retary) may not be issued or renewed unless the pol-
icy— 
‘‘(A) can be expected (in accordance with 
a uniform methodology developed by the Sec-
retary and for periods beginning 24 months 
after the date of original issue) to return to pol-
icyholders in the form of aggregate benefits at 
least 85 percent of the aggregate amount of 
premiums collected in the case of group policies 
or at least 75 percent in the case of individual 
policies (as defined by the Secretary); and 
‘‘(B) provides refunds and credits (in a 
manner specified by the Secretary) for pre-
miums collected in excess of those consistent 
with subparagraph (A). 
‘‘(4) GUARANTEED
RENEWABILITY
AND
CON-
VERTIBILITY.—Each AmeriCare supplemental pol-
icy— 
‘‘(A) shall be guaranteed renewable and 
may not be cancelled or nonrenewed solely on 
the ground of health status of the individual or 
for any reason other than nonpayment of pre-
mium or material misrepresentation; and 
‘‘(B) shall provide for— 
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‘‘(i) a right of conversion to an indi-
vidual policy (with continuation of bene-
fits) in the case of termination by a group 
policyholder 
or 
termination 
by 
a 
certificateholder of membership in a group 
through which the individual obtained cov-
erage; 
‘‘(ii) a right of continued coverage in 
the case of a group policy that succeeds 
another group policy; and 
‘‘(iii) suspension of coverage (for up 
to 24 months and in a manner specified) 
in the case of a policyholder who becomes 
entitled to benefits under this title as a 
low-income individual and who provides a 
timely notice of election of such suspen-
sion. 
‘‘(5) ADDITIONAL
STANDARDS
APPLICABLE 
ONLY TO INSURED POLICIES.—A carrier that offers 
an insured AmeriCare supplemental policy (as de-
fined in paragraph (6)) to individuals and groups in 
a State shall also comply with the following require-
ments: 
‘‘(A) OPEN
ENROLLMENT.—The carrier 
must offer the same policy to any other indi-
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vidual or group in the State on a continuous, 
year-round basis; except that— 
‘‘(i) in the case of policies offered 
through an association which is composed 
exclusively of employers (which may in-
clude self-employed individuals) and which 
has been formed for purposes other than 
obtaining health insurance, such require-
ment shall only apply to such employers 
(and individuals) who are members of the 
association; and 
‘‘(ii) a health maintenance organiza-
tion may deny enrollment with respect to 
an individual based on the uniform appli-
cation of a geographic service area or over-
all enrollment limitation based on its finan-
cial or administrative capacity. 
‘‘(B) NOTICES AND RENEWAL PERIODS.— 
The carrier shall provide advance notice of 
terms for policy renewal, which terms shall— 
‘‘(i) be the same as the terms of 
issuance, except for rates and administra-
tive changes; 
‘‘(ii) provide the same premium rates 
as for a new issue; and 
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‘‘(iii) provide a period of renewal of 
not less than 12 months. 
‘‘(c) ADDITIONAL REQUIREMENTS.— 
‘‘(1) PROHIBITION OF DUPLICATION.—The Sec-
retary shall— 
‘‘(A) establish requirements that prohibit 
(other than as required under Federal or State 
law) the knowing sale or issuance to an indi-
vidual entitled to benefits under this title of 
health insurance that duplicates benefits under 
this title, of an AmeriCare supplemental policy 
that duplicates another AmeriCare supple-
mental policy, or of another health insurance 
policy that duplicates other benefits to which 
the individual is entitled; and 
‘‘(B) provide exceptions to the prohibition 
in subparagraph (A) for enrollment in group 
health plans and similar employment-based poli-
cies and for policies which provide benefits di-
rectly and without regard to other coverage and 
notice of such duplication. 
‘‘(2) DISCLOSURE
REQUIREMENT.—The Sec-
retary shall establish a requirement that prohibits 
the sale or issuance of an AmeriCare supplemental 
policy to an individual, other than as a replacement 
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policy, without obtaining a statement (in a form 
specified by the Secretary) that discloses other 
health benefits coverage and that acknowledges limi-
tations on the need for an AmeriCare supplemental 
policy, particularly in the case of a low-income indi-
vidual. 
‘‘(3) APPLICATION
OF
FALSE
STATEMENT 
SANCTIONS.—The provisions of paragraphs (1) and 
(2) of section 1882(d) shall apply to an AmeriCare 
supplemental policy under this section in the same 
manner as they apply to medicare supplemental poli-
cies under such section. 
‘‘(4) LIMITATIONS ON SALES COMMISSIONS.— 
‘‘(A) IN GENERAL.—It is unlawful for a 
person who provides for a commission or other 
compensation to an agent or other representa-
tives with respect to the sale of an AmeriCare 
supplemental policy (or certificate)— 
‘‘(i) to provide for a first year com-
mission or other first year compensation 
that exceeds 200 percent of the commis-
sion or other compensation for the selling 
or servicing of the policy or certificate in 
a second or subsequent year; or 
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‘‘(ii) to provide for compensation with 
respect to replacement of such a policy or 
certificate that is greater than the com-
pensation that would apply to the renewal 
of the policy or certificate. 
‘‘(B) DEFINITION.—In subparagraph (A), 
the term ‘compensation’ includes pecuniary and 
nonpecuniary compensation of any kind relating 
to the sale or renewal of a policy or certificate 
and specifically includes bonuses, gifts, prizes, 
awards, and finders’ fees. 
‘‘(d) INFORMATION
DISCLOSURE.—The Secretary 
shall provide, to all individuals entitled to benefits under 
this title, such information as will permit such individuals 
to evaluate the value of AmeriCare supplemental policies 
to them and the relationship of any such policies to bene-
fits provided under this title. Such information shall in-
clude information on— 
‘‘(1) the requirements and prohibitions under 
this section; 
‘‘(2) State and Federal agencies responsible for 
compliance with such requirements and enforcement 
of such prohibitions; and 
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‘‘(3) the manner of submitting complaints re-
garding violations of such requirements and prohibi-
tions. 
‘‘(e) DEFINITIONS.—In this section: 
‘‘(1) CARRIER.—The term ‘carrier’ means any 
person that offers an AmeriCare supplemental pol-
icy. 
‘‘(2) GROUP.—The term ‘group’ means 2 or 
more employees of the same employer who normally 
perform on a monthly basis at least 171⁄2 hours of 
service per week for that employer. 
‘‘(3) HEALTH MAINTENANCE ORGANIZATION.— 
The term ‘health maintenance organization’ has the 
meaning given the term ‘eligible organization’ in sec-
tion 1876(b). 
‘‘(4) INSURED
AMERICARE
SUPPLEMENTAL 
POLICY.—The term ‘insured AmeriCare supple-
mental policy’ means any AmeriCare supplemental 
policy provided through insurance.’’. 
TITLE II—FINANCING 
PROVISIONS 
Subtitle A—Individual 
Contributions 
SEC. 201. GENERAL OBLIGATION FOR INDIVIDUALS. 
(a) PAYMENT OF PLAN PREMIUM.— 
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(1) IN GENERAL.—Each individual eligible for 
coverage under title XXII of the Social Security Act 
is liable for payment of the premium established 
under this section for such coverage of the individual 
and family members. An individual who is not re-
ceiving such coverage due to coverage under a group 
health plan described in section 2202(d) of such Act 
is not liable for payment of such premium with re-
spect to such individual. 
(2) DETERMINATION OF PREMIUM.—Such pre-
mium shall be established by the Secretary of Health 
and Human Services on the basis of the cost of cov-
erage (determined on a State by State basis and in-
cluding administrative costs) and shall be deter-
mined separately based on the class of enrollment 
for the individual (as determined under section 2202 
of the Social Security Act). 
(3) JOINT AND SEVERAL LIABILITY.—If more 
than one individual is liable under this subsection 
for payment of a premium for coverage of the same 
individual under title XXII of the Social Security 
Act, such individual shall be jointly and severally lia-
ble with each other individual who is so liable. 
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(b) REDUCTION
FOR EMPLOYER CONTRIBUTIONS 
AND LOW INCOME SUBSIDIES.—An individual’s liability 
under subsection (a) is reduced by— 
(1) the amount of any contributions made by 
the individual’s employer (or employers) under sub-
title B or otherwise (including voluntary employer 
contributions) with respect to coverage of the indi-
vidual and family members, and 
(2) the amount of any premium subsidies pro-
vided with respect to the individual under section 
202. 
(c) TIMING AND MANNER OF PAYMENT.—Each indi-
vidual that is liable for a premium under subsection (a) 
shall pay such premium in such form and manner as the 
Secretary of the Treasury may specify. Except as other-
wise provided by the Secretary of the Treasury, for pur-
poses of subtitle F of such Code, the liabilities imposed 
under subsection (a) shall be treated as if they were a 
tax imposed under section 1 of such Code. The Secretary 
of the Treasury shall provide for the withholding of such 
payments from wages under rules similar to the rules of 
chapter 24 of such Code. The Secretary of the Treasury 
may prescribe special rules for withholding payments from 
wages of individuals who work seasonally, part-time, or for 
more than one employer. 
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SEC. 202. ADDITIONAL PREMIUM SUBSIDIES. 
(a) ELIGIBILITY FOR ADDITIONAL PREMIUM SUB-
SIDIES.— 
(1) IN GENERAL.—Each premium subsidy eligi-
ble individual is entitled to a premium subsidy in ac-
cordance with this section. 
(2) 
PREMIUM
SUBSIDY
ELIGIBLE
INDI-
VIDUAL.—In this section, the term ‘‘premium sub-
sidy eligible individual’’ means an individual receiv-
ing coverage under title XXII of the Social Security 
Act who— 
(A) with respect to premiums for a taxable 
year ending in a year, has family income (as de-
fined in paragraph (3)(A)) that is less than 300 
percent of the applicable poverty level, or 
(B) with respect to a premium for a 
month, is an TANF or SSI recipient for the 
month. 
(3) ADDITIONAL DEFINITIONS.—In this section: 
(A) FAMILY INCOME.—The term ‘‘family 
income’’ means, with respect to an individual 
who— 
(i) is not a dependent of another indi-
vidual, the sum of the modified adjusted 
gross incomes (as defined in subparagraph 
(B)) for the individual, the individual’s 
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spouse, and children who are dependents of 
the individual, or 
(ii) is a dependent of another indi-
vidual, the sum of the modified adjusted 
gross incomes (as defined in subparagraph 
(B)) for the other individual, the other in-
dividual’s spouse, and children who are de-
pendents of the other individual. 
(B) MODIFIED
ADJUSTED
GROSS
IN-
COME.—The term ‘‘modified adjusted gross in-
come’’ means adjusted gross income (as defined 
in the Internal Revenue Code of 1986)— 
(i) determined without regard to sec-
tions 911, 931, and 933 of such Code, and 
(ii) increased by— 
(I) the amount of interest re-
ceived or accrued by the individual 
during the taxable year which is ex-
empt from tax, and 
(II) the amount of the social se-
curity benefits (as defined in section 
86(d) of such Code) received during 
the taxable year to the extent not in-
cluded in gross income under section 
86 of such Code. 
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The determination under the preceding sen-
tence shall be made without regard to any car-
ryover or carryback. 
(C) APPLICABLE POVERTY LEVEL.— 
(i) IN GENERAL.—The term ‘‘applica-
ble poverty level’’ means, for a family for 
a year, the official poverty line (as defined 
by the Secretary of Health and Human 
Services) applicable to a family of the size 
involved for 2010 adjusted by the percent-
age increase or decrease described in 
clause (ii) for the year involved. 
(ii) PERCENTAGE ADJUSTMENT.—The 
percentage increase or decrease described 
in this clause for a year is the percentage 
increase or decrease by which the average 
Consumer Price Index for all urban con-
sumers (U.S. city average), as published by 
the Bureau of Labor Statistics, for the 12- 
month-period ending with August 31 of the 
preceding year exceeds such average for 
the 12-month period ending with August 
31, 2010. 
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