Title I, Subtitle A
(c) APPLICATION TO SMALL EMPLOYER POOLING
ARRANGEMENTS AND FULLY-INSURED MEWAS.—As re-
quired under sections 704(b)(6)(B) and 711(c)(1)(B) of
the Employee Retirement Income Security Act of 1974,
as added by section 1401 of this Act, this section applies
to small employer pooling arrangements and to multiple
employer welfare arrangements that are fully insured
(without regard to whether such an arrangement is offered
through an association), with respect to individuals cov-
ered in the individual/small employer market, in such form
and manner as the Secretary of Labor prescribes in regu-
lation, in consultation with the Secretary of Health and
Human Services. In applying this section to a small em-
ployer pooling arrangement, the regulation shall provide
that assessments and credits under this section shall be
provided through coordination with an insurer that pro-
vides excess/stop loss coverage (as defined in section 701
of such Act) with respect to the arrangement.
PART 4—CONSUMER PROTECTIONS
SEC. 1031. REQUIREMENT FOR PROVISION OF INFORMA-
TION.
(a) CARRIERS.—
(1) IN
GENERAL.—Each carrier that offers
health insurance coverage to small employers (or eli-
gible employees of small employers) or qualifying in-
Title I, Subtitle A
dividuals must disclose to such prospective enrollees,
to brokers, and to health plan purchasing organiza-
tions the information that the Secretary may specify
relating to the performance of the carrier in provid-
ing such coverage, consistent with any quality meas-
ures established under section 5002, and relating to
differences between the coverage provided and the
most similar model benefit package established
under section 1104(b)(2). If a carrier offers to indi-
viduals or employers coverage the actuarial value of
which is more than the actuarial value for high-de-
ductible coverage but less than such value for stand-
ard coverage, the carrier must disclose to such em-
ployers or individuals detailed information on how
the coverage offered compares to any standard and
high-deductible coverage offered by the carrier to
such individuals and employers.
(2) MARKETING MATERIAL.—Each carrier that
provides any health insurance coverage in a State
shall file with the State those marketing materials
relating to the offer and sale of health insurance
coverage to be used for distribution before the mate-
rials are used. Such materials shall be in a uniform
format specified under the standards established
under section 1301.
Title I, Subtitle A
(b) GROUP HEALTH PLANS.—Each group health
plan that provides health coverage must disclose to enroll-
ees and potential enrollees information, similar to the in-
formation described in subsection (a), relating to perform-
ance of the plan in providing such coverage, consistent
with any quality measures established under section 5002,
and relating to differences between the coverage provided
and the most similar model benefit package established
under section 1104(b)(2).
(c) INFORMATION
RELATING
TO
RISK
ADJUST-
MENT.—Each carrier or group health plan providing cov-
erage in the individual/small group market (including
small employer pooling arrangements and certified mul-
tiple employer health plans that are fully insured, without
regard to whether such an arrangement or plan is offered
through an association) shall provide to the State such in-
formation as the State may require in order to carry out
section 1023 (relating to risk adjustment mechanisms).
SEC. 1032. PROHIBITION OF IMPROPER INCENTIVES.
(a) LIMITATION
ON FINANCIAL INCENTIVES.—No
carrier that provides health insurance coverage may vary
the commission or financial or other remuneration to a
person based on the claims experience or health status of
individuals enrolled by or through the person.
Title I, Subtitle A
(b) NONDISCRIMINATION
IN
AGENT
COMPENSA-
TION.—A carrier—
(1) may not vary or condition the compensation
provided to an agent or broker related to the sale or
renewal of health insurance coverage because of the
health status or claims experience of any individuals
enrolled with the carrier through the agent or
broker; and
(2) may not terminate, fail to renew, or limit its
contract or agreement of representation with an
agent or broker for any reason related to the health
status or claims experience of any individuals en-
rolled with the carrier through the agent or broker.
(c) PROHIBITION OF TIE-IN ARRANGEMENTS.—No
carrier that offers health insurance coverage may require
the purchase of any other insurance or product as a condi-
tion for the purchase of such coverage.
SEC. 1033. WRITTEN POLICIES AND PROCEDURES RESPECT-
ING ADVANCE DIRECTIVES.
A carrier and a group health plan offering health cov-
erage shall meet the requirements of section 1866(f) of
the Social Security Act (relating to maintaining written
policies and procedures respecting advance directives), in-
sofar as such requirements would apply to the carrier or
plan if the carrier or plan were an eligible organization.
Title I, Subtitle B
Subtitle B—Benefits
SEC. 1101. QUALIFIED HEALTH COVERAGE.
In this Act, the term ‘‘qualified health coverage’’
means health coverage that—
(1) provides—
(A) standard coverage consistent with sec-
tion 1102(a), or
(B) high-deductible coverage consistent
with section 1103; and
(2) meets other requirements of subtitle A ap-
plicable to the coverage and the carrier or group
health plan providing the coverage.
SEC. 1102. STANDARD COVERAGE.
(a) IN GENERAL.—Health insurance coverage is con-
sidered to provide standard coverage consistent with this
subsection and for preventive benefits under subsection
(b)(4) if—
(1) benefits under such coverage are provided
within at least each of the required categories of
benefits described in paragraph (1) of subsection (b)
and consistent with such subsection;
(2) the actuarial value of the benefits meets the
requirements of subsection (c), and
(3) the benefits comply with the minimum re-
quirements specified in subsection (d).