees at ! "t ( enrollm5t 9 ! plan & %all be prom95tly display$ 9 any m>ket+ or adv]tis+ mat]ials1 comp>ison tools1 or summ>y ( b5efits & cov]age explanation made available ) respect to su* plan by ! issu] ( ! plan1 by an ,ex*ange1 or by ! ,secret>y1 includ+ in=mation made available ?r\gh an int]net portal or ,ex*ange "u sections #acaa7;c77#e7 & #acaa7;d77#d77;,c74 7,b7 ,sep>ate disclosure ( abortion sur*>ges ,9 ! case ( a qualifi$ heal? plan t includes ! s]vices describ$ 9 p>agraph 7#a77;,b77i7 & :]e ! premium = ! plan is disclos$1 includ+ 9 any m>ket+ or adv]tis+ mat]ials or any o!r in=mation ref]r$ to 9 subp>agraph 7,a71 ! sur*>ge describ$ 9 p>agraph 7#b77;,b77i77,,ii7 t is attributable to su* s]vices %all also be disclos$ & id5tifi$ sep>ately4 4 7b7 ,effective date ,! am5dm5t made by subsection 7a7 %all apply to mat]ials1 tools1 or o!r in=mation made available m ?an #cj days aft] ! date ( ! enactm5t ( ?is ,act4 ,b ,prohibit+ ,f$]al fund+ = g5d] transition proc$ures #cjjf4 ,%ort title ,?is ,act may be cit$ z ! ,end ,taxpay] ,fund+ ( ,g5d] ,exp]im5tation ,act ( #bjbe #cjjg4 ,prohibit+ f$]al fund+ = g5d] transition proc$ures 7a7 ,def9ition ,9 ?is section1 ! t]m ,specifi$ sex-trait modification proc$ure means any ph>maceutical or surgical int]v5tion t is provid$ = ! purpose ( attempt+ to align an individual's physical appe>ance or body ) an ass]t$ id5tity t diff]s f ! individual's sex ei!r by3 7#a7 ,int5tionally disrupt+ or suppress+ ! normal developm5t ( natural biological functions1 includ+ prim>y or second>y sex-bas$ traits2 or 7#b7 ,int5tionally alt]+ an individual's physical appe>ance or body1 includ+ amputat+1 m9imiz+ or de/roy+ prim>y or second>y sex-bas$ traits su* z ! sexual & reproductive organs4 7#c7 ,?is t]m does n include proc$ures und]tak53 7,a7 ,to treat a p]son ) a m$ically v]ifiable disord] ( sexual developm5t2 or 7,b7 ,= purposes o!r ?an attempt+ to align an individual's physical appe>ance or body ) an ass]t$ id5tity t diff]s f ! individual's sex4 7b7 ,g5]al prohibition ,not)/&+ any o!r provision ( law1 no ,f$]al funds 7includ+ funds provid$ ?r\gh grants1 contracts1 insurance1 or any o!r means7 may be us$ to pay =1 reimburse1 or o!rwise support any specifi$ sex-trait modification proc$ure4 7c7 ,effective date ,! am5dm5ts made by ?is section %all take effect on ! date ( ! enactm5t ( ?is ,act & %all apply to paym5ts1 reimbursem5ts1 & s]vices provid$ on or aft] su* date4