Source: https://www.law.cornell.edu/uscode/text/42/300gg%E2%80%9318
Timestamp: 2019-06-24 23:38:07
Document Index: 696104953

Matched Legal Cases: ['§ 300', '§ 300', '§ 300', '§\u202f300', '§\u202f2718', '§\u202f1001', '§\u202f10101', '§\u202f10101']

42 U.S. Code § 300gg–18 - Bringing down the cost of health care coverage | US Law | LII / Legal Information Institute
U.S. Code › Title 42 › Chapter 6A › Subchapter XXV › Part A › Subpart ii › § 300gg–18
42 U.S. Code § 300gg–18 - Bringing down the cost of health care coverage
§ 300gg–18.
(a) Clear accounting for costsA health insurance issuer offering group or individual health insurance coverage (including a grandfathered health plan) shall, with respect to each plan year, submit to the Secretary a report concerning the ratio of the incurred loss (or incurred claims) plus the loss adjustment expense (or change in contract reserves) to earned premiums. Such report shall include the percentage of total premium revenue, after accounting for collections or receipts for risk adjustment and risk corridors and payments of reinsurance, that such coverage expends—
(A) RequirementBeginning not later than January 1, 2011, a health insurance issuer offering group or individual health insurance coverage (including a grandfathered health plan) shall, with respect to each plan year, provide an annual rebate to each enrollee under such coverage, on a pro rata basis, if the ratio of the amount of premium revenue expended by the issuer on costs described in paragraphs (1) and (2) of subsection (a) to the total amount of premium revenue (excluding Federal and State taxes and licensing or regulatory fees and after accounting for payments or receipts for risk adjustment, risk corridors, and reinsurance under sections 18061, 18062, and 18063 of this title) for the plan year (except as provided in subparagraph (B)(ii)), is less than—
(B) Rebate amount
(i) Calculation of amountThe total amount of an annual rebate required under this paragraph shall be in an amount equal to the product of—
(ii) Calculation based on average ratio
(2) Consideration in setting percentages
In determining the percentages under paragraph (1), a State shall seek to ensure adequate participation by health insurance issuers, competition in the health insurance market in the State, and value for consumers so that premiums are used for clinical services and quality improvements.
The Secretary shall promulgate regulations for enforcing the provisions of this section and may provide for appropriate penalties.
Not later than December 31, 2010, and subject to the certification of the Secretary, the National Association of Insurance Commissioners shall establish uniform definitions of the activities reported under subsection (a) and standardized methodologies for calculating measures of such activities, including definitions of which activities, and in what regard such activities, constitute activities described in subsection (a)(2). Such methodologies shall be designed to take into account the special circumstances of smaller plans, different types of plans, and newer plans.
The Secretary may adjust the rates described in subsection (b) if the Secretary determines appropriate on account of the volatility of the individual market due to the establishment of State Exchanges.
(July 1, 1944, ch. 373, title XXVII, § 2718, as added and amended Pub. L. 111–148, title I, § 1001(5), title X, § 10101(f), Mar. 23, 2010, 124 Stat. 136, 885.)
2010—Pub. L. 111–148, § 10101(f), amended section generally. Prior to amendment, the section related to clear accounting for costs, ensuring that consumers receive value for premiums, standard hospital charges, and definitions.