Source: http://uscode.house.gov/view.xhtml?req=(title:42%20section:18071%20edition:prelim)
Timestamp: 2019-06-20 02:56:59
Document Index: 511870957

Matched Legal Cases: ['§ 18071', '§18071', '§1402', '§1001', '§1001', '§1001', '§1001', '§1001', '§1001', '§1001']

[USC07] 42 USC 18071: Reduced cost-sharing for individuals enrolling in qualified health plans
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42 USC 18071: Reduced cost-sharing for individuals enrolling in qualified health plans Text contains those laws in effect on June 18, 2019
From Title 42-THE PUBLIC HEALTH AND WELFARECHAPTER 157-QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANSSUBCHAPTER IV-AFFORDABLE COVERAGE CHOICES FOR ALL AMERICANSPart A-Premium Tax Credits and Cost-Sharing Reductions
§18071. Reduced cost-sharing for individuals enrolling in qualified health plans
In the case of an eligible insured enrolled in a qualified health plan-
(1) the Secretary shall notify the issuer of the plan of such eligibility; and
(2) the issuer shall reduce the cost-sharing under the plan at the level and in the manner specified in subsection (c).
(b) Eligible insured
In this section, the term "eligible insured" means an individual-
(1) who enrolls in a qualified health plan in the silver level of coverage in the individual market offered through an Exchange; and
(2) whose household income exceeds 100 percent but does not exceed 400 percent of the poverty line for a family of the size involved.
The reduction in cost-sharing under this subsection shall first be achieved by reducing the applicable out-of pocket 1 limit under section 18022(c)(1) of this title in the case of-
(i) an eligible insured whose household income is more than 100 percent but not more than 200 percent of the poverty line for a family of the size involved, by two-thirds;
(ii) an eligible insured whose household income is more than 200 percent but not more than 300 percent of the poverty line for a family of the size involved, by one-half; and
(iii) an eligible insured whose household income is more than 300 percent but not more than 400 percent of the poverty line for a family of the size involved, by one-third.
The Secretary shall ensure the reduction under this paragraph shall not result in an increase in the plan's share of the total allowed costs of benefits provided under the plan above-
(I) 94 percent in the case of an eligible insured described in paragraph (2)(A);
(II) 87 percent in the case of an eligible insured described in paragraph (2)(B);
(III) 73 percent in the case of an eligible insured whose household income is more than 200 percent but not more than 250 percent of the poverty line for a family of the size involved; and
(IV) 70 percent in the case of an eligible insured whose household income is more than 250 percent but not more than 400 percent of the poverty line for a family of the size involved.
The Secretary shall adjust the out-of pocket 1 limits under paragraph (1) if necessary to ensure that such limits do not cause the respective actuarial values to exceed the levels specified in clause (i).
(2) Additional reduction for lower income insureds
The Secretary shall establish procedures under which the issuer of a qualified health plan to which this section applies shall further reduce cost-sharing under the plan in a manner sufficient to-
(A) in the case of an eligible insured whose household income is not less than 100 percent but not more than 150 percent of the poverty line for a family of the size involved, increase the plan's share of the total allowed costs of benefits provided under the plan to 94 percent of such costs;
(B) in the case of an eligible insured whose household income is more than 150 percent but not more than 200 percent of the poverty line for a family of the size involved, increase the plan's share of the total allowed costs of benefits provided under the plan to 87 percent of such costs; and
(C) in the case of an eligible insured whose household income is more than 200 percent but not more than 250 percent of the poverty line for a family of the size involved, increase the plan's share of the total allowed costs of benefits provided under the plan to 73 percent of such costs.
If an individual enrolls in both a qualified health plan and a plan described in section 18031(d)(2)(B)(ii)(I) 2 of this title for any plan year, subsection (a) shall not apply to that portion of any reduction in cost-sharing under subsection (c) that (under regulations prescribed by the Secretary) is properly allocable to pediatric dental benefits which are included in the essential health benefits required to be provided by a qualified health plan under section 18022(b)(1)(J) of this title.
(1) Indians under 300 percent of poverty
If an individual enrolled in any qualified health plan in the individual market through an Exchange is an Indian (as defined in section 5304(d) of title 25) whose household income is not more than 300 percent of the poverty line for a family of the size involved, then, for purposes of this section-
(A) such individual shall be treated as an eligible insured; and
(B) the issuer of the plan shall eliminate any cost-sharing under the plan.
(2) Items or services furnished through Indian health providers
If an Indian (as so defined) enrolled in a qualified health plan is furnished an item or service directly by the Indian Health Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization or through referral under contract health services-
(A) no cost-sharing under the plan shall be imposed under the plan for such item or service; and
(B) the issuer of the plan shall not reduce the payment to any such entity for such item or service by the amount of any cost-sharing that would be due from the Indian but for subparagraph (A).
If an individual who is an eligible insured is not lawfully present-
(A) no cost-sharing reduction under this section shall apply with respect to the individual; and
(i) A method under which-
(II) the taxpayer's household income is equal to the product of the taxpayer's household income (determined without regard to this subsection) and a fraction-
( Pub. L. 111–148, title I, §1402, Mar. 23, 2010, 124 Stat. 220 ; Pub. L. 111–152, title I, §1001(b), Mar. 30, 2010, 124 Stat. 1031 .)
2010-Subsec. (c)(1)(B)(i)(I). Pub. L. 111–152, §1001(b)(1)(A), substituted "94" for "90".
Subsec. (c)(1)(B)(i)(II). Pub. L. 111–152, §1001(b)(1)(B)(i), substituted "87" for "80".
Subsec. (c)(1)(B)(i)(III), (IV). Pub. L. 111–152, §1001(b)(1)(B)(ii), (C), added subcls. (III) and (IV) and struck out former subcl. (III). Prior to amendment, subcl. (III) read as follows: "70 percent in the case of an eligible insured described in clause (ii) or (iii) of subparagraph (A)."
Subsec. (c)(2)(A). Pub. L. 111–152, §1001(b)(2)(A)(i), substituted "94" for "90".
Subsec. (c)(2)(B). Pub. L. 111–152, §1001(b)(2)(B)(i), substituted "87" for "80".
Subsec. (c)(2)(C). Pub. L. 111–152, §1001(b)(2)(A)(ii), (B)(ii), (C), added subpar. (C).
1 So in original. Probably should be "out-of-pocket".
2 So in original. Probably should be "18031(d)(3)(B)(ii)(I)".