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‘‘(iv) for which the medical loss ratio 
(determined in a manner consistent with 
the determination of such ratio under sec-
tion 2718(b)(1)(A) of the Public Health 
Service Act) with respect to the individual 
insurance market for such entity for the cal-
endar year is not less than 100 percent, 
‘‘(D) any entity— 
‘‘(i)(I) which is incorporated as a non-
profit corporation under a State law, or 
‘‘(II) which is described in section 
501(c)(4) of the Internal Revenue Code of 
1986 and the activities of which consist of 
providing commercial-type insurance (with-
in the meaning of section 501(m) of such 
Code), and 
‘‘(ii) for which the medical loss ratio 
(as so determined)— 
‘‘(I) with respect to each of the in-
dividual, small group, and large group 
insurance markets for such entity for 
the calendar year is not less than 90 
percent, and
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‘‘(II) with respect to all such mar-
kets for such entity for the calendar 
year is not less than 92 percent, or 
‘‘(E) any entity— 
‘‘(i) which is a mutual insurance com-
pany, 
‘‘(ii) which for the period reported on 
the 2008 Accident and Health Policy Expe-
rience Exhibit of the National Association 
of Insurance Commissioners had— 
‘‘(I) a market share of the insured 
population of a State of at least 40 but 
not more than 60 percent, and 
‘‘(II) with respect to all markets 
described in subparagraph (D)(ii)(I), a 
medical loss ratio of not less than 90 
percent, and 
‘‘(iii) with respect to annual payment 
dates in calendar years after 2011, for 
which the medical loss ratio (determined in 
a manner consistent with the determination 
of such ratio under section 2718(b)(1)(A) of 
the Public Health Service Act) with respect 
to all such markets for such entity for the 
preceding calendar year is not less than 89
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percent (except that with respect to such an-
nual payment date for 2012, the calculation 
under 2718(b)(1)(B)(ii) of such Act is deter-
mined by reference to the previous year, and 
with respect to such annual payment date 
for 2013, such calculation is determined by 
reference to the average for the previous 2 
years).’’. 
(d) CERTAIN INSURANCE EXEMPTED FROM FEE.— 
Paragraph (3) of section 9010(h) of this Act is amended 
to read as follows: 
‘‘(3) HEALTH INSURANCE.—The term ‘health in-
surance’ shall not include— 
‘‘(A) any insurance coverage described in 
paragraph (1)(A) or (3) of section 9832(c) of the 
Internal Revenue Code of 1986, 
‘‘(B) any insurance for long-term care, or 
‘‘(C) any medicare supplemental health in-
surance (as defined in section 1882(g)(1) of the 
Social Security Act).’’. 
(e) ANTI-AVOIDANCE GUIDANCE.—Subsection (i) of 
section 9010 of this Act is amended by inserting ‘‘and shall 
prescribe such regulations as are necessary or appropriate 
to prevent avoidance of the purposes of this section, includ-
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ing inappropriate actions taken to qualify as an exempt 
entity under subsection (c)(2)’’ after ‘‘section’’. 
(f) CONFORMING AMENDMENTS.— 
(1) Section 9010(a)(1) of this Act is amended by 
striking ‘‘2009’’ and inserting ‘‘2010’’. 
(2) Section 9010(c)(2)(B) of this Act is amended 
by striking ‘‘(except’’ and all that follows through 
‘‘1323)’’. 
(3) Section 9010(c)(3) of this Act is amended by 
adding at the end the following new sentence: ‘‘If any 
entity described in subparagraph (C)(i)(I), (D)(i)(I), 
or (E)(i) of paragraph (2) is treated as a covered en-
tity by reason of the application of the preceding sen-
tence, the net premiums written with respect to health 
insurance for any United States health risk of such 
entity shall not be taken into account for purposes of 
this section.’’. 
(4) Section 9010(g)(1) of this Act is amended by 
striking ‘‘and third party administration agreement 
fees’’. 
(5) Section 9010(j) of this Act is amended— 
(A) by striking ‘‘2008’’ and inserting 
‘‘2009’’, and
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(B) by striking ‘‘, and any third party ad-
ministration agreement fees received after such 
date’’. 
(g) EFFECTIVE DATE.—The amendments made by this 
section shall take effect as if included in the enactment of 
section 9010. 
SEC. 10906. MODIFICATIONS TO ADDITIONAL HOSPITAL IN-
SURANCE TAX ON HIGH-INCOME TAXPAYERS. 
(a) FICA.—Section 3101(b)(2) of the Internal Revenue 
Code of 1986, as added by section 9015(a)(1) of this Act, 
is amended by striking ‘‘0.5 percent’’ and inserting ‘‘0.9 
percent’’. 
(b) SECA.—Section 1401(b)(2)(A) of the Internal 
Revenue Code of 1986, as added by section 9015(b)(1) of 
this Act, is amended by striking ‘‘0.5 percent’’ and inserting 
‘‘0.9 percent’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall apply with respect to remuneration received, 
and taxable years beginning, after December 31, 2012. 
SEC. 10907. EXCISE TAX ON INDOOR TANNING SERVICES IN 
LIEU OF ELECTIVE COSMETIC MEDICAL PRO-
CEDURES. 
(a) IN GENERAL.—The provisions of, and amendments 
made by, section 9017 of this Act are hereby deemed null, 
void, and of no effect.
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(b) EXCISE TAX ON INDOOR TANNING SERVICES.— 
Subtitle D of the Internal Revenue Code of 1986, as amend-
ed by this Act, is amended by adding at the end the fol-
lowing new chapter: 
‘‘CHAPTER 49—COSMETIC SERVICES 
‘‘Sec. 5000B. Imposition of tax on indoor tanning services. 
‘‘SEC. 5000B. IMPOSITION OF TAX ON INDOOR TANNING 
SERVICES. 
‘‘(a) IN GENERAL.—There is hereby imposed on any 
indoor tanning service a tax equal to 10 percent of the 
amount paid for such service (determined without regard 
to this section), whether paid by insurance or otherwise. 
‘‘(b) INDOOR TANNING SERVICE.—For purposes of this 
section— 
‘‘(1) IN GENERAL.—The term ‘indoor tanning 
service’ means a service employing any electronic 
product designed to incorporate 1 or more ultraviolet 
lamps and intended for the irradiation of an indi-
vidual by ultraviolet radiation, with wavelengths in 
air between 200 and 400 nanometers, to induce skin 
tanning. 
‘‘(2) EXCLUSION
OF
PHOTOTHERAPY
SERV-
ICES.—Such term does not include any phototherapy 
service performed by a licensed medical professional. 
‘‘(c) PAYMENT OF TAX.—
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SEC. 10908. EXCLUSION FOR ASSISTANCE PROVIDED TO 
PARTICIPANTS IN STATE STUDENT LOAN RE-
PAYMENT PROGRAMS FOR CERTAIN HEALTH 
PROFESSIONALS. 
(a) IN GENERAL.—Paragraph (4) of section 108(f) of 
the Internal Revenue Code of 1986 is amended to read as 
follows: 
‘‘(4) PAYMENTS UNDER NATIONAL HEALTH SERV-
ICE CORPS LOAN REPAYMENT PROGRAM AND CERTAIN 
STATE LOAN REPAYMENT PROGRAMS.—In the case of 
an individual, gross income shall not include any 
amount received under section 338B(g) of the Public 
Health Service Act, under a State program described 
in section 338I of such Act, or under any other State 
loan repayment or loan forgiveness program that is 
intended to provide for the increased availability of 
health care services in underserved or health profes-
sional shortage areas (as determined by such State).’’. 
(b) EFFECTIVE DATE.—The amendment made by this 
section shall apply to amounts received by an individual 
in taxable years beginning after December 31, 2008. 
SEC. 10909. EXPANSION OF ADOPTION CREDIT AND ADOP-
TION ASSISTANCE PROGRAMS. 
(a) INCREASE IN DOLLAR LIMITATION.— 
(1) ADOPTION CREDIT.—
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(A) IN GENERAL.—Paragraph (1) of section 
23(b) of the Internal Revenue Code of 1986 (re-
lating to dollar limitation) is amended by strik-
ing ‘‘$10,000’’ and inserting ‘‘$13,170’’. 
(B) CHILD WITH SPECIAL NEEDS.—Para-
graph (3) of section 23(a) of such Code (relating 
to $10,000 credit for adoption of child with spe-
cial needs regardless of expenses) is amended— 
(i) in the text by striking ‘‘$10,000’’ 
and inserting ‘‘$13,170’’, and 
(ii) 
in 
the 
heading 
by 
striking 
‘‘$10,000’’ and inserting ‘‘$13,170’’. 
(C) CONFORMING
AMENDMENT
TO
INFLA-
TION ADJUSTMENT.—Subsection (h) of section 23 
of such Code (relating to adjustments for infla-
tion) is amended to read as follows: 
‘‘(h) ADJUSTMENTS FOR INFLATION.— 
‘‘(1) DOLLAR
LIMITATIONS.—In the case of a 
taxable year beginning after December 31, 2010, each 
of the dollar amounts in subsections (a)(3) and (b)(1) 
shall be increased by an amount equal to— 
‘‘(A) such dollar amount, multiplied by 
‘‘(B) the cost-of-living adjustment deter-
mined under section 1(f)(3) for the calendar year 
in which the taxable year begins, determined by
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substituting ‘calendar year 2009’ for ‘calendar 
year 1992’ in subparagraph (B) thereof. 
If any amount as increased under the preceding sen-
tence is not a multiple of $10, such amount shall be 
rounded to the nearest multiple of $10. 
‘‘(2) INCOME LIMITATION.—In the case of a tax-
able year beginning after December 31, 2002, the dol-
lar amount in subsection (b)(2)(A)(i) shall be in-
creased by an amount equal to— 
‘‘(A) such dollar amount, multiplied by 
‘‘(B) the cost-of-living adjustment deter-
mined under section 1(f)(3) for the calendar year 
in which the taxable year begins, determined by 
substituting ‘calendar year 2001’ for ‘calendar 
year 1992’ in subparagraph (B) thereof. 
If any amount as increased under the preceding sen-
tence is not a multiple of $10, such amount shall be 
rounded to the nearest multiple of $10.’’. 
(2) ADOPTION ASSISTANCE PROGRAMS.— 
(A) IN GENERAL.—Paragraph (1) of section 
137(b) of the Internal Revenue Code of 1986 (re-
lating to dollar limitation) is amended by strik-
ing ‘‘$10,000’’ and inserting ‘‘$13,170’’. 
(B) CHILD WITH SPECIAL NEEDS.—Para-
graph (2) of section 137(a) of such Code (relat-
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ing to $10,000 exclusion for adoption of child 
with special needs regardless of expenses) is 
amended— 
(i) in the text by striking ‘‘$10,000’’ 
and inserting ‘‘$13,170’’, and 
(ii) 
in 
the 
heading 
by 
striking 
‘‘$10,000’’ and inserting ‘‘$13,170’’. 
(C) CONFORMING
AMENDMENT
TO
INFLA-
TION
ADJUSTMENT.—Subsection (f) of section 
137 of such Code (relating to adjustments for in-
flation) is amended to read as follows: 
‘‘(f) ADJUSTMENTS FOR INFLATION.— 
‘‘(1) DOLLAR
LIMITATIONS.—In the case of a 
taxable year beginning after December 31, 2010, each 
of the dollar amounts in subsections (a)(2) and (b)(1) 
shall be increased by an amount equal to— 
‘‘(A) such dollar amount, multiplied by 
‘‘(B) the cost-of-living adjustment deter-
mined under section 1(f)(3) for the calendar year 
in which the taxable year begins, determined by 
substituting ‘calendar year 2009’ for ‘calendar 
year 1992’ in subparagraph (B) thereof. 
If any amount as increased under the preceding sen-
tence is not a multiple of $10, such amount shall be 
rounded to the nearest multiple of $10.
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‘‘(2) INCOME LIMITATION.—In the case of a tax-
able year beginning after December 31, 2002, the dol-
lar amount in subsection (b)(2)(A) shall be increased 
by an amount equal to— 
‘‘(A) such dollar amount, multiplied by 
‘‘(B) the cost-of-living adjustment deter-
mined under section 1(f)(3) for the calendar year 
in which the taxable year begins, determined by 
substituting ‘calendar year 2001’ for ‘calendar 
year 1992’ in subparagraph thereof. 
If any amount as increased under the preceding sen-
tence is not a multiple of $10, such amount shall be 
rounded to the nearest multiple of $10.’’. 
(b) CREDIT MADE REFUNDABLE.— 
(1) CREDIT MOVED TO SUBPART RELATING TO 
REFUNDABLE CREDITS.—The Internal Revenue Code 
of 1986 is amended— 
(A) by redesignating section 23, as amended 
by subsection (a), as section 36C, and 
(B) by moving section 36C (as so redesig-
nated) from subpart A of part IV of subchapter 
A of chapter 1 to the location immediately before 
section 37 in subpart C of part IV of subchapter 
A of chapter 1. 
(2) CONFORMING AMENDMENTS.—
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(A) Section 24(b)(3)(B) of such Code is 
amended by striking ‘‘23,’’. 
(B) Section 25(e)(1)(C) of such Code is 
amended by striking ‘‘23,’’ both places it ap-
pears. 
(C) Section 25A(i)(5)(B) of such Code is 
amended by striking ‘‘23, 25D,’’ and inserting 
‘‘25D’’. 
(D) Section 25B(g)(2) of such Code is 
amended by striking ‘‘23,’’. 
(E) Section 26(a)(1) of such Code is amend-
ed by striking ‘‘23,’’. 
(F) Section 30(c)(2)(B)(ii) of such Code is 
amended by striking ‘‘23, 25D,’’ and inserting 
‘‘25D’’. 
(G) Section 30B(g)(2)(B)(ii) of such Code is 
amended by striking ‘‘23,’’. 
(H) Section 30D(c)(2)(B)(ii) of such Code 
is amended by striking ‘‘sections 23 and’’ and 
inserting ‘‘section’’. 
(I) Section 36C of such Code, as so redesig-
nated, is amended— 
(i) by striking paragraph (4) of sub-
section (b), and 
(ii) by striking subsection (c).