I 
114TH CONGRESS 
1ST SESSION H. R. 2650 
To restore equity, save coverage, and undo errors in the case of individuals 
who lose health insurance subsidies under King v. Burwell, and other 
individuals, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 4, 2015 
Mr. TOM PRICE of Georgia introduced the following bill; which was referred 
to the Committee on Energy and Commerce, and in addition to the Com-
mittees on Ways and Means and Education and the Workforce, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To restore equity, save coverage, and undo errors in the 
case of individuals who lose health insurance subsidies 
under King v. Burwell, and other individuals, and for 
other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS; CONTIN-
GENCY AND LIMITATION ON APPLICATION. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Restoring Equity, Saving Coverage, and Undoing Errors 
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Act of 2015’’ or as the ‘‘RESCUE America’s Health Care 
Act of 2015’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents; contingency and limitation on application. 
Sec. 2. Refundable tax credit for health insurance coverage. 
Sec. 3. Restoring to States the freedom and flexibility to regulate health insur-
ance markets. 
Sec. 4. Pool reform for individual membership expansion. 
Sec. 5. Requirements for individual health insurance. 
(c) CONTINGENCY
AND LIMITATION
ON APPLICA-
TION.— 
(1) DEPENDENT
UPON
SUPREME
COURT
DE-
TERMINATION
IN
KING
V. BURWELL.—The suc-
ceeding provisions of this Act (including the amend-
ments made by this Act) shall only apply if the Su-
preme Court determines that the premium tax credit 
under section 36B of the Internal Revenue Code of 
1986 is not available to individuals who are enrolled 
in a qualified health plan offered through the feder-
ally operated Exchange established pursuant to sec-
tion 1321(c) of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18041(c)). 
(2) APPLICATION
IN
STATES
WITHOUT
A 
STATE-OPERATED
EXCHANGE.—In the case of a 
State that has not established an Exchange under 
section 1311 of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18031) for which a pre-
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mium tax credit is available pursuant to section 
36B(b)(1)(A) of the Internal Revenue Code of 1986, 
as interpreted by the Supreme Court, the succeeding 
provisions of this Act (including the amendments 
made by this Act) shall apply, subject to paragraphs 
(1) and (4), to the State and to individuals residing 
in the State as of the date on which such credit be-
comes no longer available to such individuals pursu-
ant to the Supreme Court determination described 
in paragraph (1) (such date referred to in this Act 
as the ‘‘King v. Burwell effective date’’) . 
(3) OPTION OF APPLICATION IN STATES WITH 
A STATE-OPERATED EXCHANGE.—In the case of a 
State that has established an Exchange under sec-
tion 1311 of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18031) for which a premium 
tax 
credit 
is 
available 
pursuant 
to 
section 
36B(b)(1)(A) of the Internal Revenue Code of 1986, 
as interpreted by the Supreme Court— 
(A) the State may at any time terminate 
operation of such Exchange; and 
(B) if the State terminates operation of 
any such Exchange established under such sec-
tion 1311, the provisions of this Act (including 
the amendments made by this Act) shall apply, 
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subject to paragraphs (1) and (4), to the State 
and to individuals residing in the State as of 
the date on which the operation of such Ex-
change is terminated, but in no case shall such 
provisions and amendments apply earlier than 
the King v. Burwell effective date. 
(4) NO APPLICATION TO STATES WITH AN EX-
CHANGE
FOR
WHICH
PREMIUM
CREDIT
IS
AVAIL-
ABLE.—The succeeding provisions of this Act (in-
cluding the amendments made by this Act) shall not 
apply to a State and to individuals residing in a 
State so long as there is operating in the State an 
Exchange for which a premium tax credit is avail-
able pursuant to section 36B(b)(1)(A) of the Inter-
nal Revenue Code of 1986 to such individuals, as in-
terpreted by the Supreme Court. 
SEC. 2. REFUNDABLE TAX CREDIT FOR HEALTH INSUR-
ANCE COVERAGE. 
(a) IN GENERAL.—Subpart C of part IV of sub-
chapter A of chapter 1 of the Internal Revenue Code of 
1986 is amended by inserting after section 36B the fol-
lowing new section: 
‘‘SEC. 36C. HEALTH INSURANCE COVERAGE. 
‘‘(a) IN GENERAL.—In the case of an individual, 
there shall be allowed as a credit against the tax imposed 
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‘‘(B) the cost-of-living adjustment deter-
mined under section 1(f)(3) for the calendar 
year in which the taxable year begins, deter-
mined by substituting ‘calendar year 2015’ for 
‘calendar year 1992’ in subparagraph (B) 
thereof. 
Any increase determined under the preceding sen-
tence shall be rounded to the nearest multiple of 
$50. 
‘‘(c) ELIGIBLE COVERAGE MONTH.—For purposes of 
this section, the term ‘eligible coverage month’ means, 
with respect to any individual, any month if, as of the first 
day of such month, the individual— 
‘‘(1) is covered by qualified health insurance, 
‘‘(2) does not have other specified coverage, and 
‘‘(3) is not imprisoned under Federal, State, or 
local authority. 
‘‘(d) QUALIFYING FAMILY MEMBER.—For purposes 
of this section, the term ‘qualifying family member’ 
means— 
‘‘(1) in the case of a joint return, the taxpayer’s 
spouse, and 
‘‘(2) any dependent of the taxpayer. 
‘‘(e) QUALIFIED HEALTH INSURANCE.—For pur-
poses of this section, the term ‘qualified health insurance’ 
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means health insurance coverage (other than excepted 
benefits as defined in section 9832(c)) which constitutes 
medical care. 
‘‘(f) OTHER SPECIFIED COVERAGE.—For purposes of 
this section, an individual has other specified coverage for 
any month if, as of the first day of such month— 
‘‘(1) COVERAGE UNDER MEDICARE, MEDICAID, 
OR SCHIP.—Such individual— 
‘‘(A) is entitled to benefits under part A of 
title XVIII of the Social Security Act or is en-
rolled under part B of such title, or 
‘‘(B) is enrolled in the program under title 
XIX or XXI of such Act (other than under sec-
tion 1928 of such Act). 
‘‘(2) CERTAIN OTHER COVERAGE.—Such indi-
vidual— 
‘‘(A) is enrolled in a health benefits plan 
under chapter 89 of title 5, United States Code, 
‘‘(B) is entitled to receive benefits under 
chapter 55 of title 10, United States Code, 
‘‘(C) is entitled to receive benefits under 
chapter 17 of title 38, United States Code, 
‘‘(D) is enrolled in a group health plan 
(within the meaning of section 5000(b)(1)) 
which is subsidized by the employer, or 
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‘‘(E) is a member of a health care sharing 
ministry. 
‘‘(3) HEALTH CARE SHARING MINISTRY.—For 
purposes of this subsection, the term ‘health care 
sharing ministry’ means an organization— 
‘‘(A) 
which 
is 
described 
in 
section 
501(c)(3) and is exempt from taxation under 
section 501(a), 
‘‘(B) members of which share a common 
set of ethical or religious beliefs and share med-
ical expenses among members in accordance 
with those beliefs and without regard to the 
State in which a member resides or is em-
ployed, 
‘‘(C) members of which retain membership 
even after they develop a medical condition, 
‘‘(D) which (or a predecessor of which) has 
been in existence at all times since December 
31, 1999, and medical expenses of its members 
have been shared continuously and without 
interruption since at least December 31, 1999, 
and 
‘‘(E) which conducts an annual audit 
which is performed by an independent certified 
public accounting firm in accordance with gen-
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erally accepted accounting principles and which 
is made available to the public upon request. 
‘‘(g) SPECIAL RULES.— 
‘‘(1) CREDIT IN EXCESS OF PREMIUMS ONLY 
PAYABLE TO A HEALTH SAVINGS ACCOUNT.— 
‘‘(A) IN GENERAL.—If the credit allowed 
under subsection (a) (determined without re-
gard to clause (ii)) for any taxable year exceeds 
the amount of premiums paid by the taxpayer 
for coverage of the taxpayer and the taxpayer’s 
qualifying family members under qualified 
health insurance for eligible coverage months 
beginning in the taxable year— 
‘‘(i) at the request of the taxpayer, 
the Secretary shall pay the amount of such 
excess to one or more health savings ac-
counts of the taxpayer or of any qualifying 
family member of the taxpayer, and 
‘‘(ii) the credit allowed under sub-
section (a) for such taxable year shall not 
exceed the amount of such premiums. 
‘‘(B) MEDICAL AND HEALTH SAVINGS AC-
COUNTS.—Amounts distributed from an Archer 
MSA (as defined in section 220(d)) or from a 
health savings account (as defined in section 
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223(d)) shall not be taken into account as pre-
miums paid under subparagraph (A). 
‘‘(C) INSURANCE
WHICH
COVERS
OTHER 
INDIVIDUALS.—For purposes of this paragraph, 
rules similar to the rules of section 213(d)(6) 
shall apply with respect to any contract for 
qualified health insurance under which amounts 
are payable for coverage of an individual other 
than the taxpayer and qualifying family mem-
bers. 
‘‘(D) CONTRIBUTIONS TREATED AS ROLL-
OVERS, ETC.— 
‘‘(i) IN GENERAL.—Any amount paid 
the Secretary to a health savings account 
under this paragraph shall be treated for 
purposes of this title in the same manner 
as a rollover contribution described in sec-
tion 223(f)(5). 
‘‘(ii) COORDINATION
WITH
LIMITA-
TION
ON
ROLLOVERS.—Any amount de-
scribed in clause (i) shall not be taken into 
account in applying section 223(f)(5)(B) 
with respect to any other amount and the 
limitation of section 223(f)(5)(B) shall not 
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apply with respect to the application of 
clause (i). 
‘‘(iii) ESTABLISHMENT
OF
HSAS.— 
Nothing in any provision of law shall be 
construed— 
‘‘(I) to prevent an individual 
from establishing a health savings ac-
count (as defined in section 223(d)) 
merely because such individual is not 
an eligible individual (as defined in 
section 223(c)), or 
‘‘(II) to prevent such an account 
from being treated as a health savings 
account merely because all or a sub-
stantial portion of the contributions to 
such account are described in this 
paragraph. 
‘‘(2) COORDINATION WITH ADVANCE PAYMENTS 
OF CREDIT.—With respect to any taxable year— 
‘‘(A) the amount which would (but for this 
subsection) be allowed as a credit to the tax-
payer under subsection (a) shall be reduced 
(but not below zero) by the aggregate amount 
paid on behalf of such taxpayer under section 
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7529 for months beginning in such taxable 
year, and 
‘‘(B) the tax imposed by section 1 for such 
taxable year shall be increased by the excess (if 
any) of— 
‘‘(i) the aggregate amount paid on be-
half of such taxpayer under section 7529 
for months beginning in such taxable year, 
over 
‘‘(ii) the amount which would (but for 
this subsection) be allowed as a credit to 
the taxpayer under subsection (a). 
‘‘(3) COORDINATION
WITH
OTHER
PROVI-
SIONS.—For purposes of any deduction allowed 
under section 162(l), 213, or 224, and any credit al-
lowed under section 35, any health insurance pre-
miums which would (but for this paragraph) be 
taken into account shall be reduced (but not below 
zero) by the amount of the credit allowed under this 
section (determined without regard to paragraphs 
(1) and (2) of this subsection). 
‘‘(4) DENIAL OF CREDIT TO DEPENDENTS AND 
NONPERMANENT RESIDENT ALIEN INDIVIDUALS.— 
No credit shall be allowed under this section to any 
individual who is— 
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‘‘(A) not a citizen or lawful permanent 
resident of the United States for the calendar 
year in which the taxable year begins, or 
‘‘(B) a dependent with respect to another 
taxpayer for a taxable year beginning in the 
calendar year in which such individual’s taxable 
year begins. 
‘‘(5) REGULATIONS.—The Secretary may pre-
scribe such regulations and other guidance as may 
be necessary or appropriate to carry out this section, 
section 6050W, and section 7529.’’. 
(b) ADVANCE PAYMENT OF CREDIT.— 
(1) IN GENERAL.—Chapter 77 of the Internal 
Revenue Code of 1986 (relating to miscellaneous 
provisions) is amended by adding at the end the fol-
lowing: 
‘‘SEC. 7529. ADVANCE PAYMENT OF CREDIT FOR HEALTH 
INSURANCE COVERAGE. 
‘‘(a) GENERAL RULE.—Not later than January 1, 
2016, the Secretary shall establish a program for making 
payments to providers of qualified health insurance (as de-
fined in section 36C(e)) on behalf of taxpayers eligible for 
the credit under section 36C. 
‘‘(b) LIMITATION.—The aggregate payments made 
under this section with respect to any taxpayer, deter-
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mined as of any time during any calendar year, shall not 
exceed the monthly credit amounts determined with re-
spect to such taxpayer under section 36C for months dur-
ing such calendar year which have ended as of such time. 
‘‘(c) APPLICATION OF RULE THAT CREDITS IN EX-
CESS OF PREMIUMS ONLY PAYABLE TO A HEALTH SAV-
INGS ACCOUNT.—Under rules similar to the rules of sec-
tion 36C(g)(1), any amount otherwise payable on behalf 
of the taxpayer under subsection (a) with respect to any 
eligible coverage month which is in excess of the amount 
of premiums paid by the taxpayer for coverage of the tax-
payer and the taxpayer’s qualifying family members under 
qualified health insurance for such month shall be payable 
only to one or more health savings accounts of the tax-
payer or of any qualifying family member of the taxpayer. 
‘‘(d) CERTIFICATION PROCESS AND PROOF OF COV-
ERAGE.—The Secretary shall establish a process under 
which individuals are certified as eligible for payment 
under this section. Such process shall include an initial 
application by the taxpayer to determine eligibility and 
thereafter continued eligibility shall be determined, to the 
maximum extent feasible, by the Secretary on the basis 
of information provided under section 6050X. 
‘‘(e) DEFINITIONS.—For purposes of this section, 
terms used in this section which are also used in section 
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36C shall have the same meaning as when used in section 
36C.’’. 
(2) INFORMATION REPORTING.— 
(A) IN GENERAL.—Subpart B of part III 
of subchapter A of chapter 61 of such Code (re-
lating to information concerning transactions 
with other persons) is amended by adding at 
the end the following new section: 
‘‘SEC. 6050X. RETURNS RELATING TO CREDIT FOR HEALTH 
INSURANCE COVERAGE. 
‘‘(a) REQUIREMENT OF REPORTING.—Every person 
who provides qualified health insurance for any month of 
any calendar year with respect to any individual shall, at 
such time as the Secretary may prescribe, make the return 
described in subsection (b) with respect to each such indi-
vidual. With respect to any individual with respect to 
whom payments under section 7529 are made by the Sec-
retary, the Secretary may require that reporting under 
subsection (b) be made on a monthly basis. 
‘‘(b) FORM AND MANNER OF RETURNS.—A return 
is described in this subsection if such return— 
‘‘(1) is in such form as the Secretary may pre-
scribe, and 
‘‘(2) contains, with respect to each policy of 
qualified health insurance— 
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‘‘(A) the name, address, and TIN of each 
individual covered under such policy, 
‘‘(B) the premiums paid with respect to 
such policy, and 
‘‘(C) such other information as the Sec-
retary may prescribe. 
‘‘(c) STATEMENTS TO BE FURNISHED TO INDIVID-
UALS WITH RESPECT TO WHOM INFORMATION IS RE-
QUIRED.—Every person required to make a return under 
subsection (a) shall furnish to each individual whose name 
is required to be set forth in such return a written state-
ment showing— 
‘‘(1) the name and address of the person re-
quired to make such return and the phone number 
of the information contact for such person, and 
‘‘(2) the information required to be shown on 
the return with respect to such individual. 
The written statement required under the preceding sen-
tence shall be furnished on or before January 31 of the 
year following the calendar year to which such statement 
relates. 
‘‘(d) DEFINITIONS.—For purposes of this section, 
terms used in this section which are also used in section 
36C shall have the same meaning as when used in section 
36C.’’. 
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(B) ASSESSABLE PENALTIES.— 
(i) Subparagraph (B) of section 
6724(d)(1) of such Code is amended by 
striking ‘‘or’’ at the end of clause (xxiv), 
by striking ‘‘and’’ at the end of clause 
(xxv) and inserting ‘‘or’’, and by inserting 
after clause (xxv) the following new clause: 
‘‘(xxvi) section 6050X (relating to re-
turns relating to credit for health insur-
ance coverage), and’’. 
(ii) Paragraph (2) of section 6724(d) 
of such Code is amended by striking ‘‘or’’ 
at the end of subparagraph (GG), by strik-
ing the period at the end of subparagraph 
(HH) and inserting ‘‘, or’’, and by adding 
after subparagraph (HH) the following 
new subparagraph: 
‘‘(II) section 6050X (relating to returns 
relating to credit for health insurance cov-
erage).’’. 
(3) DISCLOSURE
OF
RETURN
INFORMATION 
FOR PURPOSES OF ADVANCE PAYMENT OF CREDIT 
AS
PREMIUMS
FOR
QUALIFIED
HEALTH
INSUR-
ANCE.— 
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(A) IN GENERAL.—Subsection (l) of sec-
tion 6103 of such Code is amended by adding 
at the end the following new paragraph: 
‘‘(23) DISCLOSURE OF RETURN INFORMATION 
RELATED TO PAYMENTS OF THE HEALTH INSUR-
ANCE COVERAGE CREDIT.—The Secretary may, on 
behalf of taxpayers eligible for the credit under sec-
tion 36C, disclose to a provider of qualified health 
insurance (as defined in section 36(e)) or a trustee 
of a health savings account (and persons acting on 
behalf of such provider or such trustee), return in-
formation with respect to any such taxpayer only to 
the extent necessary (as prescribed by regulations 
issued by the Secretary) to carry out sections 
36C(g)(1) (relating to credit in excess of premiums 
only payable to a health savings account) and 7529 
(relating to advance payment of credit for health in-
surance coverage).’’. 
(B) 
CONFIDENTIALITY
OF
INFORMA-
TION.—Paragraph (3) of section 6103(a) of 
such Code is amended by striking ‘‘or (21)’’ 
and inserting ‘‘(21), or (22)’’. 
(C) UNAUTHORIZED
DISCLOSURE.—Para-
graph (2) of section 7213(a) of such Code is 
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amended by striking ‘‘or (21)’’ and inserting 
‘‘(21), or (22)’’. 
(4) EFFECTIVE DATE.—Subject to section 1(c), 
the amendments made by this section shall take ef-
fect on the date of the enactment of this Act. 
(c) CONFORMING AMENDMENTS.— 
(1) Paragraph (2) of section 1324(b) of title 
31, United States Code, is amended by inserting 
‘‘36C,’’ after ‘‘36B,’’. 
(2) The table of sections for subpart C of part 
IV of subchapter A of chapter 1 of the Internal Rev-
enue Code of 1986 is amended by inserting after the 
item relating to section 36B the following new item: 
‘‘Sec. 36C. Health insurance coverage.’’. 
(3) The table of sections for subpart B of part 
III of subchapter A of chapter 61 of such Code is 
amended by adding at the end the following new 
item: 
‘‘Sec. 6050X. Returns relating to credit for health insurance coverage.’’. 
(4) The table of sections for chapter 77 of such 
Code is amended by adding at the end the following 
new item: 
‘‘Sec. 7529. Advance payment of credit for health insurance coverage.’’. 
(d) EFFECTIVE DATE.—Subject to section 1(c), the 
amendments made by this section shall apply with respect 
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to coverage months beginning on or after the King v. 
Burwell effective date. 
SEC. 3. RESTORING TO STATES THE FREEDOM AND FLEXI-
BILITY TO REGULATE HEALTH INSURANCE 
MARKETS. 
(a) ELIMINATION OF PPACA RESTRICTIONS ON THE 
INSURANCE MARKET.—Any provision of title I of the Pa-
tient Protection and Affordable Care Act (Public Law 
111–148) or of the Health Care and Education Reconcili-
ation Act of 2010 (Public Law 111–152) amending title 
XXVII of the Public Health Service Act (42 U.S.C. 300gg 
et seq.), or amending the Internal Revenue Code of 1986 
or the Employee Retirement Income Security Act of 1974 
in order to incorporate or apply such an amendment to 
such title XXVII, is repealed and the provisions of law 
amended by such provisions of title I of the Patient Pro-
tection and Affordable Care Act and the Health Care and 
Education Reconciliation Act of 2010 are restored or re-
vived as if such title and Act had not been enacted. 
(b) HSAS AND FSAS.—Any provision of, or amend-
ment made by, the Patient Protection and Affordable Care 
Act (Public Law 111–148) or the Health Care and Edu-
cation Reconciliation Act of 2010 (Public Law 111–152) 
applying a requirement or restriction on a health savings 
account (within the meaning of section 223(d) of the In-
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ternal Revenue Code of 1986) or a health flexible spending 
arrangement (within the meaning of section 106(c) of the 
Internal Revenue Code of 1986) is repealed and the provi-
sions of law amended by such provisions of the Patient 
Protection and Affordable Care Act and the Health Care 
and Education Reconciliation Act of 2010 are restored or 
revived as if such Acts had not been enacted. 
(c) EXPANDED HEALTH PLAN SELECTION.— 
(1) IN GENERAL.—Section 1301(a)(1) of the 
Patient Protection and Affordable Care Act (42 
U.S.C. 18021(a)(1)) is amended by striking ‘‘a 
health plan that’’ and all that follows through the 
period at the end and inserting ‘‘any health plan (as 
defined in subsection (b)).’’. 
(2) DIRECT
PRIMARY
CARE
MEDICAL
HOME 
PLANS.—Section 1301(a)(3) of such Act (42 U.S.C. 
18021(a)(3)) is amended by striking ‘‘medical home 
plan that meets criteria’’ and all that follows 
through the period at the end and inserting ‘‘medical 
home plan.’’. 
(3) STAND-ALONE DENTAL BENEFITS.—Section 
1311(d)(2)(B)(ii) 
of 
such 
Act 
(42 
U.S.C. 
18031(d)(2)(B)(ii)) is amended by striking ‘‘health 
plan) if the plan’’ and all that follows through the 
period at the end and inserting ‘‘health plan).’’. 
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(4) 
CONFORMING
AMENDMENTS.—The 
fol-
lowing provisions of the Patient Protection and Af-
fordable Care Act (Public Law 111–148) shall have 
no force or effect after the date of the enactment of 
this Act: 
(A) Section 1301(b)(1)(B) of such Act (42 
U.S.C. 18021(b)(1)(B)). 
(B) Paragraphs (1), (2), and (6) of section 
1311(c) of such Act (42 U.S.C. 18031(c)). 
(C) Section 1311(d)(4)(A) of such Act (42 
U.S.C. 18031(d)(4)(A)). 
(D) Section 1311(e) of such Act (42 
U.S.C. 18031(e)). 
(E) Section 1311(j) of such Act (42 U.S.C. 
18031(j)). 
(F) Subparagraphs (B) and (D) of section 
1321(a)(1) 
of 
such 
Act 
(42 
U.S.C. 
18041(a)(1)). 
SEC. 4. POOL REFORM FOR INDIVIDUAL MEMBERSHIP EX-
PANSION. 
The Public Health Service Act is further amended by 
adding at the end the following: 
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‘‘TITLE 
XXXIV—POOL 
REFORM 
FOR 
INDIVIDUAL 
MEMBER-
SHIP EXPANSION 
‘‘SEC. 3400. PURPOSE. 
‘‘The purpose of this title is to provide, through the 
establishment of individual health pools (or IHPs), for the 
reform of, and expansion of enrollment in, health insur-
ance coverage for individuals and small employers. 
‘‘SEC. 3401. DEFINITION OF INDIVIDUAL HEALTH POOL 
(IHP). 
‘‘(a) IN GENERAL.—For purposes of this title, the 
terms ‘individual health pool’ and ‘IHP’ mean a legal non-
profit entity that meets the following requirements: 
‘‘(1) ORGANIZATION.—The IHP— 
‘‘(A) has been formed and maintained in 
good faith for a purpose that includes the for-
mation of a risk pool in order to offer health in-
surance coverage to its members; 
‘‘(B) does not condition membership in the 
IHP on any health status-related factor relating 
to an individual (including an employee of an 
employer or a dependent of an employee); 
‘‘(C) does not make health insurance cov-
erage offered through the IHP available other 
than in connection with a member of the IHP; 
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‘‘(D) is not a health insurance issuer; and 
‘‘(E) does not receive any consideration di-
rectly or indirectly from any health insurance 
issuer in connection with the enrollment of any 
individuals, or employees of employers, in any 
health insurance coverage, except in conjunction 
with services offered through the IHP. 
‘‘(2) 
OFFERING
HEALTH
BENEFITS
COV-
ERAGE.— 
‘‘(A) DIFFERENT GROUPS.—The IHP, in 
conjunction with those health insurance issuers 
that offer health benefits coverage through the 
IHP, makes available health benefits coverage 
in the manner described in subsection (b) to all 
members of the IHP and the dependents of 
such members (and, in the case of small em-
ployers, employees and their dependents) in the 
manner described in subsection (c)(2) at rates 
that are established by the health insurance 
issuer on a policy or product specific basis and 
that may vary for individuals covered through 
an IHP. 
‘‘(B) NONDISCRIMINATION
IN
COVERAGE 
OFFERED.— 
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‘‘(i) IN GENERAL.—Subject to clause 
(ii), the IHP may not offer health benefits 
coverage to a member of an IHP unless 
the same coverage is offered to all such 
members of the IHP. 
‘‘(ii) 
CONSTRUCTION.—Nothing 
in 
this title shall be construed as requiring or 
permitting a health insurance issuer to 
provide coverage outside the service area of 
the issuer, as approved under State law, or 
preventing a health insurance issuer from 
underwriting or from excluding or limiting 
the coverage on any individual, subject to 
the requirement of section 2741 (relating 
to guaranteed availability of individual 
health insurance coverage to certain indi-
viduals with prior group coverage). 
‘‘(C) NO ASSUMPTION OF INSURANCE RISK 
BY IHP.—The IHP provides health benefits cov-
erage only through contracts with health insur-
ance issuers and does not assume insurance 
risk with respect to such coverage. 
‘‘(3) GEOGRAPHIC AREAS.—Nothing in this title 
shall be construed as preventing the establishment 
and operation of more than one IHP in a geographic 
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area or as limiting the number of IHPs that may 
operate in any area. 
‘‘(4) PROVISION OF ADMINISTRATIVE SERVICES 
TO PURCHASERS.—The IHP may provide adminis-
trative services for members. Such services may in-
clude accounting, billing, and enrollment informa-
tion. 
‘‘(b) HEALTH
BENEFITS
COVERAGE
REQUIRE-
MENTS.— 
‘‘(1) COMPLIANCE
WITH
CONSUMER
PROTEC-
TION REQUIREMENTS.—Except as provided in sec-
tion 3402, any health benefits coverage offered 
through an IHP— 
‘‘(A) shall be issued by a health insurance 
issuer that meets all applicable State standards 
relating to consumer protection; 
‘‘(B) shall be approved or otherwise per-
mitted to be offered under State law; and 
‘‘(C) may not impose any exclusion of a 
specific disease from such coverage. 
‘‘(2) WELLNESS BONUSES FOR HEALTH PRO-
MOTION.—Nothing in this title shall be construed as 
precluding a health insurance issuer offering health 
benefits coverage through an IHP from establishing 
premium discounts or rebates for members or from 
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modifying 
otherwise 
applicable 
copayments 
or 
deductibles in return for adherence to programs of 
health promotion and disease prevention so long as 
such programs are agreed to in advance by the IHP 
and comply with all other provisions of this title and 
do not discriminate among similarly situated mem-
bers. 
‘‘(c) MEMBERS; HEALTH INSURANCE ISSUERS.— 
‘‘(1) MEMBERS.— 
‘‘(A) IN
GENERAL.—Under rules estab-
lished to carry out this title, with respect to an 
individual or small employer who is a member 
of an IHP, the individual may enroll for health 
benefits coverage (including coverage for de-
pendents of such individual) or employer may 
enroll employees for health benefits coverage 
(including coverage for dependents of such em-
ployees) offered by a health insurance issuer 
through the IHP. 
‘‘(B) RULES FOR ENROLLMENT.—Nothing 
in this paragraph shall preclude an IHP from 
establishing rules of enrollment and reenroll-
ment of members. Such rules shall be applied 
consistently to all members within the IHP and 
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shall not be based in any manner on health sta-
tus-related factors. 
‘‘(2) HEALTH INSURANCE ISSUERS.—The con-
tract between an IHP and a health insurance issuer 
shall provide, with respect to a member enrolled with 
health benefits coverage offered by the issuer 
through the IHP, for the payment to the issuer of 
the premiums (if any) collected by the IHP for 
health insurance coverage offered by the issuer. 
‘‘SEC. 3402. APPLICATION OF CERTAIN LAWS AND REQUIRE-
MENTS. 
‘‘(a) PREEMPTION OF STATE LAWS RESTRICTING 
FORMATION OF IHPS.—Any State law or regulation relat-
ing to the composition or organization of an IHP is pre-
empted to the extent the law or regulation is inconsistent 
with the provisions of this title. 
‘‘(b) PREEMPTION OF STATE REQUIREMENTS RE-
LATING TO HEALTH BENEFIT COVERAGE.— 
‘‘(1) BENEFIT REQUIREMENTS.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), State laws are superseded, and shall 
not apply to health benefits coverage made 
available through an IHP, insofar as such laws 
impose benefit requirements for such coverage, 
including (but not limited to) requirements re-
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lating to coverage of specific providers, specific 
services or conditions, or the amount, duration, 
or scope of benefits. 
‘‘(B) EXCEPTION
FOR
FEDERALLY
IM-
POSED
REQUIREMENTS
AND
FOR
REQUIRE-
MENTS PROHIBITING DISEASE-SPECIFIC EXCLU-
SIONS.—Subparagraph (A) shall not apply to a 
requirement to the extent the requirement— 
‘‘(i) implements title XXVII or other 
Federal law; or 
‘‘(ii) prohibits imposition of an exclu-
sion of a specific disease from health bene-
fits coverage. 
‘‘(2) OTHER REQUIREMENTS PREVENTING OF-
FERING
OF
COVERAGE
THROUGH
AN
IHP.—State 
laws are superseded, and shall not apply to health 
benefits coverage made available through an IHP, 
insofar as such laws impose any other requirements 
(including limitations on compensation arrange-
ments) that, directly or indirectly, preclude (or have 
the effect of precluding) the offering of such cov-
erage through an IHP, if the IHP meets the re-
quirements of this title. 
‘‘(c) PREEMPTION OF STATE PREMIUM RATING RE-
QUIREMENTS.—State laws are superseded, and shall not 
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apply to the premiums imposed for health benefits cov-
erage made available through an IHP, insofar as such 
laws impose restrictions on the variation of premiums 
among such coverage offered to members of the IHP. 
‘‘SEC. 3403. DEFINITIONS. 
‘‘For purposes of this title: 
‘‘(1) DEPENDENT.—The term ‘dependent’, as 
applied to health insurance coverage offered by a 
health insurance issuer licensed (or otherwise regu-
lated) in a State, shall have the meaning applied to 
such term with respect to such coverage under the 
laws of the State relating to such coverage and such 
an issuer. Such term may include the spouse and 
children of the individual involved. 
‘‘(2) HEALTH BENEFITS COVERAGE.—The term 
‘health benefits coverage’ has the meaning given the 
term 
‘health 
insurance 
coverage’ 
in 
section 
2791(b)(1), and does not include excepted benefits 
(as defined in section 2791(c)). 
‘‘(3) HEALTH INSURANCE ISSUER.—The term 
‘health insurance issuer’ has the meaning given such 
term in section 2791(b)(2). 
‘‘(4) HEALTH STATUS-RELATED FACTOR.—The 
term ‘health status-related factor’ has the meaning 
given such term in section 2791(d)(9). 
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‘‘(5) MEMBER.—The term ‘member’ means, 
with respect to an IHP, an individual or small em-
ployer who is a member of the legal entity described 
in section 3401(a)(1) to which the IHP is offering 
coverage. 
‘‘(6) SMALL EMPLOYER.—The term ‘small em-
ployer’ has the meaning given such term in section 
712(c)(1)(B) of the Employee Retirement and In-
come Security Act of 1974.’’. 
SEC. 5. REQUIREMENTS FOR INDIVIDUAL HEALTH INSUR-
ANCE. 
(a) IN GENERAL.—Section 2741 of the Public Health 
Service Act (42 U.S.C. 300gg–41), as restored and revived 
by section 3 of this Act, is amended— 
(1) in subsection (a)— 
(A) in the heading, by striking ‘‘TO CER-
TAIN INDIVIDUALS WITH PRIOR GROUP COV-
ERAGE’’; 
(B) in paragraph (1), by striking ‘‘and sec-
tion 2744’’; 
(C) in paragraph (1)(B), by inserting ‘‘un-
less such exclusion complies with paragraph 
(2)’’ before the period; and 
(D) by striking paragraph (2) and insert-
ing the following new paragraphs: 
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‘‘(2) LIMITATION ON PREEXISTING CONDITION 
EXCLUSION PERIOD.— 
‘‘(A) LIMITATION.—A health insurance 
issuer offering health insurance coverage in the 
individual market may not, with respect to an 
enrollee in such coverage, impose any pre-
existing condition exclusion if such enrollee has 
at least 18 months of continuous creditable cov-
erage (as defined in section 2701(c)(1)) imme-
diately preceding the enrollment date. 
‘‘(B) IMPOSITION
OF
EXCLUSION.—Not-
withstanding paragraph (1)(B), a health insur-
ance issuer offering health insurance coverage 
in the individual market may, with respect to 
an enrollee in such coverage who is not de-
scribed in subparagraph (A), impose a pre-
existing condition exclusion only if— 
‘‘(i) such exclusion relates to a condi-
tion (whether physical or mental), regard-
less of the cause of the condition, for which 
medical advice, diagnosis, care, or treat-
ment was recommended or received within 
the 6-month period ending on the enroll-
ment date; 
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‘‘(ii) such exclusion extends for a pe-
riod of not more than 18 months after the 
enrollment date; and 
‘‘(iii) the period of any such pre-
existing condition exclusion is reduced by 
the aggregate of the periods of creditable 
coverage (if any, as defined in section 
2701(c)(1)) applicable to the enrollee as of 
the enrollment date. 
‘‘(C) 
PREMIUM
SURCHARGE.—Notwith-
standing paragraph (6), with respect to an en-
rollee described in subparagraph (B), a health 
insurance issuer may charge a premium for the 
coverage involved that does not exceed 150 per-
cent of the applicable standard rate, for not to 
exceed 24 months (or 36 months if the health 
insurance issuer does not impose any pre-
existing condition exclusion with respect to such 
enrollee), reduced by the aggregate of the peri-
ods of creditable coverage (if any, as defined in 
section 2701(c)(1)) applicable to the enrollee as 
of the enrollment date. For purposes of this 
subsection, the term ‘applicable standard rate’ 
means the standard premium rate that the 
issuer charges for the coverage involved with re-
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spect to an individual described in subpara-
graph (A) with the same rating characteristics 
or rating factors as the enrollee described in 
subparagraph (B), provided that any variations 
in standard premium rates are based on the 
uniform application of rating characteristics or 
rating factors that are permitted by State law 
and are not otherwise prohibited by paragraph 
(6). 
‘‘(3) 
EXCEPTIONS.—Notwithstanding 
para-
graph (2), and subject to subparagraph (D), a 
health insurance issuer offering health insurance 
coverage in the individual market, may not impose 
any of the following preexisting condition exclusions: 
‘‘(A) EXCLUSION
NOT
APPLICABLE
TO 
CERTAIN NEWBORNS.—In the case of an indi-
vidual who, as of the last day of the 30-day pe-
riod beginning with the date of birth, is a de-
pendent of an enrollee in such coverage. 
‘‘(B) EXCLUSION
NOT
APPLICABLE
TO 
CERTAIN ADOPTED CHILDREN.—In the case of 
a child who is adopted or placed for adoption 
before attaining 18 years of age and who, as of 
the last day of the 30-day period beginning on 
the date of the adoption or placement for adop-
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tion, is a dependent of an enrollee in such cov-
erage. The previous sentence shall not apply to 
coverage before the date of such adoption or 
placement for adoption. 
‘‘(C) EXCLUSION
NOT
APPLICABLE
TO 
PREGNANCY.—Relating to pregnancy as a pre-
existing condition. 
‘‘(D) LOSS IF BREAK IN COVERAGE.—Sub-
paragraphs (A) and (B) shall no longer apply 
to an individual after the end of the first 63- 
day period during all of which the individual 
was not covered under any creditable coverage. 
‘‘(4) OPEN ENROLLMENT PERIODS.—A health 
insurance issuer offering health insurance coverage 
in the individual market may limit the applicability 
of the provisions of paragraph (1) to scheduled open 
enrollment periods, provided that— 
‘‘(A) any such open enrollment period shall 
not be less than 30 days; 
‘‘(B) any period between scheduled open 
enrollment periods shall not exceed 24 months; 
and 
‘‘(C) such limitation shall not apply to any 
individual who qualifies for a special enrollment 
period under paragraph (5). 
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‘‘(5) SPECIAL ENROLLMENT PERIODS.—Subject 
to subparagraphs (E) and (F), a health insurance 
issuer offering health insurance coverage in the indi-
vidual market shall permit an individual who is an 
eligible individual or a dependent to enroll in cov-
erage during a special enrollment period if the indi-
vidual experiences any of the following qualifying 
events: 
‘‘(A) FOR DEPENDENT BENEFICIARIES.— 
The individual becomes, by reason of marriage, 
birth, adoption or placement for adoption, a de-
pendent of an individual enrolled in a plan of-
fered by the health insurance issuer and such 
individual otherwise qualifies, under the terms 
of the plan, as eligible for coverage as a depend-
ent of such enrollee. 
‘‘(B) LOSS OF GROUP COVERAGE.—The in-
dividual loses coverage under a group health 
plan as a result of— 
‘‘(i) loss of eligibility for the coverage 
(including as a result of legal separation, 
divorce, death, attaining an age at which 
eligibility terminates, termination of em-
ployment, or reduction in the number of 
hours of employment); or 
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‘‘(ii) termination of the coverage by 
the plan sponsor. 
‘‘(C) LOSS OF INDIVIDUAL COVERAGE.— 
The individual loses individual market coverage 
as a result of— 
‘‘(i) discontinuation of a plan as a re-
sult of a health insurance issuer ceasing to 
offer coverage in the individual market in 
accordance with section 2742(c)(2) (42 
U.S.C. 300gg–42(c)(2)) of this title; 
‘‘(ii) expiration of COBRA, or other, 
continuation coverage; 
‘‘(iii) ceasing to qualify, under the 
terms of the coverage, as a dependent (in-
cluding as a result of legal separation, di-
vorce, death, or attaining an age at which 
eligibility terminates); and 
‘‘(iv) permanently moving outside the 
State in which the coverage was issued, or 
in the case of a network plan, outside the 
plan’s service area. 
‘‘(D) LOSS OF ELIGIBILITY FOR A GOV-
ERNMENT
COVERAGE
PROGRAM.—The indi-
vidual loses coverage by ceasing to be eligible 
for coverage under any of the following: 
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‘‘(i) Part A or part B of title XVIII 
of the Social Security Act (42 U.S.C. 
1395c et seq.; 1395j et seq.). 
‘‘(ii) Title XIX of the Social Security 
Act (42 U.S.C. 1396 et seq.), other than 
coverage consisting solely of benefits under 
section 1928 (42 U.S.C. 1396s). 
‘‘(iii) Title XXI of the Social Security 
Act (42 U.S.C. 1397aa et seq.). 
‘‘(iv) Chapter 55 of title 10. 
‘‘(v) Chapter 89 of title 5. 
‘‘(vi) A State health benefits risk pool. 
‘‘(E) LOSS
OF
COVERAGE
DESCRIBED.— 
For purposes of this paragraph, loss of cov-
erage shall not include any of the following: 
‘‘(i) Voluntary termination of coverage 
by an individual, except if such termination 
is the result of circumstances described in 
subparagraph (C)(iv). 
‘‘(ii) Termination of coverage by the 
issuer or the plan sponsor of the coverage 
for any reason described in paragraph (1) 
or (2) of section 2742(b) (300gg–42(b)) of 
this title. 
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‘‘(iii) Loss of any coverage that con-
sists solely of coverage of excepted benefits 
(as defined in section 300gg–91(c) of this 
title). 
‘‘(F) LIMITATION
ON
SPECIAL
ENROLL-
MENT PERIOD.—Any special enrollment period 
shall not be less than 60 days and shall begin 
on the date of the qualifying event. 
‘‘(6) STANDARD
PREMIUM
RATES.—With re-
spect to the premium rate charged by a health insur-
ance issuer for health insurance coverage offered in 
the individual market, such rate, with respect to the 
particular plan or coverage involved, shall not vary 
based on any of the following health status-related 
factors in relation to an eligible individual or de-
pendent: 
‘‘(A) Health status. 
‘‘(B) Medical condition (including both 
physical and mental illnesses). 
‘‘(C) Claims experience. 
‘‘(D) Receipt of health care. 
‘‘(E) Medical history. 
‘‘(F) Genetic information. 
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‘‘(G) Evidence of insurability (including 
conditions arising out of acts of domestic vio-
lence). 
‘‘(H) Disability.’’; 
(2) by amending subsection (b) to read as fol-
lows: 
‘‘(b) DEFINITIONS.—For purposes of this section: 
‘‘(1) ELIGIBLE INDIVIDUAL.—The term ‘eligible 
individual’ means an individual who is eligible under 
applicable State law to purchase individual health in-
surance coverage in the State. 
‘‘(2) 
DEPENDENT.—The 
term 
‘dependent’ 
means an individual who, under the terms of the 
coverage and applicable State law, qualifies to enroll 
in such coverage as a dependent of an individual de-
scribed in paragraph (1).’’; and 
(3) by striking subsection (c) and redesignating 
subsection (d) and the first subsection (e) as sub-
sections (c) and (d), respectively. 
(b) CONFORMING AMENDMENT.—Section 2744 of the 
Public Health Service Act (42 U.S.C. 300gg–44), as re-
stored and revived by section 3 of this Act, is repealed. 
(c) EFFECTIVE DATE.—Subject to section 1(c), the 
amendments made by this section shall apply with respect 
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to health insurance coverage offered for plan years begin-
ning on or after the King v. Burwell effective date. 
Æ 
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