1409 
individual during a transition period 
under section 202(d)(4)(B)(ii). 
(2) TREATMENT OF FAMILY.—Except as 
the Commissioner may otherwise pro-
vide, members of the same family who 
are affordable credit eligible individuals 
shall be treated as a single affordable 
credit individual eligible for the applica-
ble credit for such a family under this 
subtitle. 
(b) LIMITATIONS ON EMPLOYEE AND DEPEND-
ENT DISQUALIFICATION.— 
(1) IN GENERAL.—Subject to paragraph 
(2), the term ‘‘affordable credit eligible in-
dividual’’ does not include a full-time em-
ployee of an employer if the employer of-
fers the employee coverage (for the em-
ployee and dependents) as a full-time em-
ployee under a group health plan if the 
coverage 
and 
employer 
contribution 
under the plan meet the requirements of 
section 312. 
(2) EXCEPTIONS.— 
(A) 
FOR
CERTAIN
FAMILY
CIR-
CUMSTANCES.—The 
Commissioner 
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shall establish such exceptions and 
special rules in the case described in 
paragraph (1) as may be appropriate 
in the case of a divorced or separated 
individual or such a dependent of an 
employee who would otherwise be an 
affordable credit eligible individual. 
(B) FOR UNAFFORDABLE EMPLOYER 
COVERAGE.—Beginning in Y2, in the 
case of full-time employees for which 
the cost of the employee premium for 
coverage under a group health plan 
would exceed 11 percent of current 
family income (determined by the 
Commissioner 
on 
the 
basis 
of 
verifiable documentation and without 
regard to section 245), paragraph (1) 
shall not apply. 
(c) INCOME DEFINED.— 
(1) IN GENERAL.—In this title, the term 
‘‘income’’ means modified adjusted gross 
income (as defined in section 59B of the 
Internal Revenue Code of 1986). 
(2) STUDY OF INCOME DISREGARDS.—The 
Commissioner shall conduct a study that 
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examines the application of income dis-
regards for purposes of this subtitle. Not 
later than the first day of Y2, the Com-
missioner shall submit to Congress a re-
port on such study and shall include such 
recommendations as the Commissioner 
determines appropriate. 
(d) CLARIFICATION
OF TREATMENT
OF AF-
FORDABILITY
CREDITS.—Affordability credits 
under this subtitle shall not be treated, for 
purposes of title IV of the Personal Responsi-
bility and Work Opportunity Reconciliation 
Act of 1996, to be a benefit provided under 
section 403 of such title. 
SEC. 243. AFFORDABILITY PREMIUM CREDIT. 
(a) IN GENERAL.—The affordability pre-
mium credit under this section for an afford-
able credit eligible individual enrolled in an 
Exchange-participating health benefits plan 
is in an amount equal to the amount (if any) 
by which the premium for the plan (or, if less, 
the reference premium amount specified in 
subsection (c)), exceeds the affordable pre-
mium amount specified in subsection (b) for 
the individual. 
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(b) AFFORDABLE PREMIUM AMOUNT.— 
(1) IN GENERAL.—The affordable pre-
mium amount specified in this subsection 
for an individual for monthly premium in 
a plan year shall be equal to 1⁄12 of the 
product of— 
(A) the premium percentage limit 
specified in paragraph (2) for the in-
dividual based upon the individual’s 
family income for the plan year; and 
(B) the individual’s family income 
for such plan year. 
(2) PREMIUM PERCENTAGE LIMITS BASED 
ON TABLE.—The Commissioner shall estab-
lish premium percentage limits so that 
for individuals whose family income is 
within an income tier specified in the 
table in subsection (d) such percentage 
limits shall increase, on a sliding scale in 
a linear manner, from the initial pre-
mium percentage to the final premium 
percentage specified in such table for 
such income tier. 
(c) REFERENCE PREMIUM AMOUNT.—The ref-
erence premium amount specified in this sub-
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section for a plan year for an individual in a 
premium rating area is equal to the average 
premium for the 3 basic plans in the area for 
the plan year with the lowest premium levels. 
In computing such amount the Commissioner 
may exclude plans with extremely limited en-
rollments. 
(d) TABLE OF PREMIUM PERCENTAGE LIMITS 
AND ACTUARIAL VALUE PERCENTAGES BASED ON 
INCOME TIER.— 
(1) IN GENERAL.—For purposes of this 
subtitle, the table specified in this sub-
section is as follows: 
In the case of fam-
ily income (ex-
pressed as a per-
cent of FPL) within 
the following in-
come tier: 
The initial 
premium 
percentage 
is— 
The final 
premium 
percentage 
is— 
The actu-
arial value 
percentage 
is— 
133% through 150% 
1.5% 
3% 
97% 
150% through 200% 
3% 
5% 
93% 
200% through 250% 
5% 
7% 
85% 
250% through 300% 
7% 
9% 
78% 
300% through 350% 
9% 
10% 
72% 
350% through 400% 
10% 
11% 
70% 
(2) SPECIAL
RULES.—For purposes of 
applying the table under paragraph (1)— 
(A) FOR
LOWEST
LEVEL
OF
IN-
COME.—In the case of an individual 
with income that does not exceed 133 
percent of FPL, the individual shall 
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be considered to have income that is 
133% of FPL. 
(B) APPLICATION OF HIGHER ACTU-
ARIAL VALUE PERCENTAGE AT TIER TRAN-
SITION POINTS.—If two actuarial value 
percentages may be determined with 
respect to an individual, the actuarial 
value percentage shall be the higher 
of such percentages. 
SEC. 244. AFFORDABILITY COST-SHARING CREDIT. 
(a) IN GENERAL.—The affordability cost- 
sharing credit under this section for an af-
fordable credit eligible individual enrolled in 
an Exchange-participating health benefits 
plan is in the form of the cost-sharing reduc-
tion described in subsection (b) provided 
under this section for the income tier in 
which the individual is classified based on the 
individual’s family income. 
(b) COST-SHARING REDUCTIONS.—The Com-
missioner shall specify a reduction in cost- 
sharing amounts and the annual limitation on 
cost-sharing specified in section 122(c)(2)(B) 
under a basic plan for each income tier speci-
fied in the table under section 243(d), with re-
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spect to a year, in a manner so that, as esti-
mated by the Commissioner, the actuarial 
value of the coverage with such reduced cost- 
sharing amounts (and the reduced annual 
cost-sharing limit) is equal to the actuarial 
value percentage (specified in the table under 
section 243(d) for the income tier involved) of 
the full actuarial value if there were no cost- 
sharing imposed under the plan. 
(c) DETERMINATION AND PAYMENT OF COST- 
SHARING AFFORDABILITY CREDIT.—In the case 
of an affordable credit eligible individual in 
a tier enrolled in an Exchange-participating 
health benefits plan offered by a QHBP offer-
ing entity, the Commissioner shall provide for 
payment to the offering entity of an amount 
equivalent to the increased actuarial value of 
the benefits under the plan provided under 
section 203(c)(2)(B) resulting from the reduc-
tion in cost-sharing described in subsection 
(b). 
SEC. 245. INCOME DETERMINATIONS. 
(a) IN GENERAL.—In applying this subtitle 
for an affordability credit for an individual 
for a plan year, the individual’s income shall 
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be the income (as defined in section 242(c)) 
for the individual for the most recent taxable 
year (as determined in accordance with rules 
of the Commissioner). The Federal poverty 
level applied shall be such level in effect as 
of the date of the application. 
(b) 
PROGRAM
INTEGRITY; 
INCOME 
VERIFICATION PROCEDURES.— 
(1) PROGRAM INTEGRITY.—The Commis-
sioner shall take such steps as may be ap-
propriate to ensure the accuracy of deter-
minations and redeterminations under 
this subtitle. 
(2) INCOME VERIFICATION.— 
(A) IN GENERAL.—Upon an initial 
application of an individual for an af-
fordability credit under this subtitle 
(or in applying section 242(b)) or 
upon an application for a change in 
the affordability credit based upon a 
significant change in family income 
described in subparagraph (A)— 
(i) the Commissioner shall re-
quest from the Secretary of the 
Treasury the disclosure to the 
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bajohnson on DSK2BSOYB1PROD with BILLS
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Commissioner of such informa-
tion as may be permitted to verify 
the information contained in such 
application; and 
(ii) the Commissioner shall 
use the information so disclosed 
to verify such information. 
(B) 
ALTERNATIVE
PROCEDURES.— 
The 
Commissioner 
shall 
establish 
procedures for the verification of in-
come for purposes of this subtitle if 
no income tax return is available for 
the most recent completed tax year. 
(c) SPECIAL RULES.— 
(1) CHANGES IN INCOME AS A PERCENT 
OF FPL.—In the case that an individual’s 
income (expressed as a percentage of the 
Federal poverty level for a family of the 
size involved) for a plan year is expected 
(in a manner specified by the Commis-
sioner) to be significantly different from 
the income (as so expressed) used under 
subsection (a), the Commissioner shall es-
tablish rules requiring an individual to 
report, consistent with the mechanism es-
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tablished under paragraph (2), significant 
changes in such income (including a sig-
nificant change in family composition) to 
the Commissioner and requiring the sub-
stitution of such income for the income 
otherwise applicable. 
(2) REPORTING OF SIGNIFICANT CHANGES 
IN
INCOME.—The Commissioner shall es-
tablish rules under which an individual 
determined to be an affordable credit eli-
gible individual would be required to in-
form the Commissioner when there is a 
significant change in the family income 
of the individual (expressed as a percent-
age of the FPL for a family of the size in-
volved) and of the information regarding 
such change. Such mechanism shall pro-
vide for guidelines that specify the cir-
cumstances that qualify as a significant 
change, the verifiable information re-
quired to document such a change, and 
the process for submission of such infor-
mation. If the Commissioner receives new 
information from an individual regarding 
the family income of the individual, the 
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Commissioner shall provide for a redeter-
mination of the individual’s eligibility to 
be an affordable credit eligible indi-
vidual. 
(3) TRANSITION FOR CHIP.—In the case 
of a child described in section 202(d)(2), 
the Commissioner shall establish rules 
under which the family income of the 
child is deemed to be no greater than the 
family income of the child as most re-
cently determined before Y1 by the State 
under title XXI of the Social Security Act. 
(4) STUDY OF GEOGRAPHIC VARIATION IN 
APPLICATION
OF
FPL.—The Commissioner 
shall examine the feasibility and implica-
tion of adjusting the application of the 
Federal poverty level under this subtitle 
for different geographic areas so as to re-
flect 
the 
variations 
in 
cost-of-living 
among different areas within the United 
States. If the Commissioner determines 
that an adjustment is feasible, the study 
should include a methodology to make 
such an adjustment. Not later than the 
first day of Y2, the Commissioner shall 
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submit to Congress a report on such 
study 
and 
shall 
include 
such 
rec-
ommendations as the Commissioner de-
termines appropriate. 
(d) PENALTIES FOR MISREPRESENTATION.— 
In the case of an individual intentionally mis-
represents family income or the individual 
fails (without regard to intent) to disclose to 
the Commissioner a significant change in 
family income under subsection (c) in a man-
ner that results in the individual becoming an 
affordable credit eligible individual when the 
individual is not or in the amount of the af-
fordability 
credit 
exceeding 
the 
correct 
amount— 
(1) the individual is liable for repay-
ment of the amount of the improper af-
fordability credit; ;and 
(2) in the case of such an intentional 
misrepresentation or other egregious cir-
cumstances specified by the Commis-
sioner, the Commissioner may impose an 
additional penalty. 
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SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTED 
ALIENS. 
Nothing in this subtitle shall allow Fed-
eral payments for affordability credits on be-
half of individuals who are not lawfully 
present in the United States. 
TITLE III—SHARED 
RESPONSIBILITY 
Subtitle A—Individual 
Responsibility 
SEC. 301. INDIVIDUAL RESPONSIBILITY. 
For an individual’s responsibility to ob-
tain acceptable coverage, see section 59B of 
the Internal Revenue Code of 1986 (as added 
by section 401 of this Act). 
Subtitle B—Employer 
Responsibility 
PART 1—HEALTH COVERAGE PARTICIPATION 
REQUIREMENTS 
SEC. 311. HEALTH COVERAGE PARTICIPATION REQUIRE-
MENTS. 
An employer meets the requirements of 
this section if such employer does all of the 
following: 
(1) OFFER
OF
COVERAGE.—The em-
ployer offers each employee individual 
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and family coverage under a qualified 
health benefits plan (or under a current 
employment-based health plan (within 
the meaning of section 102(b))) in accord-
ance with section 312. 
(2) 
CONTRIBUTION
TOWARDS
COV-
ERAGE.—If an employee accepts such offer 
of coverage, the employer makes timely 
contributions towards such coverage in 
accordance with section 312. 
(3) CONTRIBUTION
IN
LIEU
OF
COV-
ERAGE.—Beginning with Y2, if an em-
ployee declines such offer but otherwise 
obtains coverage in an Exchange-partici-
pating health benefits plan (other than 
by reason of being covered by family cov-
erage as a spouse or dependent of the 
primary insured), the employer shall 
make a timely contribution to the Health 
Insurance Exchange with respect to each 
such employee in accordance with sec-
tion 313. 
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SEC. 312. EMPLOYER RESPONSIBILITY TO CONTRIBUTE TO-
WARDS EMPLOYEE AND DEPENDENT COV-
ERAGE. 
(a) IN GENERAL.—An employer meets the 
requirements of this section with respect to 
an employee if the following requirements are 
met: 
(1) OFFERING OF COVERAGE.—The em-
ployer offers the coverage described in 
section 311(1) either through an Ex-
change-participating health benefits plan 
or other than through such a plan. 
(2) 
EMPLOYER
REQUIRED
CONTRIBU-
TION.—The employer timely pays to the 
issuer of such coverage an amount not 
less than the employer required contribu-
tion specified in subsection (b) for such 
coverage. 
(3) PROVISION
OF
INFORMATION.—The 
employer provides the Health Choices 
Commissioner, the Secretary of Labor, 
the Secretary of Health and Human Serv-
ices, and the Secretary of the Treasury, 
as applicable, with such information as 
the Commissioner may require to ascer-
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tain compliance with the requirements of 
this section. 
(4) AUTOENROLLMENT OF EMPLOYEES.— 
The 
employer 
provides 
for 
autoenrollment of the employee in ac-
cordance with subsection (c). 
(b) REDUCTION
OF
EMPLOYEE
PREMIUMS 
THROUGH MINIMUM EMPLOYER CONTRIBUTION.— 
(1) FULL-TIME
EMPLOYEES.—The min-
imum employer contribution described in 
this subsection for coverage of a full-time 
employee (and, if any, the employee’s 
spouse and qualifying children (as de-
fined in section 152(c) of the Internal 
Revenue Code of 1986) under a qualified 
health benefits plan (or current employ-
ment-based health plan) is equal to— 
(A) in case of individual coverage, 
not less than 72.5 percent of the ap-
plicable premium (as defined in sec-
tion 4980B(f)(4) of such Code, subject 
to paragraph (2)) of the lowest cost 
plan offered by the employer that is a 
qualified health benefits plan (or is 
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such 
current 
employment-based 
health plan); and 
(B) in the case of family coverage 
which includes coverage of such 
spouse and children, not less 65 per-
cent of such applicable premium of 
such lowest cost plan. 
(2) 
APPLICABLE
PREMIUM
FOR
EX-
CHANGE
COVERAGE.—In this subtitle, the 
amount of the applicable premium of the 
lowest cost plan with respect to coverage 
of an employee under an Exchange-par-
ticipating health benefits plan is the ref-
erence premium amount under section 
243(c) for individual coverage (or, if elect-
ed, family coverage) for the premium rat-
ing area in which the individual or fam-
ily resides. 
(3) MINIMUM EMPLOYER CONTRIBUTION 
FOR EMPLOYEES OTHER THAN FULL-TIME EM-
PLOYEES.—In the case of coverage for an 
employee who is not a full-time employee, 
the amount of the minimum employer 
contribution under this subsection shall 
be a proportion (as determined in accord-
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ance with rules of the Health Choices 
Commissioner, the Secretary of Labor, 
the Secretary of Health and Human Serv-
ices, and the Secretary of the Treasury, 
as applicable) of the minimum employer 
contribution under this subsection with 
respect to a full-time employee that re-
flects the proportion of— 
(A) the average weekly hours of 
employment of the employee by the 
employer, to 
(B) the minimum weekly hours 
specified by the Commissioner for an 
employee to be a full-time employee. 
(4) SALARY
REDUCTIONS
NOT
TREATED 
AS
EMPLOYER
CONTRIBUTIONS.—For pur-
poses of this section, any contribution on 
behalf of an employee with respect to 
which there is a corresponding reduction 
in the compensation of the employee 
shall not be treated as an amount paid by 
the employer. 
(c) AUTOMATIC ENROLLMENT FOR EMPLOYER 
SPONSORED HEALTH BENEFITS.— 
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(1) IN GENERAL.—The requirement of 
this subsection with respect to an em-
ployer and an employee is that the em-
ployer automatically enroll such em-
ployee into the employment-based health 
benefits plan for individual coverage 
under the plan option with the lowest ap-
plicable employee premium. 
(2) OPT-OUT.—In no case may an em-
ployer automatically enroll an employee 
in a plan under paragraph (1) if such em-
ployee makes an affirmative election to 
opt out of such plan or to elect coverage 
under an employment-based health bene-
fits plan offered by such employer. An 
employer shall provide an employee with 
a 30-day period to make such an affirma-
tive election before the employer may 
automatically enroll the employee in 
such a plan. 
(3) NOTICE REQUIREMENTS.— 
(A) IN
GENERAL.—Each employer 
described in paragraph (1) who auto-
matically enrolls an employee into a 
plan as described in such paragraph 
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1428 
shall provide the employees, within a 
reasonable period before the begin-
ning of each plan year (or, in the case 
of new employees, within a reason-
able period before the end of the en-
rollment period for such a new em-
ployee), written notice of the employ-
ees’ rights and obligations relating to 
the automatic enrollment require-
ment under such paragraph. Such no-
tice must be comprehensive and un-
derstood by the average employee to 
whom the automatic enrollment re-
quirement applies. 
(B) INCLUSION OF SPECIFIC INFOR-
MATION.—The written notice under 
subparagraph (A) must explain an 
employee’s right to opt out of being 
automatically enrolled in a plan and 
in the case that more than one level 
of benefits or employee premium 
level is offered by the employer in-
volved, the notice must explain which 
level of benefits and employee pre-
mium level the employee will be auto-
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matically enrolled in the absence of 
an affirmative election by the em-
ployee. 
SEC. 313. EMPLOYER CONTRIBUTIONS IN LIEU OF COV-
ERAGE. 
(a) IN GENERAL.—A contribution is made 
in accordance with this section with respect 
to an employee if such contribution is equal 
to an amount equal to 8 percent of the aver-
age wages paid by the employer during the 
period of enrollment (determined by taking 
into account all employees of the employer 
and in such manner as the Commissioner pro-
vides, including rules providing for the appro-
priate aggregation of related employers). Any 
such contribution— 
(1) shall be paid to the Health 
Choices Commissioner for deposit into 
the Health Insurance Exchange Trust 
Fund, and 
(2) shall not be applied against the 
premium of the employee under the Ex-
change-participating health benefits plan 
in which the employee is enrolled. 
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(b) SPECIAL RULES
FOR SMALL EMPLOY-
ERS.— 
(1) IN
GENERAL.—In the case of any 
employer who is a small employer for any 
calendar year, subsection (a) shall be ap-
plied by substituting the applicable per-
centage determined in accordance with 
the following table for ‘‘8 percent’’: 
If the annual payroll of such employer for 
the preceding calendar year: 
The applicable 
percentage is: 
Does not exceed $250,000 ...........................
0 percent 
Exceeds $250,000, but does not exceed 
$300,000.
2 percent 
Exceeds $300,000, but does not exceed 
$350,000.
4 percent 
Exceeds $350,000, but does not exceed 
$400,000.
6 percent 
(2) SMALL EMPLOYER.—For purposes of 
this subsection, the term ‘‘small em-
ployer’’ means any employer for any cal-
endar year if the annual payroll of such 
employer for the preceding calendar year 
does not exceed $400,000. 
(3) ANNUAL PAYROLL.—For purposes of 
this paragraph, the term ‘‘annual payroll’’ 
means, with respect to any employer for 
any calendar year, the aggregate wages 
paid by the employer during such cal-
endar year. 
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(4) AGGREGATION RULES.—Related em-
ployers and predecessors shall be treated 
as a single employer for purposes of this 
subsection. 
SEC. 314. AUTHORITY RELATED TO IMPROPER STEERING. 
The Health Choices Commissioner (in co-
ordination with the Secretary of Labor, the 
Secretary of Health and Human Services, and 
the Secretary of the Treasury) shall have au-
thority to set standards for determining 
whether employers or insurers are under-
taking any actions to affect the risk pool with-
in the Health Insurance Exchange by induc-
ing individuals to decline coverage under a 
qualified health benefits plan (or current em-
ployment-based health plan (within the mean-
ing of section 102(b)) offered by the employer 
and instead to enroll in an Exchange-partici-
pating health benefits plan. An employer vio-
lating such standards shall be treated as not 
meeting the requirements of this section. 
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PART 2—SATISFACTION OF HEALTH COVERAGE 
PARTICIPATION REQUIREMENTS 
SEC. 321. SATISFACTION OF HEALTH COVERAGE PARTICI-
PATION REQUIREMENTS UNDER THE EM-
PLOYEE 
RETIREMENT 
INCOME 
SECURITY 
ACT OF 1974. 
(a) IN GENERAL.—Subtitle B of title I of the 
Employee Retirement Income Security Act of 
1974 is amended by adding at the end the fol-
lowing new part: 
‘‘PART 8—NATIONAL HEALTH COVERAGE 
PARTICIPATION REQUIREMENTS 
‘‘SEC. 801. ELECTION OF EMPLOYER TO BE SUBJECT TO NA-
TIONAL HEALTH COVERAGE PARTICIPATION 
REQUIREMENTS. 
‘‘(a) IN GENERAL.—An employer may make 
an election with the Secretary to be subject 
to the health coverage participation require-
ments. 
‘‘(b) TIME AND MANNER.—An election under 
subsection (a) may be made at such time and 
in such form and manner as the Secretary 
may prescribe. 
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‘‘SEC. 802. TREATMENT OF COVERAGE RESULTING FROM 
ELECTION. 
‘‘(a) IN GENERAL.—If an employer makes 
an election to the Secretary under section 
801— 
‘‘(1) such election shall be treated as 
the establishment and maintenance of a 
group health plan (as defined in section 
733(a)) for purposes of this title, subject 
to section 151 of the America’s Affordable 
Health Choices Act of 2009, and 
‘‘(2) the health coverage participation 
requirements shall be deemed to be in-
cluded as terms and conditions of such 
plan. 
‘‘(b) PERIODIC INVESTIGATIONS TO DISCOVER 
NONCOMPLIANCE.—The Secretary shall regu-
larly audit a representative sampling of em-
ployers and group health plans and conduct 
investigations and other activities under sec-
tion 504 with respect to such sampling of 
plans so as to discover noncompliance with 
the health coverage participation require-
ments in connection with such plans. The Sec-
retary shall communicate findings of non-
compliance made by the Secretary under this 
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