1.Short title and table of
contents
(a)This Act may be cited as the Health Insurance Marketplace Modernization and
Affordability Act of 2005
.
(b)The table of contents is as follows:
Sec. 1. Short title and table of contents.
TITLE I—Small business health plans
Sec. 101. Rules governing small business health
plans.
Sec. 102. Cooperation between Federal and State
authorities.
Sec. 103. Effective date and transitional and other
rules.
TITLE II—Near-term market relief
Sec. 201. Near-term market relief.
TITLE III—Harmonization of health insurance laws
Sec. 301. Health Insurance Regulatory
Harmonization.
<enum>I</enum><header>Small business
health plans</header>
<section changed="deleted" committee-id="SSHR00" id="IDC3BAA7ABDE704F5E87B17AA7732F6E74" reported-display-style="strikethrough"><enum>101.</enum><header>Rules governing
small business health plans</header>
<subsection changed="deleted" committee-id="SSHR00" id="ID3D540A27D6C5497190D5E15D7056C63B" reported-display-style="strikethrough"><enum>(a)</enum><header>In
general</header><text>Subtitle B of title I of the
<act-name parsable-cite="ERISA">Employee Retirement Income Security Act of
1974</act-name> is amended by adding after part 7 the following new
part:</text>
<quoted-block act-name="Employee Retirement Income Security Act of 1974" changed="deleted" committee-id="SSHR00" id="ID667C01FA746D4037B396461C7925E63B" reported-display-style="strikethrough">
<part changed="deleted" committee-id="SSHR00" id="IDCCE0871241AD4B2D83F6ACE3E8A5F4D4" reported-display-style="strikethrough"><enum>8</enum><header>Rules governing
small business health plans</header>
<section changed="deleted" committee-id="SSHR00" id="ID9437F8FAACD24209875A57BF4C773AD0" reported-display-style="strikethrough"><enum>801.</enum><header>Small business
health plans</header>
<subsection changed="deleted" committee-id="SSHR00" id="IDCA2F42F41DDB4C4D9BA83B2B1DF86AB2" reported-display-style="strikethrough"><enum>(a)</enum><header>In
general</header><text>For purposes of this part, the term <term>small business
health plan</term> means a fully insured group health plan whose sponsor is (or
is deemed under this part to be) described in subsection (b).</text>
</subsection><subsection changed="deleted" committee-id="SSHR00" id="ID5D85C782393C485C821D747BC1B53390" reported-display-style="strikethrough"><enum>(b)</enum><header>Sponsorship</header><text>The
sponsor of a group health plan is described in this subsection if such
sponsor—</text>
<paragraph changed="deleted" committee-id="SSHR00" id="ID938546BA7F814B6E9080B439CFBB25CE" reported-display-style="strikethrough"><enum>(1)</enum><text>is organized and
maintained in good faith, with a constitution and bylaws specifically stating
its purpose and providing for periodic meetings on at least an annual basis, as
a bona fide trade association, a bona fide industry association (including a
rural electric cooperative association or a rural telephone cooperative
association), a bona fide professional association, or a bona fide chamber of
commerce (or similar bona fide business association, including a corporation or
similar organization that operates on a cooperative basis (within the meaning
of section 1381 of the Internal Revenue Code of 1986)), for substantial
purposes other than that of obtaining or providing medical care;</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID41B3ADA98AF94F06ABE46A8DDB33C0B0" reported-display-style="strikethrough"><enum>(2)</enum><text>is established as
a permanent entity which receives the active support of its members and
requires for membership payment on a periodic basis of dues or payments
necessary to maintain eligibility for membership in the sponsor; and</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID853D2F2D2E0342C98E22CF2CB5A994BA" reported-display-style="strikethrough"><enum>(3)</enum><text>does not condition
membership, such dues or payments, or coverage under the plan on the basis of
health status-related factors with respect to the employees of its members (or
affiliated members), or the dependents of such employees, and does not
condition such dues or payments on the basis of group health plan
participation.</text>
</paragraph><continuation-text changed="deleted" committee-id="SSHR00" continuation-text-level="subsection" reported-display-style="strikethrough">Any sponsor consisting of an
association of entities which meet the requirements of paragraphs (1), (2), and
(3) shall be deemed to be a sponsor described in this subsection.</continuation-text></subsection></section><section changed="deleted" committee-id="SSHR00" id="ID7D23027FA7EC4872B8C23051E85A466D" reported-display-style="strikethrough"><enum>802.</enum><header>Certification
of small business health plans</header>
<subsection changed="deleted" committee-id="SSHR00" id="ID72CAF9D3118F4B8F87A4D54846DF7F00" reported-display-style="strikethrough"><enum>(a)</enum><header>In
general</header><text>Not later than 6 months after the date of enactment of
this part, the applicable authority shall prescribe by interim final rule a
procedure under which the applicable authority shall certify small business
health plans which apply for certification as meeting the requirements of this
part.</text>
</subsection><subsection changed="deleted" committee-id="SSHR00" id="ID5953A00229B049E790EB6C2C4E9BC5D1" reported-display-style="strikethrough"><enum>(b)</enum><header>Requirements
applicable to certified plans</header><text>a small business health plan with
respect to which certification under this part is in effect shall meet the
applicable requirements of this part, effective on the date of certification
(or, if later, on the date on which the plan is to commence operations).</text>
</subsection><subsection changed="deleted" committee-id="SSHR00" id="ID476B864211674A0FA9EF8BE8D9D807D4" reported-display-style="strikethrough"><enum>(c)</enum><header>Requirements for
continued certification</header><text>The applicable authority may provide by
regulation for continued certification of small business health plans under
this part. Such regulation shall provide for the revocation of a certification
if the applicable authority finds that the small employer health plan involved
is failing to comply with the requirements of this part.</text>
</subsection><subsection changed="deleted" committee-id="SSHR00" id="IDF7F0288C8F974621A60E30E705DC2F1B" reported-display-style="strikethrough"><enum>(d)</enum><header>Class
certification for fully insured plans</header><text>The applicable authority
shall establish a class certification procedure for small business health plans
under which all benefits consist of health insurance coverage. Under such
procedure, the applicable authority shall provide for the granting of
certification under this part to the plans in each class of such small business
health plans upon appropriate filing under such procedure in connection with
plans in such class and payment of the prescribed fee under section
806(a).</text>
</subsection></section><section changed="deleted" committee-id="SSHR00" id="IDEF097364FAC644A5BC209200F2C8FD51" reported-display-style="strikethrough"><enum>803.</enum><header>Requirements
relating to sponsors and boards of trustees</header>
<subsection changed="deleted" committee-id="SSHR00" id="ID4FEC6C034C984FF394355C3A358F34CB" reported-display-style="strikethrough"><enum>(a)</enum><header>Sponsor</header><text>The
requirements of this subsection are met with respect to a small business health
plan if the sponsor has met (or is deemed under this part to have met) the
requirements of section 801(b) for a continuous period of not less than 3 years
ending with the date of the application for certification under this
part.</text>
</subsection><subsection changed="deleted" committee-id="SSHR00" id="ID62C08F3C0E874ACBA255DD23EB78BD27" reported-display-style="strikethrough"><enum>(b)</enum><header>Board of
trustees</header><text>The requirements of this subsection are met with respect
to a small business health plan if the following requirements are met:</text>
<paragraph changed="deleted" committee-id="SSHR00" id="IDDDFFF20BF3CF48ECAF5F69FC022B7038" reported-display-style="strikethrough"><enum>(1)</enum><header>Fiscal
control</header><text>The plan is operated, pursuant to a plan document, by a
board of trustees which pursuant to a trust agreement has complete fiscal
control over the plan and which is responsible for all operations of the
plan.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDE960A2BD26114D2EA9AA1BDFCC8549CD" reported-display-style="strikethrough"><enum>(2)</enum><header>Rules of
operation and financial controls</header><text>The board of trustees has in
effect rules of operation and financial controls, based on a 3-year plan of
operation, adequate to carry out the terms of the plan and to meet all
requirements of this title applicable to the plan.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID72936FAC5E554B08B6D67CC5FF6B7F7F" reported-display-style="strikethrough"><enum>(3)</enum><header>Rules governing
relationship to participating employers and to contractors</header>
<subparagraph changed="deleted" committee-id="SSHR00" id="ID3F1C066FDAD344A6BCEEA32150454716" reported-display-style="strikethrough"><enum>(A)</enum><header>Board
membership</header>
<clause changed="deleted" committee-id="SSHR00" id="ID62A3D4B54F0C465BBB12376C5D8FEA68" reported-display-style="strikethrough"><enum>(i)</enum><header>In
general</header><text>Except as provided in clauses (ii) and (iii), the members
of the board of trustees are individuals selected from individuals who are the
owners, officers, directors, or employees of the participating employers or who
are partners in the participating employers and actively participate in the
business.</text>
</clause><clause changed="deleted" commented="no" committee-id="SSHR00" id="ID28E59340248040539D38CD38EF5A0264" reported-display-style="strikethrough"><enum>(ii)</enum><header>Limitation</header>
<subclause changed="deleted" commented="no" committee-id="SSHR00" id="ID4928772F06354C08B850438E517F47FA" reported-display-style="strikethrough"><enum>(I)</enum><header>General
rule</header><text>Except as provided in subclauses (II) and (III), no such
member is an owner, officer, director, or employee of, or partner in, a
contract administrator or other service provider to the plan.</text>
</subclause><subclause changed="deleted" commented="no" committee-id="SSHR00" id="IDF2C4B0DE3DD24C96B2F98FC67E51A3C1" reported-display-style="strikethrough"><enum>(II)</enum><header>Limited
exception for providers of services solely on behalf of the
sponsor</header><text>Officers or employees of a sponsor which is a service
provider (other than a contract administrator) to the plan may be members of
the board if they constitute not more than 25 percent of the membership of the
board and they do not provide services to the plan other than on behalf of the
sponsor.</text>
</subclause><subclause changed="deleted" commented="no" committee-id="SSHR00" id="ID679DBE25E5FE4850853A5D6FBB5F7538" reported-display-style="strikethrough"><enum>(III)</enum><header>Treatment of
providers of medical care</header><text>In the case of a sponsor which is an
association whose membership consists primarily of providers of medical care,
subclause (I) shall not apply in the case of any service provider described in
subclause (I) who is a provider of medical care under the plan.</text>
</subclause></clause><clause changed="deleted" commented="no" committee-id="SSHR00" id="ID3D5508CF36B442428DB96A052F5EEC74" reported-display-style="strikethrough"><enum>(iii)</enum><header>Certain plans
excluded</header><text>Clause (i) shall not apply to a small business health
plan which is in existence on the date of the enactment of the
<short-title>Health Insurance Marketplace Modernization
and Affordability Act of 2005</short-title>.</text>
</clause></subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="IDBB5C3D5687914D19BFF65AC2BFA0C98E" reported-display-style="strikethrough"><enum>(B)</enum><header>Sole
authority</header><text>The board has sole authority under the plan to approve
applications for participation in the plan and to contract with insurers and
service providers.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SSHR00" id="ID307D4AF3F2D14812925CDEBF77592A1E" reported-display-style="strikethrough"><enum>(c)</enum><header>Treatment of
franchise networks</header><text>In the case of a group health plan which is
established and maintained by a franchiser for a franchise network consisting
of its franchisees—</text>
<paragraph changed="deleted" committee-id="SSHR00" id="ID1DEC1AC477D74E5BA3186FF001F4E3D3" reported-display-style="strikethrough"><enum>(1)</enum><text>the requirements
of subsection (a) and section 801(a) shall be deemed met if such requirements
would otherwise be met if the franchiser were deemed to be the sponsor referred
to in section 801(b), such network were deemed to be an association described
in section 801(b), and each franchisee were deemed to be a member (of the
association and the sponsor) referred to in section 801(b); and</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDE0C7136EA0BF490C8A89829BE0D70CA2" reported-display-style="strikethrough"><enum>(2)</enum><text>the requirements
of section 804(a)(1) shall be deemed met.</text>
</paragraph><continuation-text changed="deleted" committee-id="SSHR00" continuation-text-level="subsection" reported-display-style="strikethrough">The Secretary may by regulation
define for purposes of this subsection the terms <quote>franchiser</quote>,
<quote>franchise network</quote>, and <quote>franchisee</quote>.</continuation-text></subsection></section><section changed="deleted" committee-id="SSHR00" id="IDD179266A83AC43549CA1004EB035490A" reported-display-style="strikethrough"><enum>804.</enum><header>Participation
and coverage requirements</header>
<subsection changed="deleted" committee-id="SSHR00" id="IDD568E57281E94B178F3EEA1C9C559AD8" reported-display-style="strikethrough"><enum>(a)</enum><header>Covered
employers and individuals</header><text>The requirements of this subsection are
met with respect to a small business health plan if, under the terms of the
plan—</text>
<paragraph changed="deleted" committee-id="SSHR00" id="ID17AA46D9DEFD4DF882D0C6B21B3DE84B" reported-display-style="strikethrough"><enum>(1)</enum><text>each participating
employer must be—</text>
<subparagraph changed="deleted" committee-id="SSHR00" id="ID53DF185BA1F84CE49AEB7DB8A85C47FB" reported-display-style="strikethrough"><enum>(A)</enum><text>a member of the
sponsor;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="ID014398C15B65462AA5D8AE0D2E9B95AF" reported-display-style="strikethrough"><enum>(B)</enum><text>the sponsor;
or</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="ID18ACA334A9534C14BF2A60084983C29F" reported-display-style="strikethrough"><enum>(C)</enum><text>an affiliated
member of the sponsor with respect to which the requirements of subsection (b)
are met, except that, in the case of a sponsor which is a professional
association or other individual-based association, if at least one of the
officers, directors, or employees of an employer, or at least one of the
individuals who are partners in an employer and who actively participates in
the business, is a member or such an affiliated member of the sponsor,
participating employers may also include such employer; and</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID4DFFCFD05C2243998AC8A8C4F6331BD3" reported-display-style="strikethrough"><enum>(2)</enum><text>all individuals
commencing coverage under the plan after certification under this part must
be—</text>
<subparagraph changed="deleted" committee-id="SSHR00" id="IDA969572145CE4BB8A2F80EB518FDA39C" reported-display-style="strikethrough"><enum>(A)</enum><text>active or retired
owners (including self-employed individuals), officers, directors, or employees
of, or partners in, participating employers; or</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="IDA602591A25144F57A0134FCA66553282" reported-display-style="strikethrough"><enum>(B)</enum><text>the beneficiaries
of individuals described in subparagraph (A).</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SSHR00" id="ID2E0295C2A18846B9A8A87389F134804D" reported-display-style="strikethrough"><enum>(b)</enum><header>Coverage of
previously uninsured employees</header><text>In the case of a small business
health plan in existence on the date of the enactment of the
<short-title>Health Insurance Marketplace Modernization
and Affordability Act of 2005</short-title>, an affiliated member of the
sponsor of the plan may be offered coverage under the plan as a participating
employer only if—</text>
<paragraph changed="deleted" committee-id="SSHR00" id="ID1F28DC8B90A045F9AB7F719AF4EE9925" reported-display-style="strikethrough"><enum>(1)</enum><text>the affiliated
member was an affiliated member on the date of certification under this part;
or</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID941D3B57B5394A82ACC228A49FB47B46" reported-display-style="strikethrough"><enum>(2)</enum><text>during the
12-month period preceding the date of the offering of such coverage, the
affiliated member has not maintained or contributed to a group health plan with
respect to any of its employees who would otherwise be eligible to participate
in such small business health plan.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SSHR00" id="IDE016A054C8714D5EBA9C608BC08E3D85" reported-display-style="strikethrough"><enum>(c)</enum><header>Individual
market unaffected</header><text>The requirements of this subsection are met
with respect to a small business health plan if, under the terms of the plan,
no participating employer may provide health insurance coverage in the
individual market for any employee not covered under the plan which is similar
to the coverage contemporaneously provided to employees of the employer under
the plan, if such exclusion of the employee from coverage under the plan is
based on a health status-related factor with respect to the employee and such
employee would, but for such exclusion on such basis, be eligible for coverage
under the plan.</text>
</subsection><subsection changed="deleted" committee-id="SSHR00" id="ID44DB19B5E3834582856F23409FC79FA9" reported-display-style="strikethrough"><enum>(d)</enum><header>Prohibition of
discrimination against employers and employees eligible to
participate</header><text>The requirements of this subsection are met with
respect to a small business health plan if—</text>
<paragraph changed="deleted" committee-id="SSHR00" id="IDB8F46634428749FC952504F4E24A068B" reported-display-style="strikethrough"><enum>(1)</enum><text>under the terms of
the plan, all employers meeting the preceding requirements of this section are
eligible to qualify as participating employers for all geographically available
coverage options, unless, in the case of any such employer, participation or
contribution requirements of the type referred to in section 2711 of the
<act-name parsable-cite="PHSA">Public Health Service Act</act-name> are not
met;</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID1966AA2394D34FF580EC1A4E8CCFD54A" reported-display-style="strikethrough"><enum>(2)</enum><text>upon request, any
employer eligible to participate is furnished information regarding all
coverage options available under the plan; and</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDE217FA9D68B64E87BFD54B0ED04211A1" reported-display-style="strikethrough"><enum>(3)</enum><text>the applicable
requirements of sections 701, 702, and 703 are met with respect to the
plan.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SSHR00" id="ID6F3FFBD0EFDA41CD89ABEB41A7452645" reported-display-style="strikethrough"><enum>805.</enum><header>Other
requirements relating to plan documents, contribution rates, and benefit
options</header>
<subsection changed="deleted" committee-id="SSHR00" id="IDB5A36F92073C47C68EC44502FA695570" reported-display-style="strikethrough"><enum>(a)</enum><header>In
general</header><text>The requirements of this section are met with respect to
a small business health plan if the following requirements are met:</text>
<paragraph changed="deleted" committee-id="SSHR00" id="IDA3CF16C594F84D9F8083C7B427B6AF70" reported-display-style="strikethrough"><enum>(1)</enum><header>Contents of
governing instruments</header>
<subparagraph changed="deleted" committee-id="SSHR00" id="id57BAA461B7DD42E08D86FA6B00A19534" reported-display-style="strikethrough"><enum>(A)</enum><header>In
general</header><text>The instruments governing the plan include a written
instrument, meeting the requirements of an instrument required under section
402(a)(1), which—</text>
<clause changed="deleted" committee-id="SSHR00" id="ID16D82F1734D44787A6FE5D887A6ACD3C" reported-display-style="strikethrough"><enum>(i)</enum><text>provides that the
board of directors serves as the named fiduciary required for plans under
section 402(a)(1) and serves in the capacity of a plan administrator (referred
to in section 3(16)(A)); and</text>
</clause><clause changed="deleted" committee-id="SSHR00" id="IDB9DCB21E9549435DBCCD87A606459152" reported-display-style="strikethrough"><enum>(ii)</enum><text>provides that the
sponsor of the plan is to serve as plan sponsor (referred to in section
3(16)(B)).</text>
</clause></subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="idC9CAB86DF0874E2BB308D99D3B727B05" reported-display-style="strikethrough"><enum>(B)</enum><header>Description of
material provisions</header><text>The terms of the health insurance coverage
(including the terms of any individual certificates that may be offered to
individuals in connection with such coverage) describe the material benefit and
rating, and other provisions set forth in this section and such material
provisions are included in the summary plan description.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDBC0AEAE6C275489BACE818DB163E6452" reported-display-style="strikethrough"><enum>(2)</enum><header>Contribution
rates must be nondiscriminatory</header>
<subparagraph changed="deleted" committee-id="SSHR00" id="ID799CD91B86F64C99B2C41D049848473A" reported-display-style="strikethrough"><enum>(A)</enum><header>In
general</header><text>The contribution rates for any participating small
employer shall not vary on the basis of any health status-related factor in
relation to employees of such employer or their beneficiaries and shall not
vary on the basis of the type of business or industry in which such employer is
engaged.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="ID8CD9839E883248CCAC9468A29905C7E5" reported-display-style="strikethrough"><enum>(B)</enum><header>Effect of
title</header><text>Nothing in this title or any other provision of law shall
be construed to preclude a health insurance issuer offering health insurance
coverage in connection with a small business health plan, and at the request of
such small business health plan, from—</text>
<clause changed="deleted" committee-id="SSHR00" id="ID0DC5E34A30114AE4BF2B602FC5063EA1" reported-display-style="strikethrough"><enum>(i)</enum><text>setting
contribution rates for the small business health plan based on the claims
experience of the plan so long as any variation in such rates complies with the
requirements of clause (ii); or</text>
</clause><clause changed="deleted" committee-id="SSHR00" id="IDE42747E5AC8B4855987BF792FB3B675C" reported-display-style="strikethrough"><enum>(ii)</enum><text>varying
contribution rates for participating employers in a small business health plan
in a State to the extent that such rates could vary using the same methodology
employed in such State for regulating premium rates, subject to the terms of
part I of subtitle A of title XXIX of the Public Health Service Act (relating
to rating requirements), as added by title II of the
<short-title>Health Insurance Marketplace Modernization
and Affordability Act of 2005</short-title>.</text>
</clause></subparagraph></paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID2C368B13AD1548099D7C75E89A8CC7EE" reported-display-style="strikethrough"><enum>(3)</enum><header>Regulatory
requirements</header><text>Such other requirements as the applicable authority
determines are necessary to carry out the purposes of this part, which shall be
prescribed by the applicable authority by regulation.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SSHR00" id="IDE34F0CC698F04DECBE05F74BAB7E201E" reported-display-style="strikethrough"><enum>(b)</enum><header>Ability of small
business health plans to design benefit options</header><text>Nothing in this
part or any provision of State law (as defined in section 514(c)(1)) shall be
construed to preclude a small business health plan or a health insurance issuer
offering health insurance coverage in connection with a small business health
plan, from exercising its sole discretion in selecting the specific benefits
and services consisting of medical care to be included as benefits under such
plan or coverage, except that such benefits and services must meet the terms
and specifications of part II of subtitle A of title XXIX of the Public Health
Service Act (relating to lower cost plans), as added by title II of the
<short-title>Health Insurance Marketplace Modernization
and Affordability Act of 2005</short-title>, provided that, upon issuance by
the Secretary of Health and Human Services of the List of Required Benefits as
provided for in section 2922(a) of the Public Health Service Act, the required
scope and application for each benefit or service listed in the List of
Required Benefits shall be—</text>
<paragraph changed="deleted" committee-id="SSHR00" id="IDb142d14997ae45cd8cf627968a7c31dc" reported-display-style="strikethrough"><enum>(1)</enum><text>if the domicile
State mandates such benefit or service, the scope and application required by
the domicile State; or</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDefbbb1c963df4feba5308432e34e4631" reported-display-style="strikethrough"><enum>(2)</enum><text>if the domicile
State does not mandate such benefit or service, the scope and application
required by the non-domicile State that does require such benefit or service in
which the greatest number of the small business health plan’s participating
employers are located.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SSHR00" id="id39C88C60837843A8BF72432E8F7279B2" reported-display-style="strikethrough"><enum>(c)</enum><header>State licensure
and informational filing</header>
<paragraph changed="deleted" committee-id="SSHR00" id="id341C6753A2D64BDEA7AEAB37B40F0420" reported-display-style="strikethrough"><enum>(1)</enum><header>Domicile
state</header><text>Coverage shall be issued to a small business health plan in
the State in which the sponsor's principal place of business is located.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="id68AFAF0486F24317BD5792AAE3AB3B01" reported-display-style="strikethrough"><enum>(2)</enum><header>Non-domicile
states</header><text>With respect to a State (other than the domicile State) in
which participating employers of a small business health plan are located, an
insurer issuing coverage to such small business health plan shall not be
required to obtain full licensure in such State, except that the insurer shall
provide each State insurance commissioner (or applicable State authority) with
an informational filing describing policies sold and other relevant information
as may be requested by the applicable State authority.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SSHR00" id="IDE9DFF143F75A4EBE94F1DCF10BF13424" reported-display-style="strikethrough"><enum>806.</enum><header>Requirements
for application and related requirements</header>
<subsection changed="deleted" committee-id="SSHR00" id="ID9ED049C6D01D40769D172C06D6B49E70" reported-display-style="strikethrough"><enum>(a)</enum><header>Filing
fee</header><text>Under the procedure prescribed pursuant to section 802(a), a
small business health plan shall pay to the applicable authority at the time of
filing an application for certification under this part a filing fee in the
amount of $5,000, which shall be available in the case of the Secretary, to the
extent provided in appropriation Acts, for the sole purpose of administering
the certification procedures applicable with respect to small business health
plans.</text>
</subsection><subsection changed="deleted" committee-id="SSHR00" id="ID6D5A7B5EAE584E55BF4E774258C8AF6D" reported-display-style="strikethrough"><enum>(b)</enum><header>Information to
be included in application for certification</header><text>An application for
certification under this part meets the requirements of this section only if it
includes, in a manner and form which shall be prescribed by the applicable
authority by regulation, at least the following information:</text>
<paragraph changed="deleted" committee-id="SSHR00" id="ID8EFF544CCE2542C4A371C59C22BA1CCF" reported-display-style="strikethrough"><enum>(1)</enum><header>Identifying
information</header><text>The names and addresses of—</text>
<subparagraph changed="deleted" committee-id="SSHR00" id="ID44CC0DBCB2734F3DBD9A72E46BF90079" reported-display-style="strikethrough"><enum>(A)</enum><text>the sponsor;
and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="ID947D8418D419477AAA219BFB1DF700EC" reported-display-style="strikethrough"><enum>(B)</enum><text>the members of the
board of trustees of the plan.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID1B7EB5B5370E4D36A26E51A13206935A" reported-display-style="strikethrough"><enum>(2)</enum><header>States in which
plan intends to do business</header><text>The States in which participants and
beneficiaries under the plan are to be located and the number of them expected
to be located in each such State.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDE599E73B382E4426BCE43248779CDD91" reported-display-style="strikethrough"><enum>(3)</enum><header>Bonding
requirements</header><text>Evidence provided by the board of trustees that the
bonding requirements of section 412 will be met as of the date of the
application or (if later) commencement of operations.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID96C645B23B194B73AAC38E9300A305BF" reported-display-style="strikethrough"><enum>(4)</enum><header>Plan
documents</header><text>A copy of the documents governing the plan (including
any bylaws and trust agreements), the summary plan description, and other
material describing the benefits that will be provided to participants and
beneficiaries under the plan.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID8118501FFD414D709E8B2EEADA9C671F" reported-display-style="strikethrough"><enum>(5)</enum><header>Agreements with
service providers</header><text>A copy of any agreements between the plan,
health insurance issuer, and contract administrators and other service
providers.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SSHR00" id="ID58D3C63557C048F7B97DAF05DD04141F" reported-display-style="strikethrough"><enum>(c)</enum><header>Filing notice of
certification with States</header><text>A certification granted under this part
to a small business health plan shall not be effective unless written notice of
such certification is filed with the applicable State authority of each State
in which at least 25 percent of the participants and beneficiaries under the
plan are located. For purposes of this subsection, an individual shall be
considered to be located in the State in which a known address of such
individual is located or in which such individual is employed.</text>
</subsection><subsection changed="deleted" committee-id="SSHR00" id="ID870959A989F24F06A8A81C537F3CA674" reported-display-style="strikethrough"><enum>(d)</enum><header>Notice of
material changes</header><text>In the case of any small business health plan
certified under this part, descriptions of material changes in any information
which was required to be submitted with the application for the certification
under this part shall be filed in such form and manner as shall be prescribed
by the applicable authority by regulation. The applicable authority may require
by regulation prior notice of material changes with respect to specified
matters which might serve as the basis for suspension or revocation of the
certification.</text>
</subsection></section><section changed="deleted" commented="no" committee-id="SSHR00" id="ID283511EA75524C769BEC0ECCCCDF35E4" reported-display-style="strikethrough"><enum>807.</enum><header>Notice
requirements for voluntary termination</header><text display-inline="no-display-inline">A small business health plan which is or has
been certified under this part may terminate (upon or at any time after
cessation of accruals in benefit liabilities) only if the board of trustees,
not less than 60 days before the proposed termination date—</text>
<paragraph changed="deleted" commented="no" committee-id="SSHR00" id="ID5B8D7C3B9C3F4DA0B7552D1FE60A0D5B" reported-display-style="strikethrough"><enum>(1)</enum><text>provides to the
participants and beneficiaries a written notice of intent to terminate stating
that such termination is intended and the proposed termination date;</text>
</paragraph><paragraph changed="deleted" commented="no" committee-id="SSHR00" id="ID9B6B4C34ECBC4C1D99B47F6EB9148013" reported-display-style="strikethrough"><enum>(2)</enum><text>develops a plan
for winding up the affairs of the plan in connection with such termination in a
manner which will result in timely payment of all benefits for which the plan
is obligated; and</text>
</paragraph><paragraph changed="deleted" commented="no" committee-id="SSHR00" id="ID40D63051A1D64004B763187E62F9A946" reported-display-style="strikethrough"><enum>(3)</enum><text>submits such plan
in writing to the applicable authority.</text>
</paragraph><continuation-text changed="deleted" commented="no" committee-id="SSHR00" continuation-text-level="section" reported-display-style="strikethrough">Actions required under this
section shall be taken in such form and manner as may be prescribed by the
applicable authority by regulation.</continuation-text></section><section changed="deleted" committee-id="SSHR00" id="ID5772AD863399454399B25B25E521BFB5" reported-display-style="strikethrough"><enum>808.</enum><header>Definitions and
rules of construction</header>
<subsection changed="deleted" committee-id="SSHR00" id="ID885A0D2B3D0D488F9FCBE6CF5DEF2641" reported-display-style="strikethrough"><enum>(a)</enum><header>Definitions</header><text>For
purposes of this part—</text>
<paragraph changed="deleted" committee-id="SSHR00" id="ID3BB67D17F3824D3BAA524CAB9FC11BC0" reported-display-style="strikethrough"><enum>(1)</enum><header>Affiliated
member</header><text>The term <term>affiliated member</term> means, in
connection with a sponsor—</text>
<subparagraph changed="deleted" committee-id="SSHR00" id="IDACD54D76F750434AAA5E5077AE9657CD" reported-display-style="strikethrough"><enum>(A)</enum><text>a person who is
otherwise eligible to be a member of the sponsor but who elects an affiliated
status with the sponsor,</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="IDEE846C4550224AD68056602F256EFFEB" reported-display-style="strikethrough"><enum>(B)</enum><text>in the case of a
sponsor with members which consist of associations, a person who is a member of
any such association and elects an affiliated status with the sponsor,
or</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="ID8EF45E946D9241B9A7CBF030FB6EDF28" reported-display-style="strikethrough"><enum>(C)</enum><text>in the case of a
small business health plan in existence on the date of the enactment of the
<short-title>Health Insurance Marketplace Modernization
and Affordability Act of 2005</short-title>, a person eligible to be a member
of the sponsor or one of its member associations.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SSHR00" id="id2173D8D3AEDF40FC8D2EADB32087FF63" reported-display-style="strikethrough"><enum>(2)</enum><header>Applicable
authority</header><text>The term <term>applicable authority</term> means the
Secretary, except that, in connection with any exercise of the Secretary's
authority with respect to which the Secretary is required under section 506(d)
to consult with a State, such term means the Secretary, in consultation with
such State.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDD7BCEA90CB0041A1B50DB18E50DE8891" reported-display-style="strikethrough"><enum>(3)</enum><header>Applicable State
authority</header><text>The term <term>applicable State authority</term> means,
with respect to a health insurance issuer in a State, the State insurance
commissioner or official or officials designated by the State to enforce the
requirements of title XXVII of the <act-name parsable-cite="PHSA">Public Health
Service Act</act-name> for the State involved with respect to such
issuer.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID0F9798D9876640219F7198F71C831B3C" reported-display-style="strikethrough"><enum>(4)</enum><header>Group health
plan</header><text>The term <term>group health plan</term> has the meaning
provided in section 733(a)(1) (after applying subsection (b) of this
section).</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDE69E53F7D509459CA04C75D2D8E0590F" reported-display-style="strikethrough"><enum>(5)</enum><header>Health insurance
coverage</header><text>The term <term>health insurance coverage</term> has the
meaning provided in section 733(b)(1).</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID92F7C40FB24C49CEAB400CB062860C2A" reported-display-style="strikethrough"><enum>(6)</enum><header>Health insurance
issuer</header><text>The term <term>health insurance issuer</term> has the
meaning provided in section 733(b)(2).</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID5EF096793B264668AB45DAC0CFD75B21" reported-display-style="strikethrough"><enum>(7)</enum><header>Individual
market</header>
<subparagraph changed="deleted" committee-id="SSHR00" id="ID2B396EA753364D4DBCDF938C60EF7F2A" reported-display-style="strikethrough"><enum>(A)</enum><header>In
general</header><text>The term <term>individual market</term> means the market
for health insurance coverage offered to individuals other than in connection
with a group health plan.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="IDB9E6704758794DF998C9CBF2F55BDC20" reported-display-style="strikethrough"><enum>(B)</enum><header>Treatment of
very small groups</header>
<clause changed="deleted" committee-id="SSHR00" id="IDA9AAC49077C7488E9D6248BC54E7E2AC" reported-display-style="strikethrough"><enum>(i)</enum><header>In
general</header><text>Subject to clause (ii), such term includes coverage
offered in connection with a group health plan that has fewer than 2
participants as current employees or participants described in section
732(d)(3) on the first day of the plan year.</text>
</clause><clause changed="deleted" committee-id="SSHR00" id="ID956A1A31CE0647C1AA1CA68D1ADC5EB6" reported-display-style="strikethrough"><enum>(ii)</enum><header>State
exception</header><text>Clause (i) shall not apply in the case of health
insurance coverage offered in a State if such State regulates the coverage
described in such clause in the same manner and to the same extent as coverage
in the small group market (as defined in section 2791(e)(5) of the
<act-name parsable-cite="PHSA">Public Health Service Act</act-name>) is
regulated by such State.</text>
</clause></subparagraph></paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDBCA750E49EE84471AE6EEFA2D8BA08AA" reported-display-style="strikethrough"><enum>(8)</enum><header>Medical
care</header><text>The term <term>medical care</term> has the meaning provided
in section 733(a)(2).</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDB90281BEBF724984A4445383F85BF508" reported-display-style="strikethrough"><enum>(9)</enum><header>Participating
employer</header><text>The term <term>participating employer</term> means, in
connection with a small business health plan, any employer, if any individual
who is an employee of such employer, a partner in such employer, or a
self-employed individual who is such employer (or any dependent, as defined
under the terms of the plan, of such individual) is or was covered under such
plan in connection with the status of such individual as such an employee,
partner, or self-employed individual in relation to the plan.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID45F2D9B907A6492D857D9C1E0F0F969A" reported-display-style="strikethrough"><enum>(10)</enum><header>Small
employer</header><text>The term <term>small employer</term> means, in
connection with a group health plan with respect to a plan year, a small
employer as defined in section 2791(e)(4).</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SSHR00" id="ID7B6578BAE1094DA79450A72CD889C0E1" reported-display-style="strikethrough"><enum>(b)</enum><header>Rule of
construction</header><text>For purposes of determining whether a plan, fund, or
program is an employee welfare benefit plan which is a small business health
plan, and for purposes of applying this title in connection with such plan,
fund, or program so determined to be such an employee welfare benefit
plan—</text>
<paragraph changed="deleted" committee-id="SSHR00" id="ID0f1348f4110d4e7984aae4efb3382b5e" reported-display-style="strikethrough"><enum>(1)</enum><text>in the case of a
partnership, the term <term>employer</term> (as defined in section 3(5))
includes the partnership in relation to the partners, and the term
<term>employee</term> (as defined in section 3(6)) includes any partner in
relation to the partnership; and</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID2c1205da77864701a847cd767cee1818" reported-display-style="strikethrough"><enum>(2)</enum><text>in the case of a
self-employed individual, the term <term>employer</term> (as defined in section
3(5)) and the term <term>employee</term> (as defined in section 3(6)) shall
include such
individual.</text>
</paragraph></subsection></section></part><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection changed="deleted" commented="no" committee-id="SSHR00" id="ID1094A5B5ED4C4634AD340CBA0ED1CC15" reported-display-style="strikethrough"><enum>(b)</enum><header>Conforming
amendments to preemption rules</header>
<paragraph changed="deleted" commented="no" committee-id="SSHR00" id="IDF7E98E1A94884E05907576E856B8DC30" reported-display-style="strikethrough"><enum>(1)</enum><text>Section 514(b)(6)
of such Act (<external-xref legal-doc="usc" parsable-cite="usc/29/1144(b)(6)">29 U.S.C. 1144(b)(6)</external-xref>) is
amended by adding at the end the following new subparagraph:</text>
<quoted-block changed="deleted" committee-id="SSHR00" id="ID40AC1975CAD3437CAA0907B39EFD7A0D" reported-display-style="strikethrough">
<subparagraph changed="deleted" commented="no" committee-id="SSHR00" id="ID8F41C6B6ECE144F1837578352F46D42B" indent="up2" reported-display-style="strikethrough"><enum>(E)</enum><text>The preceding
subparagraphs of this paragraph do not apply with respect to any State law in
the case of a small business health plan which is certified under part
8.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph changed="deleted" commented="no" committee-id="SSHR00" id="ID1FDE42A56E0F4C39B248DCEC3342EABA" reported-display-style="strikethrough"><enum>(2)</enum><text>Section 514 of
such Act (<external-xref legal-doc="usc" parsable-cite="usc/29/1144">29 U.S.C.
1144</external-xref>) is amended—</text>
<subparagraph changed="deleted" commented="no" committee-id="SSHR00" id="ID0893113A7A2549B5A46414EC55A237E4" reported-display-style="strikethrough"><enum>(A)</enum><text>in subsection
(b)(4), by striking <quote>Subsection (a)</quote> and inserting
<quote>Subsections (a) and (d)</quote>;</text>
</subparagraph><subparagraph changed="deleted" commented="no" committee-id="SSHR00" id="IDC4FD93BE8BDB45E182F1A8A8B473AA68" reported-display-style="strikethrough"><enum>(B)</enum><text>in subsection
(b)(5), by striking <quote>subsection (a)</quote> in subparagraph (A) and
inserting <quote>subsection (a) of this section and subsections (a)(2)(B) and
(b) of section 805</quote>, and by striking <quote>subsection (a)</quote> in
subparagraph (B) and inserting <quote>subsection (a) of this section or
subsection (a)(2)(B) or (b) of section 805</quote>;</text>
</subparagraph><subparagraph changed="deleted" commented="no" committee-id="SSHR00" id="IDCE50B07515D84D639D11B4E180267A32" reported-display-style="strikethrough"><enum>(C)</enum><text>by redesignating
subsection (d) as subsection (e); and</text>
</subparagraph><subparagraph changed="deleted" commented="no" committee-id="SSHR00" id="ID774B0175C4C84DA096E7FDFB8BBF3993" reported-display-style="strikethrough"><enum>(D)</enum><text>by inserting after
subsection (c) the following new subsection:</text>
<quoted-block changed="deleted" committee-id="SSHR00" id="ID3F595AEBD0364021A4FF8A58C94A445F" reported-display-style="strikethrough">
<subsection changed="deleted" commented="no" committee-id="SSHR00" id="IDC58ACF37630140E9A6E95E92D725D099" reported-display-style="strikethrough"><enum>(d)</enum><paragraph commented="no" display-inline="yes-display-inline" id="IDA8CB16A9CB834C2C829E2D05328891AA"><enum>(1)</enum><text>Except as provided in
subsection (b)(4), the provisions of this title shall supersede any and all
State laws insofar as they may now or hereafter preclude a health insurance
issuer from offering health insurance coverage in connection with a small
business health plan which is certified under part 8.</text>
</paragraph><paragraph changed="deleted" commented="no" committee-id="SSHR00" id="IDD60070E3EBE34F8B9A480765B5B2EE08" indent="up1" reported-display-style="strikethrough"><enum>(2)</enum><text>In any case in
which health insurance coverage of any policy type is offered under a small
business health plan certified under part 8 to a participating employer
operating in such State, the provisions of this title shall supersede any and
all laws of such State insofar as they may establish rating and benefit
requirements that would otherwise apply to such coverage, provided the
requirements of section 805(a)(2)(B) and (b) (concerning small business health
plan rating and benefits) are
met.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph changed="deleted" commented="no" committee-id="SSHR00" id="ID40CC464BD4CE4B2489288D51BBB14DD7" reported-display-style="strikethrough"><enum>(3)</enum><text>Section
514(b)(6)(A) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/29/1144(b)(6)(A)">29 U.S.C. 1144(b)(6)(A)</external-xref>)
is amended—</text>
<subparagraph changed="deleted" commented="no" committee-id="SSHR00" id="ID9D805EB960D648C4BCD3E76D394B47C9" reported-display-style="strikethrough"><enum>(A)</enum><text>in clause (i)(II),
by striking <quote>and</quote> at the end;</text>
</subparagraph><subparagraph changed="deleted" commented="no" committee-id="SSHR00" id="ID3156697583D64BB693FF13F2E0911795" reported-display-style="strikethrough"><enum>(B)</enum><text>in clause (ii), by
inserting <quote>and which does not provide medical care (within the meaning of
section 733(a)(2)),</quote> after <quote>arrangement,</quote>, and by striking
<quote>title.</quote> and inserting <quote>title, and</quote>; and</text>
</subparagraph><subparagraph changed="deleted" commented="no" committee-id="SSHR00" id="ID7CF2070E1FBB48BE909916B534BBDB36" reported-display-style="strikethrough"><enum>(C)</enum><text>by adding at the
end the following new clause:</text>
<quoted-block changed="deleted" committee-id="SSHR00" id="IDE88F00553D6E478DA3AA223A637A9C4E" reported-display-style="strikethrough">
<clause changed="deleted" commented="no" committee-id="SSHR00" id="ID9C5DF078BC494C90A65BB7304BEB5526" indent="up2" reported-display-style="strikethrough"><enum>(iii)</enum><text>subject to
subparagraph (E), in the case of any other employee welfare benefit plan which
is a multiple employer welfare arrangement and which provides medical care
(within the meaning of section 733(a)(2)), any law of any State which regulates
insurance may
apply.</text>
</clause><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph changed="deleted" commented="no" committee-id="SSHR00" id="IDB3A8DACC34ED4259BF1B737DDF918531" reported-display-style="strikethrough"><enum>(4)</enum><text>Section 514(e) of
such Act (as redesignated by paragraph (2)(C)) is amended by striking
<quote>Nothing</quote> and inserting <quote>(1) Except as provided in paragraph
(2), nothing</quote>.</text>
</paragraph></subsection><subsection changed="deleted" commented="no" committee-id="SSHR00" id="ID44BBA82AB8484ED9AF6BAAE0946FC68E" reported-display-style="strikethrough"><enum>(c)</enum><header>Plan
sponsor</header><text>Section 3(16)(B) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/29/102(16)(B)">29 U.S.C.
102(16)(B)</external-xref>) is amended by adding at the end the following new
sentence: <quote>Such term also includes a person serving as the sponsor of a
small business health plan under part 8.</quote>.</text>
</subsection><subsection changed="deleted" commented="no" committee-id="SSHR00" id="ID8C607D036ACF4986B55CA7B3E122EDE4" reported-display-style="strikethrough"><enum>(d)</enum><header>Savings
clause</header><text>Section 731(c) of such Act is amended by inserting
<quote>or part 8</quote> after <quote>this part</quote>.</text>
</subsection><subsection changed="deleted" committee-id="SSHR00" id="IDC4D7320BD42F4058B56E99B4A713053B" reported-display-style="strikethrough"><enum>(e)</enum><header>Clerical
amendment</header><text>The table of contents in
<external-xref legal-doc="act" parsable-cite="ERISA/1">section
1</external-xref> of the <act-name parsable-cite="ERISA">Employee Retirement
Income Security Act of 1974</act-name> is amended by inserting after the item
relating to section 734 the following new items:</text>
<quoted-block act-name="Employee Retirement Income Security Act of 1974" changed="deleted" committee-id="SSHR00" id="IDBF1452A94B4244F58AA21153937ED829" reported-display-style="strikethrough" style="USC">
<toc regeneration="no-regeneration">
<toc-entry level="part">Part 8—Rules governing small business health
plans</toc-entry>
<toc-entry level="section">801. Small business health
plans.</toc-entry>
<toc-entry level="section">802. Certification of small business
health plans.</toc-entry>
<toc-entry level="section">803. Requirements relating to sponsors and
boards of trustees.</toc-entry>
<toc-entry level="section">804. Participation and coverage
requirements.</toc-entry>
<toc-entry level="section">805. Other requirements relating to plan
documents, contribution rates, and benefit options.</toc-entry>
<toc-entry level="section">806. Requirements for application and
related requirements.</toc-entry>
<toc-entry level="section">807. Notice requirements for voluntary
termination.</toc-entry>
<toc-entry level="section">808. Definitions and rules of
construction.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section changed="deleted" committee-id="SSHR00" id="IDE745A2F9EF1B4D81A4D69747DC6AD3FF" reported-display-style="strikethrough"><enum>102.</enum><header>Cooperation
between Federal and State authorities</header><text display-inline="no-display-inline">Section 506 of the
<act-name parsable-cite="ERISA">Employee Retirement Income Security Act of
1974</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/29/1136">29
U.S.C. 1136</external-xref>) is amended by adding at the end the following new
subsection:</text>
<quoted-block act-name="Employee Retirement Income Security Act of 1974" changed="deleted" committee-id="SSHR00" id="ID80AE078C3FB54D909392841514CDF2E0" reported-display-style="strikethrough">
<subsection changed="deleted" committee-id="SSHR00" id="ID19A55BADB7D641349E2C6DFFE9E0E427" reported-display-style="strikethrough"><enum>(d)</enum><header>Consultation
with States with respect to small business health plans</header>
<paragraph changed="deleted" committee-id="SSHR00" id="IDE2848DCDE0BC4879B2DA745AF307AC87" reported-display-style="strikethrough"><enum>(1)</enum><header>Agreements with
States</header><text>The Secretary shall consult with the State recognized
under paragraph (2) with respect to a small business health plan regarding the
exercise of—</text>
<subparagraph changed="deleted" committee-id="SSHR00" id="ID240A730BDDC44827B5430671EB58F2F6" reported-display-style="strikethrough"><enum>(A)</enum><text>the Secretary’s
authority under sections 502 and 504 to enforce the requirements for
certification under part 8; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="ID663AD9C3C0694210B34B7B96C34C5A39" reported-display-style="strikethrough"><enum>(B)</enum><text>the Secretary’s
authority to certify small business health plans under part 8 in accordance
with regulations of the Secretary applicable to certification under part
8.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID33D2868F9BB449A68FDF38BB3CD57176" reported-display-style="strikethrough"><enum>(2)</enum><header>Recognition of
domicile State</header><text>In carrying out paragraph (1), the Secretary shall
ensure that only one State will be recognized, with respect to any particular
small business health plan, as the State with which consultation is required.
In carrying out this paragraph such State shall be the domicile State, as
defined in section
805(c).</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section changed="deleted" committee-id="SSHR00" id="ID9A0470723CE5456D96C9B2CD273CE6E9" reported-display-style="strikethrough"><enum>103.</enum><header>Effective date
and transitional and other rules</header>
<subsection changed="deleted" committee-id="SSHR00" id="IDC55C21912FD84EC19D65617CC8C1EB0B" reported-display-style="strikethrough"><enum>(a)</enum><header>Effective
date</header><text>The amendments made by this title shall take effect 1 year
after the date of the enactment of this Act. The Secretary of Labor shall first
issue all regulations necessary to carry out the amendments made by this title
within 1 year after the date of the enactment of this Act.</text>
</subsection><subsection changed="deleted" committee-id="SSHR00" id="ID3F568417453142E6876C5F987FBC120D" reported-display-style="strikethrough"><enum>(b)</enum><header>Treatment of
certain existing health benefits programs</header>
<paragraph changed="deleted" committee-id="SSHR00" id="ID1658139A5CF347B7B29EC09CCB4F6BE8" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>In any case in which, as of the date of the enactment of
this Act, an arrangement is maintained in a State for the purpose of providing
benefits consisting of medical care for the employees and beneficiaries of its
participating employers, at least 200 participating employers make
contributions to such arrangement, such arrangement has been in existence for
at least 10 years, and such arrangement is licensed under the laws of one or
more States to provide such benefits to its participating employers, upon the
filing with the applicable authority (as defined in
<external-xref legal-doc="act" parsable-cite="ERISA/812(a)(5)">section
808(a)(2)</external-xref> of the <act-name parsable-cite="ERISA">Employee
Retirement Income Security Act of 1974</act-name> (as amended by this
subtitle)) by the arrangement of an application for certification of the
arrangement under part 8 of subtitle B of title I of such Act—</text>
<subparagraph changed="deleted" committee-id="SSHR00" id="ID2CC7CF0DDB3C4BF6BBD42822AFB6AA45" reported-display-style="strikethrough"><enum>(A)</enum><text>such arrangement
shall be deemed to be a group health plan for purposes of title I of such
Act;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="ID0B02CB9B852F446BB3F8FBCB1FCAA63C" reported-display-style="strikethrough"><enum>(B)</enum><text>the requirements
of sections 801(a) and 803(a) of the <act-name parsable-cite="ERISA">Employee
Retirement Income Security Act of 1974</act-name> shall be deemed met with
respect to such arrangement;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="ID3B4AC10F4EC048C88A4743B4EE7DC4FA" reported-display-style="strikethrough"><enum>(C)</enum><text>the requirements
of section 803(b) of such Act shall be deemed met, if the arrangement is
operated by a board of trustees which—</text>
<clause changed="deleted" committee-id="SSHR00" id="IDF6122669AB024A76AEF991B10F9B0E99" reported-display-style="strikethrough"><enum>(i)</enum><text>is elected by the
participating employers, with each employer having one vote; and</text>
</clause><clause changed="deleted" committee-id="SSHR00" id="ID0F914B52860F40F6B561BF91B968B16F" reported-display-style="strikethrough"><enum>(ii)</enum><text>has complete
fiscal control over the arrangement and which is responsible for all operations
of the arrangement;</text>
</clause></subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="IDE16BDD3004EE41B3860AEAB4D37E4FC7" reported-display-style="strikethrough"><enum>(D)</enum><text>the requirements
of section 804(a) of such Act shall be deemed met with respect to such
arrangement; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="ID6AAE5F59761046DFBECE3D1D79FEB6D7" reported-display-style="strikethrough"><enum>(E)</enum><text>the arrangement
may be certified by any applicable authority with respect to its operations in
any State only if it operates in such State on the date of
certification.</text>
</subparagraph><continuation-text changed="deleted" committee-id="SSHR00" continuation-text-level="paragraph" reported-display-style="strikethrough">The provisions of this subsection
shall cease to apply with respect to any such arrangement at such time after
the date of the enactment of this Act as the applicable requirements of this
subsection are not met with respect to such arrangement or at such time that
the arrangement provides coverage to participants and beneficiaries in any
State other than the States in which coverage is provided on such date of
enactment.</continuation-text></paragraph><paragraph changed="deleted" commented="no" committee-id="SSHR00" display-inline="no-display-inline" id="IDDBEBFCC8AF194CAF9B1B4321459D9321" reported-display-style="strikethrough"><enum>(2)</enum><header>Definitions</header><text>For
purposes of this subsection, the terms <term>group health plan</term>,
<term>medical care</term>, and <term>participating employer</term> shall have
the meanings provided in
<external-xref legal-doc="act" parsable-cite="ERISA/812">section
808</external-xref> of the <act-name parsable-cite="ERISA">Employee Retirement
Income Security Act of 1974</act-name>, except that the reference in paragraph
(7) of such section to an <quote>small business health plan</quote> shall be
deemed a reference to an arrangement referred to in this subsection.</text>
</paragraph></subsection></section><enum>II</enum><header>Near-term market
relief</header>
<section changed="deleted" committee-id="SSHR00" id="id700109EFB60B42279EF5415EAA9CBD59" reported-display-style="strikethrough"><enum>201.</enum><header>Near-term
market relief</header><text display-inline="no-display-inline">The Public
Health Service Act (42 U.S.C. 201 et seq.) is amended by adding at the end the
following:</text>
<quoted-block changed="deleted" committee-id="SSHR00" display-inline="no-display-inline" id="idE1431951A9E84ACAA169F1BE6AB0501F" reported-display-style="strikethrough" style="OLC">
<title changed="deleted" committee-id="SSHR00" id="id3C62421077D8405D9751D2D0FBF923D1" reported-display-style="strikethrough"><enum>XXIX</enum><header>Health care
insurance marketplace reform</header>
<section changed="deleted" committee-id="SSHR00" id="id54F51CCEF40B4FE5AC5FEAE0FE15FB5D" reported-display-style="strikethrough"><enum>2901.</enum><header>General
insurance definitions</header>
<subsection changed="deleted" committee-id="SSHR00" id="id6993EB9028AC4F63BC3BA4ED6099E261" reported-display-style="strikethrough"><enum></enum><text>In this title, the terms
<term>health insurance coverage</term>, <term>health insurance issuer</term>,
<term>group health plan</term>, and <term>individual health insurance</term>
shall have the meanings given such terms in section 2791.</text>
</subsection></section><subtitle changed="deleted" committee-id="SSHR00" id="idC0ADBAAE89724C0E86B308B64699BCC4" reported-display-style="strikethrough"><enum>A</enum><header>Near-term market
relief</header>
<part changed="deleted" committee-id="SSHR00" id="idC8FD8E41E0C2431DAE4DDAA9D3857AB6" reported-display-style="strikethrough"><enum>I</enum><header>Rating
requirements</header>
<section changed="deleted" committee-id="SSHR00" id="id0D3E72E387194D9AA15CD3A347717060" reported-display-style="strikethrough"><enum>2911.</enum><header>Definitions</header>
<subsection changed="deleted" committee-id="SSHR00" id="id1049DDD3D101421AB0381B1AC34BF9B0" reported-display-style="strikethrough"><enum></enum><text display-inline="yes-display-inline">In this part:</text>
<paragraph changed="deleted" committee-id="SSHR00" id="ID37dde65b6539420b9ccbf73de24b9250" reported-display-style="strikethrough"><enum>(1)</enum><header>Adopting
state</header><text>The term <term>adopting State</term> means a State that has
enacted either the NAIC model rules or the National Interim Model Rating Rules
in their entirety and as the exclusive laws of the State that relate to rating
in the small group insurance market.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="id537975DBD4A74D15A7F1DD0D56C365C0" reported-display-style="strikethrough"><enum>(2)</enum><header>Commission</header><text>The
term <term>Commission</term> means the Harmonized Standards Commission
established under section 2921.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDb3dbbb3bd63a4825a6b542d36278635b" reported-display-style="strikethrough"><enum>(3)</enum><header>Eligible
insurer</header><text>The term <term>eligible insurer</term> means a health
insurance issuer that is licensed in a nonadopting State and that—</text>
<subparagraph changed="deleted" committee-id="SSHR00" id="ID95dde76105434d51a96e8f04d7da0bb4" reported-display-style="strikethrough"><enum>(A)</enum><text>notifies the
Secretary, not later than 30 days prior to the offering of coverage described
in this subparagraph, that the issuer intends to offer small group health
insurance coverage consistent with the National Interim Model Rating Rules in a
nonadopting State;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="IDe97f2a43608146da8fd546a9cc91480d" reported-display-style="strikethrough"><enum>(B)</enum><text>notifies the
insurance department of a nonadopting State (or other State agency), not later
than 30 days prior to the offering of coverage described in this subparagraph,
that the issuer intends to offer small group health insurance coverage in that
State consistent with the National Interim Model Rating Rules, and provides
with such notice a copy of any insurance policy that it intends to offer in the
State, its most recent annual and quarterly financial reports, and any other
information required to be filed with the insurance department of the State (or
other State agency) by the Secretary in regulations; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="ID8d126dfcefdd4a0b8482e9fe6bfa3953" reported-display-style="strikethrough"><enum>(C)</enum><text>includes in the
terms of the health insurance coverage offered in nonadopting States (including
in the terms of any individual certificates that may be offered to individuals
in connection with such group health coverage) and filed with the State
pursuant to subparagraph (B), a description in the insurer's contract of the
National Interim Model Rating Rules and an affirmation that such Rules are
included in the terms of such contract.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID0b5537e52a3d4199bb6e6cbc1901bfe9" reported-display-style="strikethrough"><enum>(4)</enum><header>Health insurance
coverage</header><text>The term <term>health insurance coverage</term> means
any coverage issued in small group health insurance market.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="id25B57CBDB0184384BEDE24263A4874D0" reported-display-style="strikethrough"><enum>(5)</enum><header>NAIC model
rules</header><text>The term <term>NAIC model rules</term> means the rating
rules provided for in the 1992 Adopted Small Employer Health Insurance
Availability Model Act of the National Association of Insurance
Commissioners.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDf67639a115d4425c9f2caa9995f7bfb7" reported-display-style="strikethrough"><enum>(6)</enum><header>National Interim
Model Rating Rules</header><text>The term <term>National Interim Model Rating
Rules</term> means the rules promulgated under section 2912(a).</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDf5b54b08f34341df816c658cc6eb5b52" reported-display-style="strikethrough"><enum>(7)</enum><header>Nonadopting
state</header><text>The term <term>nonadopting State</term> means a State that
is not an adopting State.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="idAEF060D700064709B7E368BA8E8C15B3" reported-display-style="strikethrough"><enum>(8)</enum><header>Small group
insurance market</header><text>The term <term>small group insurance
market</term> shall have the meaning given the term <term>small group
market</term> in section 2791(e)(5).</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID94a260a0a53f4193befec1b959378a53" reported-display-style="strikethrough"><enum>(9)</enum><header>State
law</header><text>The term <term>State law</term> means all laws, decisions,
rules, regulations, or other State actions (including actions by a State
agency) having the effect of law, of any State.</text>
</paragraph></subsection></section><section changed="deleted" committee-id="SSHR00" id="idCDDC6762328C40A58DFE64CD20C16DB3" reported-display-style="strikethrough"><enum>2912.</enum><header>Rating
rules</header>
<subsection changed="deleted" committee-id="SSHR00" id="idF6188014F0634FDCAF494222CB593E51" reported-display-style="strikethrough"><enum>(a)</enum><header>National interim
model rating rules</header><text>Not later than 6 months after the date of
enactment of this title, the Secretary, in consultation with the National
Association of Insurance Commissioners, shall, through expedited rulemaking
procedures, promulgate National Interim Model Rating Rules that shall be
applicable to the small group insurance market in certain States until such
time as the provisions of subtitle B become effective. Such Model Rules shall
apply in States as provided for in this section beginning with the first plan
year after the such Rules are promulgated.</text>
</subsection><subsection changed="deleted" committee-id="SSHR00" id="id41CB317ADBBE4038AD4DBF8F2FDD1C58" reported-display-style="strikethrough"><enum>(b)</enum><header>Utilization of
NAIC model rules</header><text>In promulgating the National Interim Model
Rating Rules under subsection (a), the Secretary, except as otherwise provided
in this subtitle, shall utilize the NAIC model rules regarding premium rating
and premium variation.</text>
</subsection><subsection changed="deleted" committee-id="SSHR00" id="id3FE6F81D08724DD19FBC675F66726A56" reported-display-style="strikethrough"><enum>(c)</enum><header>Transition in
certain States</header>
<paragraph changed="deleted" committee-id="SSHR00" id="id01D56682BC5F4653B93A5D205CB5F8BE" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>In promulgating the National Interim Model Rating Rules
under subsection (a), the Secretary shall have discretion to modify the NAIC
model rules in accordance with this subsection to the extent necessary to
provide for a graduated transition, of not to exceed 3 years following the
promulgation of such National Interim Rules, with respect to the application of
such Rules to States.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="idC8B6A364C58B4B5BBFC7776E609E8C7C" reported-display-style="strikethrough"><enum>(2)</enum><header>Initial premium
variation</header>
<subparagraph changed="deleted" committee-id="SSHR00" id="id317922353FCF4F2B886D5C852FEB262E" reported-display-style="strikethrough"><enum>(A)</enum><header>In
general</header><text>Under the modified National Interim Model Rating Rules as
provided for in paragraph (1), the premium variation provision of subparagraph
(C) shall be applicable only with respect to small group policies issued in
States which, on the date of enactment of this title, have in place premium
rating band requirements that vary by less than 50 percent from the premium
variation standards contained in subparagraph (C) with respect to the standards
provided for under the NAIC model rules.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="id908519CE9DC14F5E83AE1C834E61CA70" reported-display-style="strikethrough"><enum>(B)</enum><header>Other
States</header><text>Health insurance coverage offered in a State that, on the
date of enactment of this title, has in place premium rating band requirements
that vary by more than 50 percent from the premium variation standards
contained in subparagraph (C) shall be subject to such graduated transition
schedules as may be provided by the Secretary pursuant to paragraph (1).</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="id48A7A94066CB40BDB2768D1B7CB911DC" reported-display-style="strikethrough"><enum>(C)</enum><header>Amount of
variation</header><text>The amount of a premium rating variation from the base
premium rate due to health conditions of covered individuals under this
subparagraph shall not exceed a factor of—</text>
<clause changed="deleted" committee-id="SSHR00" id="idE6681BA96EAD415D841B1B9A4F71F77C" reported-display-style="strikethrough"><enum>(i)</enum><text>+/- 25 percent
upon the issuance of the policy involved; and</text>
</clause><clause changed="deleted" committee-id="SSHR00" id="id3B23DC0C298B40228F96C8D5653FB79A" reported-display-style="strikethrough"><enum>(ii)</enum><text>+/- 15 percent
upon the renewal of the policy.</text>
</clause></subparagraph></paragraph><paragraph changed="deleted" committee-id="SSHR00" id="id9589FBF203674514BEF2F3412B82F814" reported-display-style="strikethrough"><enum>(3)</enum><header>Other
transitional authority</header><text>In developing the National Interim Model
Rating Rules, the Secretary may also provide for the application of
transitional standards in certain States with respect to the following:</text>
<subparagraph changed="deleted" committee-id="SSHR00" id="ID89328df0d2144f5891ead64390bf8977" reported-display-style="strikethrough"><enum>(A)</enum><text>Independent rating
classes for old and new business.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="IDf41e23ab9d084d848daa1ac6068819ca" reported-display-style="strikethrough"><enum>(B)</enum><text>Such additional
transition standards as the Secretary may determine necessary for an effective
transition.</text>
</subparagraph></paragraph></subsection></section><section changed="deleted" committee-id="SSHR00" id="IDb9ad26b9611d47c4b244ac74046cda65" reported-display-style="strikethrough"><enum>2913.</enum><header>Application
and preemption</header>
<subsection changed="deleted" committee-id="SSHR00" id="IDf23fa58340bf417986973503316ab735" reported-display-style="strikethrough"><enum>(a)</enum><header>Superceding of
state law</header><text></text>
<paragraph changed="deleted" committee-id="SSHR00" id="IDe10be47ec4644fcd8a4c2e1d34ec7137" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>This part shall supersede any and all State laws insofar
as such State laws (whether enacted prior to or after the date of enactment of
this subtitle) relate to rating in the small group insurance market as applied
to an eligible insurer, or small group health insurance coverage issued by an
eligible insurer, in a nonadopting State.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDc38b5eb7d6c24fc98cec7f34f6ddb118" reported-display-style="strikethrough"><enum>(2)</enum><header>Nonadopting
states</header><text>This part shall supersede any and all State laws of a
nonadopting State insofar as such State laws (whether enacted prior to or after
the date of enactment of this subtitle)—</text>
<subparagraph changed="deleted" committee-id="SSHR00" id="id5BFEB68BE54E4913B255B3A3573A6619" reported-display-style="strikethrough"><enum>(A)</enum><text>prohibit an
eligible insurer from offering coverage consistent with the National Interim
Model Rating Rules in a nonadopting State; or</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="idBC942BA91CE9451CA90EC5D3DC04CDD6" reported-display-style="strikethrough"><enum>(B)</enum><text>discriminate
against or among eligible insurers offering health insurance coverage
consistent with the National Interim Model Rating Rules in a nonadopting
state.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SSHR00" id="IDb7e7ffcf87c64da69499387ed79fe925" reported-display-style="strikethrough"><enum>(b)</enum><header>Savings clause
and construction</header><text></text>
<paragraph changed="deleted" committee-id="SSHR00" id="ID4171e333d9934232bd37636fe4381c00" reported-display-style="strikethrough"><enum>(1)</enum><header>Nonapplication
to adopting states</header><text>Subsection (a) shall not apply with respect to
adopting states.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID3ae3584ba1424659bbf480664981f636" reported-display-style="strikethrough"><enum>(2)</enum><header>Nonapplication
to certain insurers</header><text>Subsection (a) shall not apply with respect
to insurers that do not qualify as eligible insurers that offer small group
health insurance coverage in a nonadopting State.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID428b882ef79e426aa074e89cd328b016" reported-display-style="strikethrough"><enum>(3)</enum><header>Nonapplication
where obtaining relief under state law</header><text>Subsection (a)(1) shall
not apply to any State law in a nonadopting State to the extent necessary to
permit individuals or the insurance department of the State (or other State
agency) to obtain relief under State law to require an eligible insurer to
comply with the terms of the small group health insurance coverage issued in
the nonadopting State. In no case shall this paragraph, or any other provision
of this title, be construed to create a cause of action on behalf of an
individual or any other person under State law in connection with a group
health plan that is subject to the Employee Retirement Income Security Act of
1974 or health insurance coverage issued in connection with such a plan.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID330b95a208fb404caee5376137310252" reported-display-style="strikethrough"><enum>(4)</enum><header>Nonapplication
to enforce requirements relating to the national rule</header><text>Subsection
(a)(1) shall not apply to any State law in a nonadopting State to the extent
necessary to provide the insurance department of the State (or other State
agency) with the authority to enforce State law requirements relating to the
National Interim Model Rating Rules that are not set forth in the terms of the
small group health insurance coverage issued in a nonadopting State, in a
manner that is consistent with the National Interim Model Rating Rules and that
imposes no greater duties or obligations on health insurance issuers than the
National Interim Model Rating Rules.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDf06e0aa681104a5f9917801382e093ee" reported-display-style="strikethrough"><enum>(5)</enum><header>Nonapplication
to subsection (a)(2)</header><text>Paragraphs (3) and (4) shall not apply with
respect to subsection (a)(2).</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID6fddc629e3e5473ba12fdc30ded2911e" reported-display-style="strikethrough"><enum>(6)</enum><header>No affect on
preemption</header><text>In no case shall this subsection be construed to
affect the scope of the preemption provided for under the Employee Retirement
Income Security Act of 1974.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SSHR00" id="ID1307996c70b94ac682768261ffd4d01c" reported-display-style="strikethrough"><enum>(c)</enum><header>Effective
date</header><text>This section shall apply beginning in the first plan year
following the issuance of the final rules by the Secretary under the National
Interim Model Rating Rules.</text>
</subsection></section><section changed="deleted" committee-id="SSHR00" id="ID153080fcff484458a1583a2c39bf6a75" reported-display-style="strikethrough"><enum>2914.</enum><header>Civil actions
and jurisdiction</header>
<subsection changed="deleted" committee-id="SSHR00" id="IDf0be43808ca74c4bbf665397914820f0" reported-display-style="strikethrough"><enum>(a)</enum><header>In
general</header><text>The district courts of the United States shall have
exclusive jurisdiction over civil actions involving the interpretation of this
part.</text>
</subsection><subsection changed="deleted" committee-id="SSHR00" id="ID2c0c62285afb4d0b9b3cd913f4ae2c02" reported-display-style="strikethrough"><enum>(b)</enum><header>Actions</header><text>A
health insurance issuer may bring an action in the district courts of the
United States for injunctive or other equitable relief against a nonadopting
State in connection with the application of a state law that violates this
part.</text>
</subsection><subsection changed="deleted" committee-id="SSHR00" id="ID46abe282956c40aea47d891dad13d143" reported-display-style="strikethrough"><enum>(c)</enum><header>Violations of
section 2913</header><text>In the case of a nonadopting State that is in
violation of section 2913(a)(2), a health insurance issuer may bring an action
in the district courts of the United States for damages against the nonadopting
State and, if the health insurance issuer prevails in such action, the district
court shall award the health insurance issuer its reasonable attorneys fees and
costs.</text>
</subsection></section><section changed="deleted" committee-id="SSHR00" id="id01B1D8DCCCC5484C9334A53E200872ED" reported-display-style="strikethrough"><enum>2915.</enum><header>Sunset</header><text display-inline="no-display-inline">The National Interim Model Rating Rules
shall remain in effect in a non-adopting State until such time as the
harmonized national rating rules are promulgated and effective pursuant to part
II. Upon such effective date, such harmonized rules shall supersede the
National Rules.</text>
</section></part><part changed="deleted" committee-id="SSHR00" id="id71A68226AE2C4E8FB8BEA287F01675EA" reported-display-style="strikethrough"><enum>II</enum><header>Lower cost
plans</header>
<section changed="deleted" committee-id="SSHR00" id="id512EE6BC5994452F835974CD27A14ED1" reported-display-style="strikethrough"><enum>2921.</enum><header>Definitions</header><text display-inline="no-display-inline">In this part:</text>
<paragraph changed="deleted" committee-id="SSHR00" id="idAE2BC96227284E09AE2447721B10E7E8" reported-display-style="strikethrough"><enum>(1)</enum><header>Adopting
state</header><text>The term <term>adopting State</term> means a State that has
enacted the State Benefit Compendium in its entirety and as the exclusive laws
of the State that relate to benefit, service, and provider mandates in the
group and individual insurance markets.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="id9E85183DA7584762ABF790E307F50D98" reported-display-style="strikethrough"><enum>(2)</enum><header>Eligible
insurer</header><text>The term <term>eligible insurer</term> means a health
insurance issuer that is licensed in a nonadopting State and that—</text>
<subparagraph changed="deleted" committee-id="SSHR00" id="idA4005FDACDD14E8AAC3D2878586731A7" reported-display-style="strikethrough"><enum>(A)</enum><text>notifies the
Secretary, not later than 30 days prior to the offering of coverage described
in this subparagraph, that the issuer intends to offer group health insurance
coverage consistent with the State Benefit Compendium in a nonadopting
State;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="id391B3C8DECF240D78CAAE311CBF1B205" reported-display-style="strikethrough"><enum>(B)</enum><text>notifies the
insurance department of a nonadopting State (or other State agency), not later
than 30 days prior to the offering of coverage described in this subparagraph,
that the issuer intends to offer group health insurance coverage in that State
consistent with the State Benefit Compendium, and provides with such notice a
copy of any insurance policy that it intends to offer in the State, its most
recent annual and quarterly financial reports, and any other information
required to be filed with the insurance department of the State (or other State
agency) by the Secretary in regulations; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="idBE78A10F761C4FC9B44043EEB5C95086" reported-display-style="strikethrough"><enum>(C)</enum><text>includes in the
terms of the health insurance coverage offered in nonadopting States (including
in the terms of any individual certificates that may be offered to individuals
in connection with such group health coverage) and filed with the State
pursuant to subparagraph (B), a description in the insurer's contract of the
State Benefit Compendium and that adherence to the Compendium is included as a
term of such contract.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SSHR00" id="id7A73BC450E0B4DFBA7482F8FF867742E" reported-display-style="strikethrough"><enum>(3)</enum><header>Health insurance
coverage</header><text>The term <term>health insurance coverage</term> means
any coverage issued in the group or individual health insurance markets.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="id28698B5794324E238F16D4724C761F51" reported-display-style="strikethrough"><enum>(4)</enum><header>Nonadopting
state</header><text>The term <term>nonadopting State</term> means a State that
is not an adopting State.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDe49280833d0144d6a7d76666852032a2" reported-display-style="strikethrough"><enum>(5)</enum><header>State Benefit
Compendium</header><text>The term <term>State Benefit Compendium</term> means
the Compendium issued under section 2922.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="idDBFC2EBCDF114027BFD6EF3CE97B9A9E" reported-display-style="strikethrough"><enum>(6)</enum><header>State
law</header><text>The term <term>State law</term> means all laws, decisions,
rules, regulations, or other State actions (including actions by a State
agency) having the effect of law, of any State.</text>
</paragraph></section><section changed="deleted" commented="no" committee-id="SSHR00" display-inline="no-display-inline" id="id114EAB22FFB440B1B073DBCF5A9FC723" reported-display-style="strikethrough" section-type="subsequent-section"><enum>2922.</enum><header>Offering lower cost
plans</header>
<subsection changed="deleted" committee-id="SSHR00" id="ID56f9fad1feba4e76a6107971e34fbe62" reported-display-style="strikethrough"><enum>(a)</enum><header>List of Required
Benefits</header><text>Not later than 3 months after the date of enactment of
this title, the Secretary shall issue by interim final rule a list (to be known
as the <quote>List of Required Benefits</quote>) of the benefit, service, and
provider mandates that are required to be provided by health insurance issuers
in at least 45 States as a result of the application of State benefit, service,
and provider mandate laws.</text>
</subsection><subsection changed="deleted" committee-id="SSHR00" id="IDc1172d206605444aa67f0b939c3fd575" reported-display-style="strikethrough"><enum>(b)</enum><header>State benefit
compendium</header><text></text>
<paragraph changed="deleted" committee-id="SSHR00" id="IDfd5d418480f6401485d4035479f6b993" reported-display-style="strikethrough"><enum>(1)</enum><header>Variance</header><text>Not
later than 12 months after the date of enactment of this title, the Secretary
shall issue by interim final rule a compendium (to be known as the <quote>State
Benefit Compendium</quote>) of harmonized descriptions of the benefit, service,
and provider mandates identified under subsection (a). In developing the
Compendium, with respect to differences in State mandate laws identified under
subsection (a) relating to similar benefits, services, or providers, the
Secretary shall review and define the scope and application of such State laws
so that a common approach shall be applicable under such Compendium in a
uniform manner. In making such determination, the Secretary shall adopt an
approach reflective of the approach used by a plurality of the States requiring
such benefit, service, or provider mandate.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID1b2942c79bc841888e00faff503c7183" reported-display-style="strikethrough"><enum>(2)</enum><header>Effect</header><text>The
State Benefit Compendium shall provide that any State benefit, service, and
provider mandate law (enacted prior to or after the date of enactment of this
title) other than those described in the Compendium shall not be binding on
health insurance issuers in an adopting State.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDbf49605252e64829ac404e4ba2c5eb18" reported-display-style="strikethrough"><enum>(3)</enum><header>Implementation</header><text>The
effective date of the State Benefit Compendium shall be the later of—</text>
<subparagraph changed="deleted" committee-id="SSHR00" id="id1B3197DA8C4C48C2BEC8AFDAF5ED93D9" reported-display-style="strikethrough"><enum>(A)</enum><text>the date that is
12 months from the date of enactment of this title; or</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="idA94338134CCE42269667E7738EFE4F40" reported-display-style="strikethrough"><enum>(B)</enum><text>such subsequent
date on which the interim final rule for the State Benefit Compendium shall be
issued.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SSHR00" id="IDb458c677741841c3acf63e3c5df9afed" reported-display-style="strikethrough"><enum>(c)</enum><header>Non-association
coverage</header><text>With respect to health insurers selling insurance to
small employers (as defined in section 808(a)(10) of the Employee Retirement
Income Security Act of 1974), in the event the Secretary fails to issue the
State Benefit Compendium within 12 months of the date of enactment of this
title, the required scope and application for each benefit or service listed in
the List of Required Benefits shall, other than with respect to insurance
issued to a Small Business Health Plan, be—</text>
<paragraph changed="deleted" committee-id="SSHR00" id="ID51f61e464d1541cd82e86535d2b4ffd3" reported-display-style="strikethrough"><enum>(1)</enum><text>if the State in
which the insurer issues a policy mandates such benefit or service, the scope
and application required by such State; or</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDbc5da726ee694d04a88852fe21e699a9" reported-display-style="strikethrough"><enum>(2)</enum><text>if the State in
which the insurer issues a policy does not mandate such benefit or service, the
scope and application required by such other State that does require such
benefit or service in which the greatest number of the insurer’s small employer
policyholders are located.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SSHR00" id="ID01579d28d8ab40e6879de33d85de8fb9" reported-display-style="strikethrough"><enum>(d)</enum><header>Updating of
State benefit compendium</header><text>Not later than 2 years after the date on
which the Compendium is issued under subsection (b)(1), and every 2 years
thereafter, the Secretary, applying the same methodology provided for in
subsections (a) and (b)(1), in consultation with the National Association of
Insurance Commissioners, shall update the Compendium. The Secretary shall issue
the updated Compendium by regulation, and such updated Compendium shall be
effective upon the first plan year following the issuance of such
regulation.</text>
</subsection></section><section changed="deleted" committee-id="SSHR00" id="id10F5DE1B113A424B8E8197C3E21B228B" reported-display-style="strikethrough"><enum>2923.</enum><header>Application
and preemption</header>
<subsection changed="deleted" committee-id="SSHR00" id="IDd42ab114375c4301ab9cdd6fd4d0a0b2" reported-display-style="strikethrough"><enum>(a)</enum><header>Superceding of
state law</header><text></text>
<paragraph changed="deleted" committee-id="SSHR00" id="ID1b8450b67de4481494f986c441d0694d" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>This part shall supersede any and all State laws (whether
enacted prior to or after the date of enactment of this title) insofar as such
laws relate to benefit, service, or provider mandates in the health insurance
market as applied to an eligible insurer, or health insurance coverage issued
by an eligible insurer, in a nonadopting State.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID4ba17dd88ee6458791cae5d766aae4ac" reported-display-style="strikethrough"><enum>(2)</enum><header>Nonadopting
states</header><text>This part shall supersede any and all State laws of a
nonadopting State (whether enacted prior to or after the date of enactment of
this title) insofar as such laws—</text>
<subparagraph changed="deleted" committee-id="SSHR00" id="idA25C694B67014D71B7C785E349E5F2C8" reported-display-style="strikethrough"><enum>(A)</enum><text>prohibit an
eligible insurer from offering coverage consistent with the State Benefit
Compendium, as provided for in section 2922(a), in a nonadopting State;
or</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="id94C0CFE00C4142BDB219470906539B36" reported-display-style="strikethrough"><enum>(B)</enum><text>discriminate
against or among eligible insurers offering or seeking to offer health
insurance coverage consistent with the State Benefit Compendium in a
nonadopting State.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SSHR00" id="ID22eda467fea242f2bacfa12b7c3efbb5" reported-display-style="strikethrough"><enum>(b)</enum><header>Savings clause
and construction</header><text></text>
<paragraph changed="deleted" committee-id="SSHR00" id="ID3ecab177b6764a0999c7873b3d32cbe9" reported-display-style="strikethrough"><enum>(1)</enum><header>Nonapplication
to adopting states</header><text>Subsection (a) shall not apply with respect to
adopting States.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDceb4c94a29e74fb68ffe556db3559156" reported-display-style="strikethrough"><enum>(2)</enum><header>Nonapplication
to certain insurers</header><text>Subsection (a) shall not apply with respect
to insurers that do not qualify as eligible insurers who offer health insurance
coverage in a nonadopting State.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID26d15c82ca734300b02d047502b56d22" reported-display-style="strikethrough"><enum>(3)</enum><header>Nonapplication
where obtaining relief under state law</header><text>Subsection (a)(1) shall
not apply to any State law of a nonadopting State to the extent necessary to
permit individuals or the insurance department of the State (or other State
agency) to obtain relief under State law to require an eligible insurer to
comply with the terms of the group health insurance coverage issued in a
nonadopting State. In no case shall this paragraph, or any other provision of
this title, be construed to create a cause of action on behalf of an individual
or any other person under State law in connection with a group health plan that
is subject to the Employee Retirement Income Security Act of 1974 or health
insurance coverage issued in connection with such plan.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID63fa8904f7aa47e8a57c6ac7c8878017" reported-display-style="strikethrough"><enum>(4)</enum><header>Nonapplication
to enforce requirements relating to the compendium</header><text>Subsection
(a)(1) shall not apply to any State law in a nonadopting State to the extent
necessary to provide the insurance department of the State (or other state
agency) authority to enforce State law requirements relating to the State
Benefit Compendium that are not set forth in the terms of the group health
insurance coverage issued in a nonadopting State, in a manner that is
consistent with the State Benefit Compendium and imposes no greater duties or
obligations on health insurance issuers than the State Benefit
Compendium.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDb0f17ce4b3c743d2a5fcabe3bbeb9b0f" reported-display-style="strikethrough"><enum>(5)</enum><header>Nonapplication
to subsection (a)(2)</header><text>Paragraphs (3) and (4) shall not apply with
respect to subsection (a)(2).</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="idED3F2140CEF94D6AAF2459FFAFE096BF" reported-display-style="strikethrough"><enum>(6)</enum><header>No affect on
preemption</header><text>In no case shall this subsection be construed to
affect the scope of the preemption provided for under the Employee Retirement
Income Security Act of 1974.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SSHR00" id="ID31eb893ae191457aac876a24cf24c125" reported-display-style="strikethrough"><enum>(c)</enum><header>Effective
date</header><text>This section shall apply upon the first plan year following
final issuance by the Secretary of the State Benefit Compendium.</text>
</subsection></section><section changed="deleted" committee-id="SSHR00" id="IDade5a7eefb794ea994750263bd07ff45" reported-display-style="strikethrough"><enum>2924.</enum><header>Civil actions
and jurisdiction</header>
<subsection changed="deleted" committee-id="SSHR00" id="ID5c0ed5cd76484d6a919ee248847b3064" reported-display-style="strikethrough"><enum>(a)</enum><header>In
general</header><text>The district courts of the United States shall have
exclusive jurisdiction over civil actions involving the interpretation of this
part.</text>
</subsection><subsection changed="deleted" committee-id="SSHR00" id="IDf15591cec94047978405be9e7949d10e" reported-display-style="strikethrough"><enum>(b)</enum><header>Actions</header><text>A
health insurance issuer may bring an action in the district courts of the
United States for injunctive or other equitable relief against a nonadopting
State in connection with the application of a State law that violates this
part.</text>
</subsection><subsection changed="deleted" committee-id="SSHR00" id="ID9a7fd009c31d4de49acfba1b764b5d24" reported-display-style="strikethrough"><enum>(c)</enum><header>Violations of
section 2923</header><text>In the case of a nonadopting State that is in
violation of section 2923(a)(2), a health insurance issuer may bring an action
in the district courts of the United States for damages against the nonadopting
State and, if the health insurance issuer prevails in such action, the district
court shall award the health insurance issuer its reasonable attorneys fees and
costs.</text>
</subsection></section></part></subtitle>.
<enum>III</enum><header>Harmonization of
health insurance laws</header>
<section changed="deleted" committee-id="SSHR00" id="id122488CEB2344B07BC8190618D1B8DC5" reported-display-style="strikethrough"><enum>301.</enum><header>Health
Insurance Regulatory Harmonization</header><text display-inline="no-display-inline">Title XXIX of the Public Health Service Act
(as added by section 201) is amended by adding at the end the following:</text>
<quoted-block changed="deleted" committee-id="SSHR00" display-inline="no-display-inline" id="id6085DE69FCAB484B960BDF04410CDBA5" reported-display-style="strikethrough" style="OLC">
<subtitle changed="deleted" committee-id="SSHR00" id="idE74777258DD446DFB483D36A80CF327D" reported-display-style="strikethrough"><enum>B</enum><header>Regulatory
harmonization</header>
<section changed="deleted" committee-id="SSHR00" id="id80E82E7A086F4FB69E4555CFDDF2C7CC" reported-display-style="strikethrough"><enum>2931.</enum><header>Definitions</header><text display-inline="no-display-inline">In this subtitle:</text>
<paragraph changed="deleted" committee-id="SSHR00" id="IDec2eb06f91524382bec7da0218a968df" reported-display-style="strikethrough"><enum>(1)</enum><header>Access</header><text>The
term <term>access</term> means any requirements of State law that regulate the
following elements of access:</text>
<subparagraph changed="deleted" committee-id="SSHR00" id="ID60fbae9533614f2b9ac16858c86795c2" reported-display-style="strikethrough"><enum>(A)</enum><text>Renewability of
coverage.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="ID982c1b3d253148fa9d7353d27968ab7e" reported-display-style="strikethrough"><enum>(B)</enum><text>Guaranteed
issuance as provided for in title XXVII.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="IDd05dd346b867426b92b55afbc208feff" reported-display-style="strikethrough"><enum>(C)</enum><text>Guaranteed issue
for individuals not eligible under subparagraph (B).</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="IDd48ca0c865784c95a2235ae67f828481" reported-display-style="strikethrough"><enum>(D)</enum><text>High risk
pools.</text>
</subparagraph><subparagraph changed="deleted" commented="no" committee-id="SSHR00" display-inline="no-display-inline" id="ID7564d43d2dc14540976d6f3bb1770809" reported-display-style="strikethrough"><enum>(E)</enum><text>Pre-existing
conditions limitations.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID892c9303129e4e1a849d4fc044119067" reported-display-style="strikethrough"><enum>(2)</enum><header>Adopting
state</header><text>The term <term>adopting State</term> means a State that has
enacted the harmonized standards adopted under this subtitle in their entirety
and as the exclusive laws of the State that relate to the harmonized
standards.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID05a83b0f4aa74f8b87809b8a152da2a3" reported-display-style="strikethrough"><enum>(3)</enum><header>Eligible
insurer</header><text>The term <term>eligible insurer</term> means a health
insurance issuer that is licensed in a nonadopting State and that—</text>
<subparagraph changed="deleted" committee-id="SSHR00" id="id977D9336BD874F3581A8BEA1C8F3AD8A" reported-display-style="strikethrough"><enum>(A)</enum><text>notifies the
Secretary, not later than 30 days prior to the offering of coverage described
in this subparagraph, that the issuer intends to offer health insurance
coverage consistent with the harmonized standards in a nonadopting
State;</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="id3E66E4F870FC46468E579E994A72815E" reported-display-style="strikethrough"><enum>(B)</enum><text>notifies the
insurance department of a nonadopting State (or other State agency), not later
than 30 days prior to the offering of coverage described in this subparagraph,
that the issuer intends to offer group health insurance coverage in that State
consistent with the State Benefit Compendium, and provides with such notice a
copy of any insurance policy that it intends to offer in the State, its most
recent annual and quarterly financial reports, and any other information
required to be filed with the insurance department of the State (or other State
agency) by the Secretary in regulations; and</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="idAE617F1237E14F508712C914376E4AF4" reported-display-style="strikethrough"><enum>(C)</enum><text>includes in the
terms of the health insurance coverage offered in nonadopting States (including
in the terms of any individual certificates that may be offered to individuals
in connection with such group health coverage) and filed with the State
pursuant to subparagraph (B), a description of the harmonized standards
published pursuant to section 2932(g)(2) and an affirmation that such standards
are a term of the contract.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID5226b520eb464fdb985e35c29aca6433" reported-display-style="strikethrough"><enum>(4)</enum><header>Harmonized
standards</header><text>The term <term>harmonized standards</term> means the
standards adopted by the Secretary under section 2932(d).</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="id7844336BF967475A8406521FF86B17DC" reported-display-style="strikethrough"><enum>(5)</enum><header>Health insurance
coverage</header><text>The term <term>health insurance coverage</term> means
any coverage issued in the health insurance market.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDf4bd4b844eb341569dbad93f4b3fad26" reported-display-style="strikethrough"><enum>(6)</enum><header>Nonadopting
state</header><text>The term <term>nonadopting State</term> means a State that
fails to enact, within 2 years of the date in which final regulations are
issued by the Secretary adopting the harmonized standards under this subtitle,
the harmonized standards in their entirety and as the exclusive laws of the
State that relate to the harmonized standards.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDd73943847ce6480d9980c0c08ba7fb0a" reported-display-style="strikethrough"><enum>(7)</enum><header>Patient
protections</header><text>The term <term>patient protections</term> means any
requirement of State law that regulate the following elements of patient
protections:</text>
<subparagraph changed="deleted" committee-id="SSHR00" id="IDb60f6392d22444dd87d8ad98d80d28d0" reported-display-style="strikethrough"><enum>(A)</enum><text>Internal
appeals.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="ID257969d275b2413988780532e977539e" reported-display-style="strikethrough"><enum>(B)</enum><text>External
appeals.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="ID37ce6d6d462a46df8a5d8aaef84c5d9e" reported-display-style="strikethrough"><enum>(C)</enum><text>Direct access to
providers.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="IDec8f9031fafa4d4996d5b8008df576ff" reported-display-style="strikethrough"><enum>(D)</enum><text>Prompt payment of
claims.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="IDa69806e94d074b1b9f216baa6fd10f23" reported-display-style="strikethrough"><enum>(E)</enum><text>Utilization
review.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="ID6d4a98b2f1b6486babf7726db55d6063" reported-display-style="strikethrough"><enum>(F)</enum><text>Marketing
standards.</text>
</subparagraph></paragraph><paragraph changed="deleted" commented="no" committee-id="SSHR00" display-inline="no-display-inline" id="IDc1a731a768c24622a34d6197e2647e12" reported-display-style="strikethrough"><enum>(8)</enum><header>Plurality
requirement</header><text>The term <term>plurality requirement</term> means the
most common substantially similar requirements for elements within each area
described in section 2932(b)(1).</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDd01d06ed601d420e942c382451623912" reported-display-style="strikethrough"><enum>(9)</enum><header>Rating</header><text>The
term <term>rating</term> means, at the time of issuance or renewal,
requirements of State law the regulate the following elements of rating:</text>
<subparagraph changed="deleted" committee-id="SSHR00" id="ID58259b4465da46f4b4754f5994acba3f" reported-display-style="strikethrough"><enum>(A)</enum><text>Limits on the
types of variations in rates based on health status.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="IDaca522a0614a441a8287ff45dd752c64" reported-display-style="strikethrough"><enum>(B)</enum><text>Limits on the
types of variations in rates based on age and gender.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="ID21660dd5205c4e10b1c91f2f87ca10bd" reported-display-style="strikethrough"><enum>(C)</enum><text>Limits on the
types of variations in rates based on geography, industry and group
size.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="ID81c140c9ceee48b586432c6b1d73c212" reported-display-style="strikethrough"><enum>(D)</enum><text>Periods of time
during which rates are guaranteed.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="IDb55cf85832be4037974d4abd5c8fbb08" reported-display-style="strikethrough"><enum>(E)</enum><text>The review and
approval of rates.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="IDfbcae7e10f154993a4366ca778826be9" reported-display-style="strikethrough"><enum>(F)</enum><text>The establishment
of classes or blocks of business.</text>
</subparagraph><subparagraph changed="deleted" commented="no" committee-id="SSHR00" display-inline="no-display-inline" id="ID635f7f7beb8c4190b3f8b0f18bd19124" reported-display-style="strikethrough"><enum>(G)</enum><text>The use of
actuarial justifications for rate variations.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SSHR00" id="idEF487EF22B8C49B1B698682D6B40E170" reported-display-style="strikethrough"><enum>(10)</enum><header>State
law</header><text>The term <term>State law</term> means all laws, decisions,
rules, regulations, or other State actions (including actions by a State
agency) having the effect of law, of any State.</text>
</paragraph><paragraph changed="deleted" commented="no" committee-id="SSHR00" display-inline="no-display-inline" id="ID954e503764704c6e952c808af671d5c6" reported-display-style="strikethrough"><enum>(11)</enum><header>Substantially
similar</header><text>The term <term>substantially similar</term> means a
requirement of State law applicable to an element of an area identified in
section 2932 that is similar in most material respects. Where the most common
State action with respect to an element is to adopt no requirement for an
element of an area identified in such section 2932, the plurality requirement
shall be deemed to impose no requirements for such element.</text>
</paragraph></section><section changed="deleted" committee-id="SSHR00" id="id1C5D6E001FA744B3B8FA2331E46441F6" reported-display-style="strikethrough"><enum>2932.</enum><header>Harmonized
standards</header>
<subsection changed="deleted" committee-id="SSHR00" id="IDa5f72be9da384cbfa9ead0b688b0e038" reported-display-style="strikethrough"><enum>(a)</enum><header>Commission</header><text></text>
<paragraph changed="deleted" committee-id="SSHR00" id="ID1aac6d720df843369feb278fc32c629b" reported-display-style="strikethrough"><enum>(1)</enum><header>Establishment</header><text>The
Secretary, in consultation with the NAIC, shall establish the Commission on
Health Insurance Standards Harmonization (referred to in this subtitle as the
<quote>Commission</quote>) to develop recommendations that harmonize
inconsistent State health insurance laws in accordance with the laws adopted in
a plurality of the States.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDe68581790bbd4f2697573019b45386ba" reported-display-style="strikethrough"><enum>(2)</enum><header>Composition</header><text>The
Commission shall be composed of the following individuals to be appointed by
the Secretary:</text>
<subparagraph changed="deleted" committee-id="SSHR00" id="ID268ac4c6d6074aed8b5a6c7e686264a8" reported-display-style="strikethrough"><enum>(A)</enum><text>Two State
insurance commissioners, of which one shall be a Democrat and one shall be a
Republican, and of which one shall be designated as the chairperson and one
shall be designated as the vice chairperson.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="id77E76EDE52B346E8A61D256CB7F99D6C" reported-display-style="strikethrough"><enum>(B)</enum><text>Two
representatives of State government, one of which shall be a governor of a
State and one of which shall be a State legislator, and one of which shall be a
Democrat and one of which shall be a Republican.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="IDf80671eb48a041fa896abfa0561d4d7f" reported-display-style="strikethrough"><enum>(C)</enum><text>Two
representatives of employers, of which one shall represent small employers and
one shall represent large employers.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="IDcbb39d746d4e4cb192b43f16d99fff5b" reported-display-style="strikethrough"><enum>(D)</enum><text>Two
representatives of health insurers, of which one shall represent insurers that
offer coverage in all markets (including individual, small, and large markets),
and one shall represent insurers that offer coverage in the small
market.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="IDcc3766c3e91d4a60bef54d68e60444a8" reported-display-style="strikethrough"><enum>(E)</enum><text>Two
representatives of consumer organizations.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="IDf8341779bdc64bcc9efe622119c39d5c" reported-display-style="strikethrough"><enum>(F)</enum><text>Two
representatives of insurance agents and brokers.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="id56D769A611434C8DAC8217AED202707E" reported-display-style="strikethrough"><enum>(G)</enum><text>Two
representatives of healthcare providers.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="ID98319c08a3de4990b8b0c6318148c704" reported-display-style="strikethrough"><enum>(H)</enum><text>Two independent
representatives of the American Academy of Actuaries who have familiarity with
the actuarial methods applicable to health insurance.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="ID1fc92ef561fa4cd792129dc6497c921c" reported-display-style="strikethrough"><enum>(I)</enum><text>One administrator
of a qualified high risk pool.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID3886d6b00a4d476fb8989597e530ddcb" reported-display-style="strikethrough"><enum>(3)</enum><header>Terms</header><text>The
members of the Commission shall serve for the duration of the Commission. The
Secretary shall fill vacancies in the Commission as needed and in a manner
consistent with the composition described in paragraph (2).</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SSHR00" id="IDed81156f58284882b48b23fad6997c43" reported-display-style="strikethrough"><enum>(b)</enum><header>Development of
harmonized standards</header>
<paragraph changed="deleted" committee-id="SSHR00" id="id068EDA6365A64DB1ABF03771F924E366" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>In accordance with the process described in subsection
(c), the Commission shall identify and recommend nationally harmonized
standards for the small group health insurance market, the individual health
insurance market, and the large group health insurance market that relate to
the following areas:</text>
<subparagraph changed="deleted" committee-id="SSHR00" id="IDd51fe25faa9c4a52ac52b9c69ec9788c" reported-display-style="strikethrough"><enum>(A)</enum><text>Rating.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="IDab366bd868e54d299738e8dbb0cc82b1" reported-display-style="strikethrough"><enum>(B)</enum><text>Access to
coverage.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="ID1a93cb495880475a9df40c5bfa0199f9" reported-display-style="strikethrough"><enum>(C)</enum><text>Patient
protections.</text>
</subparagraph></paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID516f2e44897542c59aaf8e1e997ade8a" reported-display-style="strikethrough"><enum>(2)</enum><header>Recommendations</header><text>The
Commission shall recommend separate harmonized standards with respect to each
of the three insurance markets described in paragraph (1) and separate
standards for each element of the areas described in subparagraph (A) through
(C) of such paragraph within each such market. Notwithstanding the previous
sentence, the Commission shall not recommend any harmonized standards that
disrupt, expand, or duplicate the benefit, service, or provider mandate
standards provided in the State Benefit Compendium pursuant to section
2922(a).</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SSHR00" id="IDf1fe7043da524b129f7dcc1905c770d9" reported-display-style="strikethrough"><enum>(c)</enum><header>Process for
identifying harmonized standards</header><text></text>
<paragraph changed="deleted" committee-id="SSHR00" id="IDc416c8bb0cc44eec911902bf67969656" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>The Commission shall develop recommendations to harmonize
inconsistent State insurance laws with the laws adopted in a plurality of the
States. In carrying out the previous sentence, the Commission shall review all
State laws that regulate insurance in each of the insurance markets and areas
described in subsection (b)(1) and identify the plurality requirement within
each element of such areas. Such plurality requirement shall be the harmonized
standard for such area in each such market.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="IDcbfed401acc5456d9dbee30803e3f23b" reported-display-style="strikethrough"><enum>(2)</enum><header>Consultation</header><text>The
Commission shall consult with the National Association of Insurance
Commissioners in identifying the plurality requirements for each element within
the area and in recommending the harmonized standards.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID701bbee4d4e5412c89c9980761cb466e" reported-display-style="strikethrough"><enum>(3)</enum><header>Review of
federal laws</header><text>The Commission shall review whether any Federal law
imposes a requirement relating to the markets and areas described in subsection
(b)(1). In such case, such Federal requirement shall be deemed the plurality
requirement and the Commission shall recommend the Federal requirement as the
harmonized standard for such elements.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SSHR00" id="IDc6b0682bb2024db0b4391df7d3242210" reported-display-style="strikethrough"><enum>(d)</enum><header>Recommendations
and adoption by Secretary</header><text></text>
<paragraph changed="deleted" committee-id="SSHR00" id="ID7e3a3010cbe94a1692012cc4aeca67e5" reported-display-style="strikethrough"><enum>(1)</enum><header>Recommendations</header><text>Not
later than 1 year after the date of enactment of this title, the Commission
shall recommend to the Secretary the adoption of the harmonized standards
identified pursuant to subsection (c).</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID19cdde339c68427aa81ab58ffbc2752d" reported-display-style="strikethrough"><enum>(2)</enum><header>Regulations</header><text>Not
later than 120 days after receipt of the Commission's recommendations under
paragraph (1), the Secretary shall issue final regulations adopting the
recommended harmonized standards. If the Secretary finds the recommended
standards for an element of an area to be arbitrary and inconsistent with the
plurality requirements of this section, the Secretary may issue a unique
harmonized standard only for such element through the application of a process
similar to the process set forth in subsection (c) and through the issuance of
proposed and final regulations.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID93252db1a8cf494684b4762a90eec707" reported-display-style="strikethrough"><enum>(3)</enum><header>Effective
date</header><text>The regulations issued by the Secretary under paragraph (2)
shall be effective on the date that is 2 years after the date on which such
regulations were issued.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SSHR00" id="ID93c65c16940941b797683f15e9c6484f" reported-display-style="strikethrough"><enum>(e)</enum><header>Termination</header><text>The
Commission shall terminate and be dissolved after making the recommendations to
the Secretary pursuant to subsection (d)(1).</text>
</subsection><subsection changed="deleted" committee-id="SSHR00" id="IDcc1016a54bc44e48b028c9d12f27c569" reported-display-style="strikethrough"><enum>(f)</enum><header>Updated
harmonized standards</header>
<paragraph changed="deleted" committee-id="SSHR00" id="id67285ACFDB9D482CBCBD3C4C66096F39" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>Not later than 2 years after the termination of the
Commission under subsection (e), and every 2 years thereafter, the Secretary
shall update the harmonized standards. Such updated standards shall be adopted
in accordance with paragraph (2).</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID22cf58c9024041dc85b19c84331b50d4" reported-display-style="strikethrough"><enum>(2)</enum><header>Updating of
standards</header>
<subparagraph changed="deleted" committee-id="SSHR00" id="id1B677466A9D34CF081A95458A7B306D9" reported-display-style="strikethrough"><enum>(A)</enum><header>In
general</header><text>The Secretary shall review all State laws that regulate
insurance in each of the markets and elements of areas set forth in subsection
(b)(1) and identify whether a plurality of States have adopted substantially
similar requirements that differ from the harmonized standards adopted by the
Secretary pursuant to subsection (d). In such case, the Secretary shall
consider State laws that have been enacted with effective dates that are
contingent upon adoption as a harmonized standard by the Secretary.
Substantially similar requirements for each element within such area shall be
considered to be an updated harmonized standard for such an area.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="ID3b7f3ceae46f44fb8cc108f13b8e0f9a" reported-display-style="strikethrough"><enum>(B)</enum><header>Report</header><text>The
Secretary shall request the National Association of Insurance Commissioners to
issue a report to the Secretary every 2 years to assist the Secretary in
identifying the updated harmonized standards under this paragraph. Nothing in
this subparagraph shall be construed to prohibit the Secretary from issuing
updated harmonized standards in the absence of such a report.</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="ID9ebff5aa67c449f881c451d0770c474a" reported-display-style="strikethrough"><enum>(C)</enum><header>Regulations</header><text>The
Secretary shall issue regulations adopting updated harmonized standards under
this paragraph within 90 days of identifying such standards. Such regulations
shall be effective beginning on the date that is 2 years after the date on
which such regulations are issued.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SSHR00" id="IDeadd13aa2198449a8a3a4d1ab01ce044" reported-display-style="strikethrough"><enum>(g)</enum><header>Publication</header><text></text>
<paragraph changed="deleted" committee-id="SSHR00" id="ID1535de19216845c592422ca4d3ee624f" reported-display-style="strikethrough"><enum>(1)</enum><header>Listing</header><text>The
Secretary shall maintain an up to date listing of all harmonized standards
adopted under this section on the Internet website of the Department of Health
and Human Services.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID6b32fda24be44b148d1dd1ed7b576b73" reported-display-style="strikethrough"><enum>(2)</enum><header>Sample contract
language</header><text>The Secretary shall publish on the Internet website of
the Department of Health and Human Services sample contract language that
incorporates the harmonized standards adopted under this section, which may be
used by insurers seeking to qualify as an eligible insurer. The types of
harmonized standards that shall be included in sample contract language are the
standards that are relevant to the contractual bargain between the insurer and
insured.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SSHR00" id="IDf1aa2e706be14d518b6e23edba861f89" reported-display-style="strikethrough"><enum>(h)</enum><header>State adoption
and enforcement</header><text>Not later than 2 years after the issuance by the
Secretary of final regulations adopting harmonized standards under this
section, the States may adopt such harmonized standards (and become an adopting
State) and, in which case, shall enforce the harmonized standards pursuant to
State law.</text>
</subsection></section><section changed="deleted" committee-id="SSHR00" id="id2FB729055FE8421299B34B5C6AF0246A" reported-display-style="strikethrough"><enum>2933.</enum><header>Application
and preemption</header>
<subsection changed="deleted" committee-id="SSHR00" id="ID2478c803ed60464ea3085455c32d4681" reported-display-style="strikethrough"><enum>(a)</enum><header>Superceding of
state law</header>
<paragraph changed="deleted" committee-id="SSHR00" id="idC3CF673A7F114BA5B316EEE543552925" reported-display-style="strikethrough"><enum>(1)</enum><header>In
general</header><text>The harmonized standards adopted under this subtitle
shall supersede any and all State laws (whether enacted prior to or after the
date of enactment of this title) insofar as such State laws relate to the areas
of harmonized standards as applied to an eligible insurer, or health insurance
coverage issued by a eligible insurer, in a nonadopting State.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID127be26faa354543bf69dbe8fd9b5ab6" reported-display-style="strikethrough"><enum>(2)</enum><header>Nonadopting
states</header><text>This subtitle shall supersede any and all State laws of a
nonadopting State (whether enacted prior to or after the date of enactment of
this title) insofar as they may—</text>
<subparagraph changed="deleted" committee-id="SSHR00" id="id24590FF12E164D669BFC7952FAD7A3FD" reported-display-style="strikethrough"><enum>(A)</enum><text>prohibit an
eligible insurer from offering coverage consistent with the harmonized
standards in the nonadopting State; or</text>
</subparagraph><subparagraph changed="deleted" committee-id="SSHR00" id="id9EA08BCCB8BA4AB29D6E910E3A9C6D7A" reported-display-style="strikethrough"><enum>(B)</enum><text>discriminate
against or among eligible insurers offering or seeking to offer health
insurance coverage consistent with the harmonized standards in the nonadopting
State.</text>
</subparagraph></paragraph></subsection><subsection changed="deleted" committee-id="SSHR00" id="ID2badb3bb22b34408bf9e05b7af2a29dc" reported-display-style="strikethrough"><enum>(b)</enum><header>Savings clause
and construction</header><text></text>
<paragraph changed="deleted" committee-id="SSHR00" id="ID8c9ba41fa3984866aeabc8fa7fca89fa" reported-display-style="strikethrough"><enum>(1)</enum><header>Nonapplication
to adopting states</header><text>Subsection (a) shall not apply with respect to
adopting States.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID1219757fbee44725a548bc3379349f73" reported-display-style="strikethrough"><enum>(2)</enum><header>Nonapplication
to certain insurers</header><text>Subsection (a) shall not apply with respect
to insurers that do not qualify as eligible insurers who offer health insurance
coverage in a nonadopting State.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="ID8fcfde0b3a0d4168bff3d764842f57a0" reported-display-style="strikethrough"><enum>(3)</enum><header>Nonapplication
where obtaining relief under state law</header><text>Subsection (a)(1) shall
not apply to any State law of a nonadopting State to the extent necessary to
permit individuals or the insurance department of the State (or other State
agency) to obtain relief under State law to require an eligible insurer to
comply with the terms of the health insurance coverage issued in a nonadopting
State. In no case shall this paragraph, or any other provision of this
subtitle, be construed to permit a cause of action on behalf of an individual
or any other person under State law in connection with a group health plan that
is subject to the Employee Retirement Income Security Act of 1974 or health
insurance coverage issued in connection with such plan.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="id8D46ED49C07D453E8A027E88A9C94EA3" reported-display-style="strikethrough"><enum>(4)</enum><header>Nonapplication
to enforce requirements relating to the compendium</header><text>Subsection
(a)(1) shall not apply to any State law in a nonadopting State to the extent
necessary to provide the insurance department of the State (or other state
agency) authority to enforce State law requirements relating to the harmonized
standards that are not set forth in the terms of the health insurance coverage
issued in a nonadopting State, in a manner that is consistent with the
harmonized standards and imposes no greater duties or obligations on health
insurance issuers than the harmonized standards.</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="id7F9BE8A0546D4D05B25908E22B0A7F0F" reported-display-style="strikethrough"><enum>(5)</enum><header>Nonapplication
to subsection <enum-in-header>(a)(2)</enum-in-header></header><text>Paragraphs
(3) and (4) shall not apply with respect to subsection (a)(2).</text>
</paragraph><paragraph changed="deleted" committee-id="SSHR00" id="idCF5EE60D1FEA464C9CC24D6446C23C2B" reported-display-style="strikethrough"><enum>(6)</enum><header>No affect on
preemption</header><text>In no case shall this subsection be construed to
affect the scope of the preemption provided for under the Employee Retirement
Income Security Act of 1974.</text>
</paragraph></subsection><subsection changed="deleted" committee-id="SSHR00" id="ID73db740941624f9688da663452d0a709" reported-display-style="strikethrough"><enum>(c)</enum><header>Effective
date</header><text>This section shall apply beginning on the date that is 2
years after the date on which final regulations are issued by the Secretary
under this subtitle adopting the harmonized standards.</text>
</subsection></section><section changed="deleted" committee-id="SSHR00" id="ID463f5967468445c2935ffde188d6c7d4" reported-display-style="strikethrough"><enum>2934.</enum><header>Civil actions
and jurisdiction</header>
<subsection changed="deleted" committee-id="SSHR00" id="IDa929c469dead4c4dadd292c5655bd595" reported-display-style="strikethrough"><enum>(a)</enum><header>In
general</header><text>The district courts of the United States shall have
exclusive jurisdiction over civil actions involving the interpretation of this
subtitle.</text>
</subsection><subsection changed="deleted" committee-id="SSHR00" id="id6C2A9B20A2C64837A73B0AD01255B6FE" reported-display-style="strikethrough"><enum>(b)</enum><header>Actions</header><text>A
health insurance issuer may bring an action in the district courts of the
United States for injunctive or other equitable relief against a nonadopting
State in connection with the application of a State law that violates this
subtitle.</text>
</subsection><subsection changed="deleted" committee-id="SSHR00" id="id0C5517495CEC4C7787DF5577EBF31C03" reported-display-style="strikethrough"><enum>(c)</enum><header>Violations of
section 2933</header><text>In the case of a nonadopting State that is in
violation of section 2933(a)(2), a health insurance issuer may bring an action
in the district courts of the United States for damages against the nonadopting
State and, if the health insurance issuer prevails in such action, the district
court shall award the health insurance issuer its reasonable attorneys fees and
costs.</text>
</subsection></section><section changed="deleted" commented="no" committee-id="SSHR00" display-inline="no-display-inline" id="ID19a07290776843259dda9c45d706fa06" reported-display-style="strikethrough" section-type="subsequent-section"><enum>2935.</enum><header>Authorization of
appropriations</header><text display-inline="no-display-inline">There are
authorized to be appropriated such sums as may be necessary to carry out this
subtitle.</text>
</section></subtitle><after-quoted-block>.</after-quoted-block></quoted-block>
</section>
1.Short title; table of
contents; purpose
(a)This Act may be cited as the Health Insurance Marketplace Modernization and
Affordability Act of 2006
.
(b)The table of contents is as follows:
Sec. 1. Short title; table of contents;
purposes.
TITLE I—Small business health plans
Sec. 101. Rules governing small business health
plans.
Sec. 102. Cooperation between Federal and State
authorities.
Sec. 103. Effective date and transitional and other
rules.
TITLE II—Market relief
Sec. 201. Market relief.
TITLE III—Harmonization of health insurance
standards
Sec. 301. Health Insurance Standards Harmonization.
(c)It
is the purpose of this Act to—
(1)make more affordable
health insurance options available to small businesses, working families, and
all Americans;
(2)assure effective State
regulatory protection of the interests of health insurance consumers;
and
(3)create a more efficient
and affordable health insurance marketplace through collaborative development
of uniform regulatory standards.
<enum>I</enum><header>Small business health
plans</header>
<section changed="added" committee-id="SSHR00" id="id63ec4198-d504-47da-8c3a-9ea8f2e0493b" reported-display-style="italic"><enum>101.</enum><header>Rules governing small
business health plans</header>
<subsection changed="added" committee-id="SSHR00" id="idf80a9e0e-fadd-481e-8ad5-2051d97631a9" reported-display-style="italic"><enum>(a)</enum><header>In
general</header><text>Subtitle B of title I of the
<act-name parsable-cite="ERISA">Employee Retirement Income Security Act of
1974</act-name> is amended by adding after part 7 the following new
part:</text>
<quoted-block act-name="Employee Retirement Income Security Act of 1974" changed="added" committee-id="SSHR00" id="id0d4fe743-2189-4532-8823-2dffd1eefa36" reported-display-style="italic">
<part changed="added" committee-id="SSHR00" id="ide5c17d0b-1329-4590-944d-c2d8ea5dd8d4" reported-display-style="italic"><enum>8</enum><header>Rules governing small
business health plans</header>
<section changed="added" committee-id="SSHR00" id="idcee5bb61-497c-4204-9ba8-3ea895d6c119" reported-display-style="italic"><enum>801.</enum><header>Small business health
plans</header>
<subsection changed="added" committee-id="SSHR00" id="id6a38716a-f2aa-4f64-9354-875f402cca25" reported-display-style="italic"><enum>(a)</enum><header>In
general</header><text>For purposes of this part, the term <term>small business
health plan</term> means a fully insured group health plan whose sponsor is (or
is deemed under this part to be) described in subsection (b).</text>
</subsection><subsection changed="added" committee-id="SSHR00" id="idd34a2c20-4527-4471-9004-f4d046e1697c" reported-display-style="italic"><enum>(b)</enum><header>Sponsorship</header><text>The
sponsor of a group health plan is described in this subsection if such
sponsor—</text>
<paragraph changed="added" committee-id="SSHR00" id="id1a63f12d-fa12-482a-bf08-ffa20b3ba8e6" reported-display-style="italic"><enum>(1)</enum><text>is organized and
maintained in good faith, with a constitution and bylaws specifically stating
its purpose and providing for periodic meetings on at least an annual basis, as
a bona fide trade association, a bona fide industry association (including a
rural electric cooperative association or a rural telephone cooperative
association), a bona fide professional association, or a bona fide chamber of
commerce (or similar bona fide business association, including a corporation or
similar organization that operates on a cooperative basis (within the meaning
of section 1381 of the Internal Revenue Code of 1986)), for substantial
purposes other than that of obtaining medical care;</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id98e9d683-a158-46dc-baef-c6dbe506e165" reported-display-style="italic"><enum>(2)</enum><text>is established as a
permanent entity which receives the active support of its members and requires
for membership payment on a periodic basis of dues or payments necessary to
maintain eligibility for membership;</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="idadec4fe9-be1b-4c59-87f0-c7ee75d200c0" reported-display-style="italic"><enum>(3)</enum><text>does not condition
membership, such dues or payments, or coverage under the plan on the basis of
health status-related factors with respect to the employees of its members (or
affiliated members), or the dependents of such employees, and does not
condition such dues or payments on the basis of group health plan
participation; and</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="idA63D185E87F54092A35E890BF3D63DA1" reported-display-style="italic"><enum>(4)</enum><text>does not condition
membership on the basis of a minimum group size.</text>
</paragraph><continuation-text changed="added" committee-id="SSHR00" continuation-text-level="subsection" reported-display-style="italic">Any
sponsor consisting of an association of entities which meet the requirements of
paragraphs (1), (2), (3), and (4) shall be deemed to be a sponsor described in
this subsection.</continuation-text></subsection></section><section changed="added" committee-id="SSHR00" id="id627e2dc3-4431-41f1-9fd5-7d8609d67ec7" reported-display-style="italic"><enum>802.</enum><header>Certification of small
business health plans</header>
<subsection changed="added" committee-id="SSHR00" id="id0bb416bf-35eb-412b-9231-98bb8956ae50" reported-display-style="italic"><enum>(a)</enum><header>In
general</header><text>Not later than 6 months after the date of enactment of
this part, the applicable authority shall prescribe by interim final rule a
procedure under which the applicable authority shall certify small business
health plans which apply for certification as meeting the requirements of this
part.</text>
</subsection><subsection changed="added" committee-id="SSHR00" id="id3b48b6d0-a427-493e-b622-23eb2dfdf59f" reported-display-style="italic"><enum>(b)</enum><header>Requirements applicable
to certified plans</header><text>A small business health plan with respect to
which certification under this part is in effect shall meet the applicable
requirements of this part, effective on the date of certification (or, if
later, on the date on which the plan is to commence operations).</text>
</subsection><subsection changed="added" committee-id="SSHR00" id="id04fa468f-0dd1-49e2-9105-4b616175b77d" reported-display-style="italic"><enum>(c)</enum><header>Requirements for
continued certification</header><text>The applicable authority may provide by
regulation for continued certification of small business health plans under
this part. Such regulation shall provide for the revocation of a certification
if the applicable authority finds that the small business health plan involved
is failing to comply with the requirements of this part.</text>
</subsection><subsection changed="added" committee-id="SSHR00" id="id33168a19-5714-4446-908e-833c9882a006" reported-display-style="italic"><enum>(d)</enum><header>Expedited and deemed
certification</header>
<paragraph changed="added" committee-id="SSHR00" id="idE87AB197F4B84873B5A79EC3D8D832DE" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>If the Secretary fails to act on an application for
certification under this section within 90 days of receipt of such application,
the applying small business health plan shall be deemed certified until such
time as the Secretary may deny for cause the application for
certification.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="idF8295EA2363947D9BA5E7D4F9B771BE7" reported-display-style="italic"><enum>(2)</enum><header>Civil
penalty</header><text>The Secretary may assess a civil penalty against the
board of trustees and plan sponsor (jointly and severally) of a small business
health plan that is deemed certified under paragraph (1) of up to $500,000 in
the event the Secretary determines that the application for certification of
such small business health plan was willfully or with gross negligence
incomplete or inaccurate.</text>
</paragraph></subsection></section><section changed="added" committee-id="SSHR00" id="id1d967d14-2845-4c01-a504-cb053572074c" reported-display-style="italic"><enum>803.</enum><header>Requirements relating
to sponsors and boards of trustees</header>
<subsection changed="added" committee-id="SSHR00" id="idd098221b-fe3b-4978-ba19-0f2bc00d39a8" reported-display-style="italic"><enum>(a)</enum><header>Sponsor</header><text>The
requirements of this subsection are met with respect to a small business health
plan if the sponsor has met (or is deemed under this part to have met) the
requirements of section 801(b) for a continuous period of not less than 3 years
ending with the date of the application for certification under this
part.</text>
</subsection><subsection changed="added" committee-id="SSHR00" id="id77eccb53-c997-4da3-8031-d52775ba9cf0" reported-display-style="italic"><enum>(b)</enum><header>Board of
trustees</header><text>The requirements of this subsection are met with respect
to a small business health plan if the following requirements are met:</text>
<paragraph changed="added" committee-id="SSHR00" id="idf37486b5-5b10-43a7-856b-d278e81b2591" reported-display-style="italic"><enum>(1)</enum><header>Fiscal
control</header><text>The plan is operated, pursuant to a plan document, by a
board of trustees which pursuant to a trust agreement has complete fiscal
control over the plan and which is responsible for all operations of the
plan.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id4f4e3c57-ad7a-4d32-a540-613e09f2c82c" reported-display-style="italic"><enum>(2)</enum><header>Rules of operation and
financial controls</header><text>The board of trustees has in effect rules of
operation and financial controls, based on a 3-year plan of operation, adequate
to carry out the terms of the plan and to meet all requirements of this title
applicable to the plan.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id61567f7c-bfd4-44dc-9ebe-92a6d3bbf133" reported-display-style="italic"><enum>(3)</enum><header>Rules governing
relationship to participating employers and to contractors</header>
<subparagraph changed="added" committee-id="SSHR00" id="idc89f4a55-42fb-4924-afae-2d4c2cd3a3d7" reported-display-style="italic"><enum>(A)</enum><header>Board
membership</header>
<clause changed="added" committee-id="SSHR00" id="idcc5044d8-0981-4dfb-ab98-ec7ac88ee656" reported-display-style="italic"><enum>(i)</enum><header>In
general</header><text>Except as provided in clauses (ii) and (iii), the members
of the board of trustees are individuals selected from individuals who are the
owners, officers, directors, or employees of the participating employers or who
are partners in the participating employers and actively participate in the
business.</text>
</clause><clause changed="added" commented="no" committee-id="SSHR00" id="idd7f29c2d-c315-4267-a442-b7dad32d11c2" reported-display-style="italic"><enum>(ii)</enum><header>Limitation</header>
<subclause changed="added" commented="no" committee-id="SSHR00" id="id023b3af9-ecc2-42e8-a20d-b817e200f63e" reported-display-style="italic"><enum>(I)</enum><header>General
rule</header><text>Except as provided in subclauses (II) and (III), no such
member is an owner, officer, director, or employee of, or partner in, a
contract administrator or other service provider to the plan.</text>
</subclause><subclause changed="added" commented="no" committee-id="SSHR00" id="idd4bd00dc-e0ee-4cb6-8b85-616cd82d30e0" reported-display-style="italic"><enum>(II)</enum><header>Limited exception for
providers of services solely on behalf of the sponsor</header><text>Officers or
employees of a sponsor which is a service provider (other than a contract
administrator) to the plan may be members of the board if they constitute not
more than 25 percent of the membership of the board and they do not provide
services to the plan other than on behalf of the sponsor.</text>
</subclause><subclause changed="added" commented="no" committee-id="SSHR00" id="id0d03aa73-ed03-4756-8fb9-43501bc8ecbe" reported-display-style="italic"><enum>(III)</enum><header>Treatment of
providers of medical care</header><text>In the case of a sponsor which is an
association whose membership consists primarily of providers of medical care,
subclause (I) shall not apply in the case of any service provider described in
subclause (I) who is a provider of medical care under the plan.</text>
</subclause></clause><clause changed="added" commented="no" committee-id="SSHR00" id="id724ae138-f036-4120-9a04-ec88cdfdcdce" reported-display-style="italic"><enum>(iii)</enum><header>Certain plans
excluded</header><text>Clause (i) shall not apply to a small business health
plan which is in existence on the date of the enactment of the
<short-title>Health Insurance Marketplace Modernization
and Affordability Act of 2006</short-title>.</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SSHR00" id="id2d615b4e-4663-4087-89dc-6bd91d848927" reported-display-style="italic"><enum>(B)</enum><header>Sole
authority</header><text>The board has sole authority under the plan to approve
applications for participation in the plan and to contract with
insurers.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SSHR00" id="idade4dc4b-d1a1-4aa1-97ad-6cd256439505" reported-display-style="italic"><enum>(c)</enum><header>Treatment of franchise
networks</header><text>In the case of a group health plan which is established
and maintained by a franchiser for a franchise network consisting of its
franchisees—</text>
<paragraph changed="added" committee-id="SSHR00" id="ide647c69d-3fd5-4fd2-8cf1-fa3bb73c1748" reported-display-style="italic"><enum>(1)</enum><text>the requirements of
subsection (a) and section 801(a) shall be deemed met if such requirements
would otherwise be met if the franchiser were deemed to be the sponsor referred
to in section 801(b), such network were deemed to be an association described
in section 801(b), and each franchisee were deemed to be a member (of the
association and the sponsor) referred to in section 801(b); and</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id79587e47-d05e-4e78-95c3-445b6de18635" reported-display-style="italic"><enum>(2)</enum><text>the requirements of
section 804(a)(1) shall be deemed met.</text>
</paragraph><continuation-text changed="added" committee-id="SSHR00" continuation-text-level="subsection" reported-display-style="italic">The
Secretary may by regulation define for purposes of this subsection the terms
<quote>franchiser</quote>, <quote>franchise network</quote>, and
<quote>franchisee</quote>.</continuation-text></subsection></section><section changed="added" committee-id="SSHR00" id="id6cb1b4ba-743c-4d82-8255-1f53ccbb6827" reported-display-style="italic"><enum>804.</enum><header>Participation and
coverage requirements</header>
<subsection changed="added" committee-id="SSHR00" id="id3c04fae2-2148-4458-a143-a3c87aec2647" reported-display-style="italic"><enum>(a)</enum><header>Covered employers and
individuals</header><text>The requirements of this subsection are met with
respect to a small business health plan if, under the terms of the plan—</text>
<paragraph changed="added" committee-id="SSHR00" id="id50b73eaa-1a3c-47fd-ad5a-a797769b0db3" reported-display-style="italic"><enum>(1)</enum><text>each participating
employer must be—</text>
<subparagraph changed="added" committee-id="SSHR00" id="id356055df-c1f3-400f-ba52-da148cdad1df" reported-display-style="italic"><enum>(A)</enum><text>a member of the
sponsor;</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="idf1626757-4c41-4a21-93ce-0563883a0a32" reported-display-style="italic"><enum>(B)</enum><text>the sponsor; or</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="id9b0a3b33-3593-47ef-b7cf-f3ddbd26fde2" reported-display-style="italic"><enum>(C)</enum><text>an affiliated member of
the sponsor, except that, in the case of a sponsor which is a professional
association or other individual-based association, if at least one of the
officers, directors, or employees of an employer, or at least one of the
individuals who are partners in an employer and who actively participates in
the business, is a member or such an affiliated member of the sponsor,
participating employers may also include such employer; and</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSHR00" id="id60cdbbcc-f373-42ad-a234-355bc7af9985" reported-display-style="italic"><enum>(2)</enum><text>all individuals
commencing coverage under the plan after certification under this part must
be—</text>
<subparagraph changed="added" committee-id="SSHR00" id="id3a81c002-04ac-4650-a1a7-c68b90443d31" reported-display-style="italic"><enum>(A)</enum><text>active or retired owners
(including self-employed individuals), officers, directors, or employees of, or
partners in, participating employers; or</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="idab4018cc-267b-4a64-a7e5-dfb399035a37" reported-display-style="italic"><enum>(B)</enum><text>the dependents of
individuals described in subparagraph (A).</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SSHR00" id="id8a62c4fc-f074-49c9-9ece-6f35c8aff25f" reported-display-style="italic"><enum>(b)</enum><header>Individual market
unaffected</header><text>The requirements of this subsection are met with
respect to a small business health plan if, under the terms of the plan, no
participating employer may provide health insurance coverage in the individual
market for any employee not covered under the plan which is similar to the
coverage contemporaneously provided to employees of the employer under the
plan, if such exclusion of the employee from coverage under the plan is based
on a health status-related factor with respect to the employee and such
employee would, but for such exclusion on such basis, be eligible for coverage
under the plan.</text>
</subsection><subsection changed="added" committee-id="SSHR00" id="idc7db66e2-2b45-4696-8786-5c9297691c9f" reported-display-style="italic"><enum>(c)</enum><header>Prohibition of
discrimination against employers and employees eligible to
participate</header><text>The requirements of this subsection are met with
respect to a small business health plan if—</text>
<paragraph changed="added" committee-id="SSHR00" id="id44df3d13-d26c-43bb-bcef-2f7e1548179c" reported-display-style="italic"><enum>(1)</enum><text>under the terms of the
plan, all employers meeting the preceding requirements of this section are
eligible to qualify as participating employers for all geographically available
coverage options, unless, in the case of any such employer, participation or
contribution requirements of the type referred to in section 2711 of the
<act-name parsable-cite="PHSA">Public Health Service Act</act-name> are not
met;</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="ida7da6ffb-8cb3-456b-81cf-3d375ee9b210" reported-display-style="italic"><enum>(2)</enum><text>information regarding all
coverage options available under the plan is made readily available to any
employer eligible to participate; and</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="idbc8743d3-d4b3-459f-b96a-1ab5badd6be6" reported-display-style="italic"><enum>(3)</enum><text>the applicable
requirements of sections 701, 702, and 703 are met with respect to the
plan.</text>
</paragraph></subsection></section><section changed="added" committee-id="SSHR00" id="idf6862f00-d043-4b81-b148-0a5658230e94" reported-display-style="italic"><enum>805.</enum><header>Other requirements
relating to plan documents, contribution rates, and benefit options</header>
<subsection changed="added" committee-id="SSHR00" id="idc2c6b90e-7760-4dc1-bba2-05c36dd65c64" reported-display-style="italic"><enum>(a)</enum><header>In
general</header><text>The requirements of this section are met with respect to
a small business health plan if the following requirements are met:</text>
<paragraph changed="added" committee-id="SSHR00" id="id62a56cc4-3f2a-4b4d-88f5-564680b94269" reported-display-style="italic"><enum>(1)</enum><header>Contents of governing
instruments</header>
<subparagraph changed="added" committee-id="SSHR00" id="id80b600fb-4b69-4d60-8abd-c5bd4f2780f5" reported-display-style="italic"><enum>(A)</enum><header>In
general</header><text>The instruments governing the plan include a written
instrument, meeting the requirements of an instrument required under section
402(a)(1), which—</text>
<clause changed="added" committee-id="SSHR00" id="ida25db33b-1302-4008-a9b9-b72eec594114" reported-display-style="italic"><enum>(i)</enum><text>provides that the board
of trustees serves as the named fiduciary required for plans under section
402(a)(1) and serves in the capacity of a plan administrator (referred to in
section 3(16)(A)); and</text>
</clause><clause changed="added" committee-id="SSHR00" id="id3784b19a-d43e-48cd-a113-f358d35e5f78" reported-display-style="italic"><enum>(ii)</enum><text>provides that the
sponsor of the plan is to serve as plan sponsor (referred to in section
3(16)(B)).</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SSHR00" id="idef1ab5fe-2388-4c97-a07a-b375840bb578" reported-display-style="italic"><enum>(B)</enum><header>Description of material
provisions</header><text>The terms of the health insurance coverage (including
the terms of any individual certificates that may be offered to individuals in
connection with such coverage) describe the material benefit and rating, and
other provisions set forth in this section and such material provisions are
included in the summary plan description.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSHR00" id="id35fafb0e-647a-4a7f-98cd-d573b621357a" reported-display-style="italic"><enum>(2)</enum><header>Contribution rates must
be nondiscriminatory</header>
<subparagraph changed="added" committee-id="SSHR00" id="id25908aa3-c762-49db-9790-4eb5cd168eca" reported-display-style="italic"><enum>(A)</enum><header>In
general</header><text>The contribution rates for any participating small
employer shall not vary on the basis of any health status-related factor in
relation to employees of such employer or their beneficiaries and shall not
vary on the basis of the type of business or industry in which such employer is
engaged.</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="id881cbd22-d9ef-4c0c-8a76-472d6ddf21f1" reported-display-style="italic"><enum>(B)</enum><header>Effect of
title</header><text>Nothing in this title or any other provision of law shall
be construed to preclude a health insurance issuer offering health insurance
coverage in connection with a small business health plan, and at the request of
such small business health plan, from—</text>
<clause changed="added" committee-id="SSHR00" id="id63fff387-018e-4d1d-9d3f-f846b81691a4" reported-display-style="italic"><enum>(i)</enum><text>setting contribution
rates for the small business health plan based on the claims experience of the
plan so long as any variation in such rates complies with the requirements of
clause (ii), except that small business health plans shall not be subject to
paragraphs (1)(A) and (3) of section 2911(b) of the Public Health Service Act;
or</text>
</clause><clause changed="added" committee-id="SSHR00" id="id32852a41-b128-4117-ab27-d8a7625cfea4" reported-display-style="italic"><enum>(ii)</enum><text>varying contribution
rates for participating employers in a small business health plan in a State to
the extent that such rates could vary using the same methodology employed in
such State for regulating small group premium rates, subject to the terms of
part I of subtitle A of title XXIX of the Public Health Service Act (relating
to rating requirements), as added by title II of the
<short-title>Health Insurance Marketplace Modernization
and Affordability Act of 2006</short-title>.</text>
</clause></subparagraph></paragraph><paragraph changed="added" committee-id="SSHR00" id="idB83A689918FE436A8D125BF2A86AF6DD" reported-display-style="italic"><enum>(3)</enum><header>Exceptions regarding
self-employed and large employers</header>
<subparagraph changed="added" committee-id="SSHR00" id="id0B8CDED486B24A61BE53AAE494BBDBDE" reported-display-style="italic"><enum>(A)</enum><header>Self employed</header>
<clause changed="added" committee-id="SSHR00" id="ID5ad77e3575e64eeb9be66d98f507e370" reported-display-style="italic"><enum>(i)</enum><header>In
general</header><text>Small business health plans with participating employers
who are self-employed individuals (and their dependents) shall enroll such
self-employed participating employers in accordance with rating rules that do
not violate the rating rules for self-employed individuals in the State in
which such self-employed participating employers are located.</text>
</clause><clause changed="added" committee-id="SSHR00" id="IDf4637e49ce884fe6ac191e520101a36a" reported-display-style="italic"><enum>(ii)</enum><header>Guarantee
issue</header><text>Small business health plans with participating employers
who are self-employed individuals (and their dependents) may decline to
guarantee issue to such participating employers in States in which guarantee
issue is not otherwise required for the self-employed in that State.</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SSHR00" id="IDf864fc14833145d8ba867463d03356a8" reported-display-style="italic"><enum>(B)</enum><header>Large
employers</header><text>Small business health plans with participating
employers that are larger than small employers (as defined in section
808(a)(10)) shall enroll such large participating employers in accordance with
rating rules that do not violate the rating rules for large employers in the
State in which such large participating employers are located.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSHR00" id="idf877fb84-c33c-4bc9-a4c1-b86cf6dbfa1b" reported-display-style="italic"><enum>(4)</enum><header>Regulatory
requirements</header><text>Such other requirements as the applicable authority
determines are necessary to carry out the purposes of this part, which shall be
prescribed by the applicable authority by regulation.</text>
</paragraph></subsection><subsection changed="added" committee-id="SSHR00" id="idb5e66279-45de-4f5f-a7b0-310bdefe793c" reported-display-style="italic"><enum>(b)</enum><header>Ability of small
business health plans to design benefit options</header><text>Nothing in this
part or any provision of State law (as defined in section 514(c)(1)) shall be
construed to preclude a small business health plan or a health insurance issuer
offering health insurance coverage in connection with a small business health
plan from exercising its sole discretion in selecting the specific benefits and
services consisting of medical care to be included as benefits under such plan
or coverage, except that such benefits and services must meet the terms and
specifications of part II of subtitle A of title XXIX of the Public Health
Service Act (relating to lower cost plans), as added by title II of the
<short-title>Health Insurance Marketplace Modernization
and Affordability Act of 2006</short-title>.</text>
</subsection><subsection changed="added" committee-id="SSHR00" id="id2d042b35-4f56-4cd2-a624-06dfdbcfd8c2" reported-display-style="italic"><enum>(c)</enum><header>Domicile and
non-domicile States</header>
<paragraph changed="added" committee-id="SSHR00" id="id665687d6-c513-4cbc-a354-e37277d9c574" reported-display-style="italic"><enum>(1)</enum><header>Domicile
state</header><text>Coverage shall be issued to a small business health plan in
the State in which the sponsor's principal place of business is located.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="idb872c5ed-4c4a-4e14-86ed-88b02c3f2fba" reported-display-style="italic"><enum>(2)</enum><header>Non-domicile
states</header><text>With respect to a State (other than the domicile State) in
which participating employers of a small business health plan are located but
in which the insurer of the small business health plan in the domicile State is
not yet licensed, the following shall apply:</text>
<subparagraph changed="added" committee-id="SSHR00" id="id48554C7B993846C884F8E6F67F5D6726" reported-display-style="italic"><enum>(A)</enum><header>Temporary
preemption</header><text>If, upon the expiration of the 90-day period following
the submission of a licensure application by such insurer (that includes a
certified copy of an approved licensure application as submitted by such
insurer in the domicile State) to such State, such State has not approved or
denied such application, such State's health insurance licensure laws shall be
temporarily preempted and the insurer shall be permitted to operate in such
State, subject to the following terms:</text>
<clause changed="added" committee-id="SSHR00" id="idFC615C2848D141BDB246D98C4DB82C9D" reported-display-style="italic"><enum>(i)</enum><header>Application of
non-domicile State law</header><text>Except with respect to licensure and with
respect to the terms of subtitle A of title XXIX of the Public Health Service
Act (relating to rating and benefits as added by the
<short-title>Health Insurance Marketplace Modernization
and Affordability Act of 2006</short-title>), the laws and authority of the
non-domicile State shall remain in full force and effect.</text>
</clause><clause changed="added" committee-id="SSHR00" id="id1807C9550AF1457A873EBCF79497C6B7" reported-display-style="italic"><enum>(ii)</enum><header>Revocation of
preemption</header><text>The preemption of a non-domicile State's health
insurance licensure laws pursuant to this subparagraph, shall be terminated
upon the occurrence of either of the following:</text>
<subclause changed="added" committee-id="SSHR00" id="idFD98FFFFE61C4B9492F25A9E9D1BBCB0" reported-display-style="italic"><enum>(I)</enum><header>Approval or denial of
application</header><text>The approval of denial of an insurer's licensure
application, following the laws and regulations of the non-domicile State with
respect to licensure.</text>
</subclause><subclause changed="added" committee-id="SSHR00" id="id340446A22FC84038B729346D0E188CDE" reported-display-style="italic"><enum>(II)</enum><header>Determination of
material violation</header><text>A determination by a non-domicile State that
an insurer operating in a non-domicile State pursuant to the preemption
provided for in this subparagraph is in material violation of the insurance
laws (other than licensure and with respect to the terms of subtitle A of title
XXIX of the Public Health Service Act (relating to rating and benefits added by
the <short-title>Health Insurance Marketplace
Modernization and Affordability Act of 2006</short-title>)) of such
State.</text>
</subclause></clause></subparagraph><subparagraph changed="added" committee-id="SSHR00" id="idA746AA6FE23C4E56A55760F037D92DCE" reported-display-style="italic"><enum>(B)</enum><header>No prohibition on
promotion</header><text>Nothing in this paragraph shall be construed to
prohibit a small business health plan or an insurer from promoting coverage
prior to the expiration of the 90-day period provided for in subparagraph (A),
except that no enrollment or collection of contributions shall occur before the
expiration of such 90-day period.</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="ID49920b8d1c6347ceb3b392e45ab9e8ff" reported-display-style="italic"><enum>(C)</enum><header>licensure</header><text>Except
with respect to the application of the temporary preemption provision of this
paragraph, nothing in this part shall be construed to limit the requirement
that insurers issuing coverage to small business health plans shall be licensed
in each State in which the small business health plans operate.</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="ID3b0c70049cf94ddb8ba95009138d990f" reported-display-style="italic"><enum>(D)</enum><header>Servicing by licensed
insurers</header><text>Notwithstanding subparagraph (C), the requirements of
this subsection may also be satisfied if the participating employers of a small
business health plan are serviced by a licensed insurer in that State, even
where such insurer is not the insurer of such small business health plan in the
State in which such small business health plan is domiciled.</text>
</subparagraph></paragraph></subsection></section><section changed="added" committee-id="SSHR00" id="id10fc4550-d7c7-4e7d-b9f3-d2adc2d8d76f" reported-display-style="italic"><enum>806.</enum><header>Requirements for
application and related requirements</header>
<subsection changed="added" committee-id="SSHR00" id="ida1ab8260-8d8a-447d-825e-95a65d936edc" reported-display-style="italic"><enum>(a)</enum><header>Filing
fee</header><text>Under the procedure prescribed pursuant to section 802(a), a
small business health plan shall pay to the applicable authority at the time of
filing an application for certification under this part a filing fee in the
amount of $5,000, which shall be available in the case of the Secretary, to the
extent provided in appropriation Acts, for the sole purpose of administering
the certification procedures applicable with respect to small business health
plans.</text>
</subsection><subsection changed="added" committee-id="SSHR00" id="id8ced235a-07ca-4820-b448-056250275e3d" reported-display-style="italic"><enum>(b)</enum><header>Information to be
included in application for certification</header><text>An application for
certification under this part meets the requirements of this section only if it
includes, in a manner and form which shall be prescribed by the applicable
authority by regulation, at least the following information:</text>
<paragraph changed="added" committee-id="SSHR00" id="id39054b10-ee14-4ef3-a8ce-363de0478f34" reported-display-style="italic"><enum>(1)</enum><header>Identifying
information</header><text>The names and addresses of—</text>
<subparagraph changed="added" committee-id="SSHR00" id="id322343e9-73a5-4ec2-97ad-4107d1546c58" reported-display-style="italic"><enum>(A)</enum><text>the sponsor; and</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="idcc80f58a-7f7b-45c6-99b8-89aa87582c84" reported-display-style="italic"><enum>(B)</enum><text>the members of the board
of trustees of the plan.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSHR00" id="idb947d3cf-af3b-45e9-b6cb-8817411e521e" reported-display-style="italic"><enum>(2)</enum><header>States in which plan
intends to do business</header><text>The States in which participants and
beneficiaries under the plan are to be located and the number of them expected
to be located in each such State.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="idb0751cb6-3364-41ba-97fb-2532699b6c58" reported-display-style="italic"><enum>(3)</enum><header>Bonding
requirements</header><text>Evidence provided by the board of trustees that the
bonding requirements of section 412 will be met as of the date of the
application or (if later) commencement of operations.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id13009586-57d9-428f-af19-553142effbfd" reported-display-style="italic"><enum>(4)</enum><header>Plan
documents</header><text>A copy of the documents governing the plan (including
any bylaws and trust agreements), the summary plan description, and other
material describing the benefits that will be provided to participants and
beneficiaries under the plan.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="ida4d1a229-a633-4bcb-b62f-da1eba72ccbf" reported-display-style="italic"><enum>(5)</enum><header>Agreements with service
providers</header><text>A copy of any agreements between the plan, health
insurance issuer, and contract administrators and other service
providers.</text>
</paragraph></subsection><subsection changed="added" committee-id="SSHR00" id="id324c2055-3a63-4e14-a6d9-ee3b4f77db83" reported-display-style="italic"><enum>(c)</enum><header>Filing notice of
certification with States</header><text>A certification granted under this part
to a small business health plan shall not be effective unless written notice of
such certification is filed with the applicable State authority of each State
in which the small business health plans operate.</text>
</subsection><subsection changed="added" committee-id="SSHR00" id="id670c7533-d198-408c-9417-eb96324b982b" reported-display-style="italic"><enum>(d)</enum><header>Notice of material
changes</header><text>In the case of any small business health plan certified
under this part, descriptions of material changes in any information which was
required to be submitted with the application for the certification under this
part shall be filed in such form and manner as shall be prescribed by the
applicable authority by regulation. The applicable authority may require by
regulation prior notice of material changes with respect to specified matters
which might serve as the basis for suspension or revocation of the
certification.</text>
</subsection></section><section changed="added" commented="no" committee-id="SSHR00" id="id51968150-ed6e-430c-89ea-9d59c10215f5" reported-display-style="italic"><enum>807.</enum><header>Notice requirements
for voluntary termination</header><text display-inline="no-display-inline">A
small business health plan which is or has been certified under this part may
terminate (upon or at any time after cessation of accruals in benefit
liabilities) only if the board of trustees, not less than 60 days before the
proposed termination date—</text>
<paragraph changed="added" commented="no" committee-id="SSHR00" id="idda2f2765-80f1-4a3c-a09d-0c358534d0ed" reported-display-style="italic"><enum>(1)</enum><text>provides to the
participants and beneficiaries a written notice of intent to terminate stating
that such termination is intended and the proposed termination date;</text>
</paragraph><paragraph changed="added" commented="no" committee-id="SSHR00" id="id58cf220f-c023-4f34-b769-cda934cae465" reported-display-style="italic"><enum>(2)</enum><text>develops a plan for
winding up the affairs of the plan in connection with such termination in a
manner which will result in timely payment of all benefits for which the plan
is obligated; and</text>
</paragraph><paragraph changed="added" commented="no" committee-id="SSHR00" id="id887bfd03-e1dd-4b36-ab91-10d8b51e1804" reported-display-style="italic"><enum>(3)</enum><text>submits such plan in
writing to the applicable authority.</text>
</paragraph><continuation-text changed="added" commented="no" committee-id="SSHR00" continuation-text-level="section" reported-display-style="italic">Actions
required under this section shall be taken in such form and manner as may be
prescribed by the applicable authority by regulation.</continuation-text></section><section changed="added" committee-id="SSHR00" id="id6617430a-d99e-4ea3-aa61-495636db8d39" reported-display-style="italic"><enum>808.</enum><header>Definitions and rules
of construction</header>
<subsection changed="added" committee-id="SSHR00" id="ida383b2a7-ba22-4627-b6c3-7c18603046f2" reported-display-style="italic"><enum>(a)</enum><header>Definitions</header><text>For
purposes of this part—</text>
<paragraph changed="added" committee-id="SSHR00" id="ida6fdc3a8-f52e-4010-aa23-213531a65149" reported-display-style="italic"><enum>(1)</enum><header>Affiliated
member</header><text>The term <term>affiliated member</term> means, in
connection with a sponsor—</text>
<subparagraph changed="added" committee-id="SSHR00" id="idb91bbe35-133a-4070-b4fc-d2641e9225a1" reported-display-style="italic"><enum>(A)</enum><text>a person who is otherwise
eligible to be a member of the sponsor but who elects an affiliated status with
the sponsor, or</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="idce94c73b-f36b-4baf-ae84-8f6d76b6ac20" reported-display-style="italic"><enum>(B)</enum><text>in the case of a sponsor
with members which consist of associations, a person who is a member or
employee of any such association and elects an affiliated status with the
sponsor.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSHR00" id="idb87ea210-0292-49be-bee0-8e759b25bfb4" reported-display-style="italic"><enum>(2)</enum><header>Applicable
authority</header><text>The term <term>applicable authority</term> means the
Secretary of Labor, except that, in connection with any exercise of the
Secretary's authority with respect to which the Secretary is required under
section 506(d) to consult with a State, such term means the Secretary, in
consultation with such State.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id2c840f24-6362-475d-abeb-ffd22ae2ab19" reported-display-style="italic"><enum>(3)</enum><header>Applicable State
authority</header><text>The term <term>applicable State authority</term> means,
with respect to a health insurance issuer in a State, the State insurance
commissioner or official or officials designated by the State to enforce the
requirements of title XXVII of the <act-name parsable-cite="PHSA">Public Health
Service Act</act-name> for the State involved with respect to such
issuer.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id14f532ae-360c-4fe2-9ce2-124c7705da68" reported-display-style="italic"><enum>(4)</enum><header>Group health
plan</header><text>The term <term>group health plan</term> has the meaning
provided in section 733(a)(1) (after applying subsection (b) of this
section).</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="ide23736df-764f-43bf-a9b7-2cdf5c5206aa" reported-display-style="italic"><enum>(5)</enum><header>Health insurance
coverage</header><text>The term <term>health insurance coverage</term> has the
meaning provided in section 733(b)(1), except that such term shall not include
excepted benefits (as defined in section 733(c)).</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id4744c025-720c-4d54-a753-9a2fb3d48333" reported-display-style="italic"><enum>(6)</enum><header>Health insurance
issuer</header><text>The term <term>health insurance issuer</term> has the
meaning provided in section 733(b)(2).</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id201f6485-3131-4142-9e26-b9990cb1d509" reported-display-style="italic"><enum>(7)</enum><header>Individual
market</header>
<subparagraph changed="added" committee-id="SSHR00" id="idd56da2d8-1407-44a0-b7f7-031259ea69e2" reported-display-style="italic"><enum>(A)</enum><header>In
general</header><text>The term <term>individual market</term> means the market
for health insurance coverage offered to individuals other than in connection
with a group health plan.</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="idfa3aee4c-72c2-4e27-828b-6b15ace656eb" reported-display-style="italic"><enum>(B)</enum><header>Treatment of very small
groups</header>
<clause changed="added" committee-id="SSHR00" id="id4b94893d-a4ed-46ea-b28b-842b53e17ef7" reported-display-style="italic"><enum>(i)</enum><header>In
general</header><text>Subject to clause (ii), such term includes coverage
offered in connection with a group health plan that has fewer than 2
participants as current employees or participants described in section
732(d)(3) on the first day of the plan year.</text>
</clause><clause changed="added" committee-id="SSHR00" id="id92f5c062-2fb0-4f92-9466-14770ea5f240" reported-display-style="italic"><enum>(ii)</enum><header>State
exception</header><text>Clause (i) shall not apply in the case of health
insurance coverage offered in a State if such State regulates the coverage
described in such clause in the same manner and to the same extent as coverage
in the small group market (as defined in section 2791(e)(5) of the
<act-name parsable-cite="PHSA">Public Health Service Act</act-name>) is
regulated by such State.</text>
</clause></subparagraph></paragraph><paragraph changed="added" committee-id="SSHR00" id="idce3aae42-5837-4ab4-b02e-650df82b83ac" reported-display-style="italic"><enum>(8)</enum><header>Medical
care</header><text>The term <term>medical care</term> has the meaning provided
in section 733(a)(2).</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="idee7b9045-ea9a-44d2-869d-e7910d17a8ea" reported-display-style="italic"><enum>(9)</enum><header>Participating
employer</header><text>The term <term>participating employer</term> means, in
connection with a small business health plan, any employer, if any individual
who is an employee of such employer, a partner in such employer, or a
self-employed individual who is such employer (or any dependent, as defined
under the terms of the plan, of such individual) is or was covered under such
plan in connection with the status of such individual as such an employee,
partner, or self-employed individual in relation to the plan.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id66c903a2-1436-448f-9b60-2c77f4770cf2" reported-display-style="italic"><enum>(10)</enum><header>Small
employer</header><text>The term <term>small employer</term> means, in
connection with a group health plan with respect to a plan year, a small
employer as defined in section 2791(e)(4).</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id667669DCEAB1481B9185112DB9FDD295" reported-display-style="italic"><enum>(11)</enum><header>Trade association and
professional association</header><text>The terms <term>trade association</term>
and <term>professional association</term> mean an entity that meets the
requirements of section 1.501(c)(6)-1 of title 26, Code of Federal Regulations
(as in effect on the date of enactment of this Act).</text>
</paragraph></subsection><subsection changed="added" committee-id="SSHR00" id="ide74732e3-aafd-409b-a651-8a7341176d14" reported-display-style="italic"><enum>(b)</enum><header>Rule of
construction</header><text>For purposes of determining whether a plan, fund, or
program is an employee welfare benefit plan which is a small business health
plan, and for purposes of applying this title in connection with such plan,
fund, or program so determined to be such an employee welfare benefit
plan—</text>
<paragraph changed="added" committee-id="SSHR00" id="id57761bfd-ecaf-42a0-8e84-8ec9854a6359" reported-display-style="italic"><enum>(1)</enum><text>in the case of a
partnership, the term <term>employer</term> (as defined in section 3(5))
includes the partnership in relation to the partners, and the term
<term>employee</term> (as defined in section 3(6)) includes any partner in
relation to the partnership; and</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id8cc2ca5c-ecbd-4b19-994e-c781a114960a" reported-display-style="italic"><enum>(2)</enum><text>in the case of a
self-employed individual, the term <term>employer</term> (as defined in section
3(5)) and the term <term>employee</term> (as defined in section 3(6)) shall
include such individual.</text>
</paragraph></subsection><subsection changed="added" committee-id="SSHR00" id="ID43ea75c054a34d6f816798b719a0d940" reported-display-style="italic"><enum>(c)</enum><header>Renewal</header><text>Notwithstanding
any provision of law to the contrary, a participating employer in a small
business health plan shall not be deemed to be a plan sponsor in applying
requirements relating to coverage renewal.</text>
</subsection><subsection changed="added" commented="no" committee-id="SSHR00" display-inline="no-display-inline" id="id40A52E18064B43168A20E661973CD8D2" reported-display-style="italic"><enum>(d)</enum><header>Health savings
accounts</header><text display-inline="yes-display-inline">Nothing in this part
shall be construed to inhibit the development of health savings accounts
pursuant to section 223 of the Internal Revenue Code of
1986.</text>
</subsection></section></part><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection changed="added" commented="no" committee-id="SSHR00" id="id25aa70b6-233d-4330-aa35-594b5ca9b99c" reported-display-style="italic"><enum>(b)</enum><header>Conforming amendments
to preemption rules</header>
<paragraph changed="added" commented="no" committee-id="SSHR00" id="idc4f36b4f-9127-4cae-af65-2ac6345cb4ac" reported-display-style="italic"><enum>(1)</enum><text>Section 514(b)(6) of such
Act (<external-xref legal-doc="usc" parsable-cite="usc/29/1144(b)(6)">29 U.S.C.
1144(b)(6)</external-xref>) is amended by adding at the end the following new
subparagraph:</text>
<quoted-block changed="added" committee-id="SSHR00" id="id24ac8b50-f81d-40f0-aa32-00b98d8d74f6" reported-display-style="italic">
<subparagraph changed="added" commented="no" committee-id="SSHR00" id="id63a5d1b1-f249-4b69-a260-803d88e48ad5" indent="up2" reported-display-style="italic"><enum>(E)</enum><text>The preceding
subparagraphs of this paragraph do not apply with respect to any State law in
the case of a small business health plan which is certified under part
8.</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph changed="added" commented="no" committee-id="SSHR00" id="id36d94f86-3c66-47a0-8913-f109c9848233" reported-display-style="italic"><enum>(2)</enum><text>Section 514 of such Act
(<external-xref legal-doc="usc" parsable-cite="usc/29/1144">29 U.S.C.
1144</external-xref>) is amended—</text>
<subparagraph changed="added" commented="no" committee-id="SSHR00" id="id605b2321-32b3-4a21-bb68-12750f6994fd" reported-display-style="italic"><enum>(A)</enum><text>in subsection (b)(4), by
striking <quote>Subsection (a)</quote> and inserting <quote>Subsections (a) and
(d)</quote>;</text>
</subparagraph><subparagraph changed="added" commented="no" committee-id="SSHR00" id="id2338e576-42d6-4b3e-9b41-6a9270ae1c28" reported-display-style="italic"><enum>(B)</enum><text>in subsection (b)(5), by
striking <quote>subsection (a)</quote> in subparagraph (A) and inserting
<quote>subsection (a) of this section and subsections (a)(2)(B) and (b) of
section 805</quote>, and by striking <quote>subsection (a)</quote> in
subparagraph (B) and inserting <quote>subsection (a) of this section or
subsection (a)(2)(B) or (b) of section 805</quote>;</text>
</subparagraph><subparagraph changed="added" commented="no" committee-id="SSHR00" id="id21e9f341-529c-4b26-97f3-96a4d9587769" reported-display-style="italic"><enum>(C)</enum><text>by redesignating
subsection (d) as subsection (e); and</text>
</subparagraph><subparagraph changed="added" commented="no" committee-id="SSHR00" id="id4d8de338-ef9a-44f7-bcd7-2e0682b3a46c" reported-display-style="italic"><enum>(D)</enum><text>by inserting after
subsection (c) the following new subsection:</text>
<quoted-block changed="added" committee-id="SSHR00" id="ide03ad37a-baf9-4c44-8d2f-3cf68af94963" reported-display-style="italic">
<subsection changed="added" commented="no" committee-id="SSHR00" id="idc30ac077-84eb-44b4-aa25-b310c975b9ae" reported-display-style="italic"><enum>(d)</enum><paragraph commented="no" display-inline="yes-display-inline" id="id2d68db45-eaf4-4ef5-8592-431aef763016"><enum>(1)</enum><text>Except as provided
in subsection (b)(4), the provisions of this title shall supersede any and all
State laws insofar as they may now or hereafter preclude a health insurance
issuer from offering health insurance coverage in connection with a small
business health plan which is certified under part 8.</text>
</paragraph><paragraph changed="added" commented="no" committee-id="SSHR00" id="idb83097c7-d06a-4fd5-bfac-243b91e6c39a" indent="up1" reported-display-style="italic"><enum>(2)</enum><text>In any case in which
health insurance coverage of any policy type is offered under a small business
health plan certified under part 8 to a participating employer operating in
such State, the provisions of this title shall supersede any and all laws of
such State insofar as they may establish rating and benefit requirements that
would otherwise apply to such coverage, provided the requirements of subtitle A
of title XXIX of the Public Health Service Act (as added by title II of the
Health Insurance Marketplace Modernization and Affordability Act of 2006)
(concerning health plan rating and benefits) are
met.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</subparagraph></paragraph></subsection><subsection changed="added" commented="no" committee-id="SSHR00" id="id70bd699c-368f-415e-b284-2b3e619eb891" reported-display-style="italic"><enum>(c)</enum><header>Plan
sponsor</header><text>Section 3(16)(B) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/29/102(16)(B)">29 U.S.C.
102(16)(B)</external-xref>) is amended by adding at the end the following new
sentence: <quote>Such term also includes a person serving as the sponsor of a
small business health plan under part 8.</quote>.</text>
</subsection><subsection changed="added" commented="no" committee-id="SSHR00" id="idf708d789-eb10-4ebc-b48d-eae38dfb4281" reported-display-style="italic"><enum>(d)</enum><header>Savings
clause</header><text>Section 731(c) of such Act is amended by inserting
<quote>or part 8</quote> after <quote>this part</quote>.</text>
</subsection><subsection changed="added" committee-id="SSHR00" id="id8063452c-a830-4802-84ea-958e4ad1eed6" reported-display-style="italic"><enum>(e)</enum><header>Clerical
amendment</header><text>The table of contents in
<external-xref legal-doc="act" parsable-cite="ERISA/1">section
1</external-xref> of the <act-name parsable-cite="ERISA">Employee Retirement
Income Security Act of 1974</act-name> is amended by inserting after the item
relating to section 734 the following new items:</text>
<quoted-block act-name="Employee Retirement Income Security Act of 1974" changed="added" committee-id="SSHR00" id="idd651f4fe-480f-4b9c-88cc-3d10c1f22e8e" reported-display-style="italic" style="USC">
<toc regeneration="no-regeneration">
<toc-entry level="part">Part 8—Rules governing small business health
plans</toc-entry>
<toc-entry level="section">801. Small business health
plans.</toc-entry>
<toc-entry level="section">802. Certification of small business
health plans.</toc-entry>
<toc-entry level="section">803. Requirements relating to sponsors and
boards of trustees.</toc-entry>
<toc-entry level="section">804. Participation and coverage
requirements.</toc-entry>
<toc-entry level="section">805. Other requirements relating to plan
documents, contribution rates, and benefit options.</toc-entry>
<toc-entry level="section">806. Requirements for application and
related requirements.</toc-entry>
<toc-entry level="section">807. Notice requirements for voluntary
termination.</toc-entry>
<toc-entry level="section">808. Definitions and rules of
construction.</toc-entry>
</toc>
<after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section changed="added" committee-id="SSHR00" id="ida791efae-4d0f-4e9f-9977-615b1fb58a5d" reported-display-style="italic"><enum>102.</enum><header>Cooperation between
Federal and State authorities</header><text display-inline="no-display-inline">Section 506 of the
<act-name parsable-cite="ERISA">Employee Retirement Income Security Act of
1974</act-name> (<external-xref legal-doc="usc" parsable-cite="usc/29/1136">29
U.S.C. 1136</external-xref>) is amended by adding at the end the following new
subsection:</text>
<quoted-block act-name="Employee Retirement Income Security Act of 1974" changed="added" committee-id="SSHR00" id="id46ea9ba9-1dcf-48c8-badb-6722d2851fa1" reported-display-style="italic">
<subsection changed="added" committee-id="SSHR00" id="idafecdf4a-f623-4902-8be3-94a40205ea38" reported-display-style="italic"><enum>(d)</enum><header>Consultation with
States with respect to small business health plans</header>
<paragraph changed="added" committee-id="SSHR00" id="id3fd2f938-7749-4cc7-970a-7a01a9d8b613" reported-display-style="italic"><enum>(1)</enum><header>Agreements with
States</header><text>The Secretary shall consult with the State recognized
under paragraph (2) with respect to a small business health plan regarding the
exercise of—</text>
<subparagraph changed="added" committee-id="SSHR00" id="idd3e5ec13-c790-4aee-9872-f7eba8a16bb3" reported-display-style="italic"><enum>(A)</enum><text>the Secretary’s authority
under sections 502 and 504 to enforce the requirements for certification under
part 8; and</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="ideb7690fe-8d91-4915-a65b-3c9aa641a543" reported-display-style="italic"><enum>(B)</enum><text>the Secretary’s authority
to certify small business health plans under part 8 in accordance with
regulations of the Secretary applicable to certification under part 8.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSHR00" id="id78cc6842-7860-4c24-9106-a50830b45a98" reported-display-style="italic"><enum>(2)</enum><header>Recognition of domicile
State</header><text>In carrying out paragraph (1), the Secretary shall ensure
that only one State will be recognized, with respect to any particular small
business health plan, as the State with which consultation is required. In
carrying out this paragraph such State shall be the domicile State, as defined
in section
805(c).</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section changed="added" committee-id="SSHR00" id="id7b5731b8-e4f8-4bdc-a4a6-2c904ba4b1e0" reported-display-style="italic"><enum>103.</enum><header>Effective date and
transitional and other rules</header>
<subsection changed="added" commented="no" committee-id="SSHR00" id="id8a511b19-025c-4e63-8218-f86c74febb41" reported-display-style="italic"><enum>(a)</enum><header>Effective
date</header><text>The amendments made by this title shall take effect 12
months after the date of the enactment of this Act. The Secretary of Labor
shall first issue all regulations necessary to carry out the amendments made by
this title within 6 months after the date of the enactment of this Act.</text>
</subsection><subsection changed="added" committee-id="SSHR00" id="ideb6017dd-92db-48cc-9884-72f8bf49da06" reported-display-style="italic"><enum>(b)</enum><header>Treatment of certain
existing health benefits programs</header>
<paragraph changed="added" committee-id="SSHR00" id="idf13af77b-0cf0-4611-9177-00607ddbeed7" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>In any case in which, as of the date of the enactment of
this Act, an arrangement is maintained in a State for the purpose of providing
benefits consisting of medical care for the employees and beneficiaries of its
participating employers, at least 200 participating employers make
contributions to such arrangement, such arrangement has been in existence for
at least 10 years, and such arrangement is licensed under the laws of one or
more States to provide such benefits to its participating employers, upon the
filing with the applicable authority (as defined in
<external-xref legal-doc="act" parsable-cite="ERISA/812(a)(5)">section
808(a)(2)</external-xref> of the <act-name parsable-cite="ERISA">Employee
Retirement Income Security Act of 1974</act-name> (as amended by this
subtitle)) by the arrangement of an application for certification of the
arrangement under part 8 of subtitle B of title I of such Act—</text>
<subparagraph changed="added" committee-id="SSHR00" id="ida1a0b79b-7f3f-464c-b685-f88bad36ba9d" reported-display-style="italic"><enum>(A)</enum><text>such arrangement shall be
deemed to be a group health plan for purposes of title I of such Act;</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="id05436dea-75ee-4f83-976c-d35c8ae2d8bf" reported-display-style="italic"><enum>(B)</enum><text>the requirements of
sections 801(a) and 803(a) of the <act-name parsable-cite="ERISA">Employee
Retirement Income Security Act of 1974</act-name> shall be deemed met with
respect to such arrangement;</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="ida8152279-2b78-45e3-bea6-5e3ab33496e7" reported-display-style="italic"><enum>(C)</enum><text>the requirements of
section 803(b) of such Act shall be deemed met, if the arrangement is operated
by a board of trustees which—</text>
<clause changed="added" committee-id="SSHR00" id="id122fe9b0-197a-41b2-92a7-75065667cd34" reported-display-style="italic"><enum>(i)</enum><text>is elected by the
participating employers, with each employer having one vote; and</text>
</clause><clause changed="added" committee-id="SSHR00" id="id28bcdea5-4378-4f64-a164-df13576749ad" reported-display-style="italic"><enum>(ii)</enum><text>has complete fiscal
control over the arrangement and which is responsible for all operations of the
arrangement;</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SSHR00" id="id9badf1c1-32f2-4ed7-9781-4f6ff9eeb1a9" reported-display-style="italic"><enum>(D)</enum><text>the requirements of
section 804(a) of such Act shall be deemed met with respect to such
arrangement; and</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="id09349b1b-1ecd-45c4-bd9e-6ec7c5366c46" reported-display-style="italic"><enum>(E)</enum><text>the arrangement may be
certified by any applicable authority with respect to its operations in any
State only if it operates in such State on the date of certification.</text>
</subparagraph><continuation-text changed="added" committee-id="SSHR00" continuation-text-level="paragraph" reported-display-style="italic">The
provisions of this subsection shall cease to apply with respect to any such
arrangement at such time after the date of the enactment of this Act as the
applicable requirements of this subsection are not met with respect to such
arrangement or at such time that the arrangement provides coverage to
participants and beneficiaries in any State other than the States in which
coverage is provided on such date of enactment.</continuation-text></paragraph><paragraph changed="added" commented="no" committee-id="SSHR00" display-inline="no-display-inline" id="id527881ac-2273-453a-bd41-ad73615209af" reported-display-style="italic"><enum>(2)</enum><header>Definitions</header><text>For
purposes of this subsection, the terms <term>group health plan</term>,
<term>medical care</term>, and <term>participating employer</term> shall have
the meanings provided in
<external-xref legal-doc="act" parsable-cite="ERISA/812">section
808</external-xref> of the <act-name parsable-cite="ERISA">Employee Retirement
Income Security Act of 1974</act-name>, except that the reference in paragraph
(7) of such section to an <quote>small business health plan</quote> shall be
deemed a reference to an arrangement referred to in this subsection.</text>
</paragraph></subsection></section><enum>II</enum><header>Market relief</header>
<section changed="added" committee-id="SSHR00" id="idc07aeeb9-cb2e-4d5f-9b7e-d471df655a82" reported-display-style="italic"><enum>201.</enum><header>Market
relief</header><text display-inline="no-display-inline">The Public Health
Service Act (42 U.S.C. 201 et seq.) is amended by adding at the end the
following:</text>
<quoted-block changed="added" committee-id="SSHR00" display-inline="no-display-inline" id="id96ffd512-64a7-4da5-bb2f-24d65c79332b" reported-display-style="italic" style="OLC">
<title changed="added" committee-id="SSHR00" id="idbddea2ca-ec1e-4e70-89f7-266e339e0d62" reported-display-style="italic"><enum>XXIX</enum><header>Health care insurance
marketplace modernization</header>
<section changed="added" committee-id="SSHR00" id="id7aa8b11e-f2a0-4127-9cbb-10b14fbe8b93" reported-display-style="italic"><enum>2901.</enum><header>General insurance
definitions</header><text display-inline="no-display-inline">In this title, the
terms <term>health insurance coverage</term>, <term>health insurance
issuer</term>, <term>group health plan</term>, and <term>individual health
insurance</term> shall have the meanings given such terms in section
2791.</text>
</section><subtitle changed="added" committee-id="SSHR00" id="id93edeaa4-a775-4674-be8b-61ead0138b04" reported-display-style="italic"><enum>A</enum><header>Market relief</header>
<part changed="added" committee-id="SSHR00" id="ide5c4acea-8df9-402a-aa92-2314481321d7" reported-display-style="italic"><enum>I</enum><header>Rating
requirements</header>
<section changed="added" committee-id="SSHR00" id="id0c80d34d-2dde-469d-b993-c220e6c54b77" reported-display-style="italic"><enum>2911.</enum><header>Definitions</header>
<subsection changed="added" committee-id="SSHR00" id="idA14D900749C84FBBB6F9553E2FCEE10D" reported-display-style="italic"><enum>(a)</enum><header>General
definitions</header><text display-inline="yes-display-inline">In this
part:</text>
<paragraph changed="added" committee-id="SSHR00" id="idf34c50d1-73b5-4c1f-aa4f-539693f77cd9" reported-display-style="italic"><enum>(1)</enum><header>Adopting
state</header><text>The term <term>adopting State</term> means a State that,
with respect to the small group market, has enacted either the Model Small
Group Rating Rules or, if applicable to such State, the Transitional Model
Small Group Rating Rules, each in their entirety and as the exclusive laws of
the State that relate to rating in the small group insurance market.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="ID4431272aedd24b398cb8a466443a960c" reported-display-style="italic"><enum>(2)</enum><header>Applicable State
authority</header><text>The term <quote>applicable State authority</quote>
means, with respect to a health insurance issuer in a State, the State
insurance commissioner or official or officials designated by the State to
enforce the insurance laws of such State.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="ID5e216acc84084b0090565627b53f3a01" reported-display-style="italic"><enum>(3)</enum><header>Base premium
rate</header><text>The term <quote>base premium rate</quote> means, for each
class of business with respect to a rating period, the lowest premium rate
charged or that could have been charged under a rating system for that class of
business by the small employer carrier to small employers with similar case
characteristics for health benefit plans with the same or similar
coverage</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id8dad7d99-4a04-493c-9b98-c96b8966e4f6" reported-display-style="italic"><enum>(4)</enum><header>Eligible
insurer</header><text>The term <term>eligible insurer</term> means a health
insurance issuer that is licensed in a State and that—</text>
<subparagraph changed="added" committee-id="SSHR00" id="id49ca3763-21a8-433e-918e-1a47bf220835" reported-display-style="italic"><enum>(A)</enum><text>notifies the Secretary,
not later than 30 days prior to the offering of coverage described in this
subparagraph, that the issuer intends to offer health insurance coverage
consistent with the Model Small Group Rating Rules or, as applicable,
transitional small group rating rules in a State;</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="id39ad77e7-2780-4e60-a50f-425da1a53825" reported-display-style="italic"><enum>(B)</enum><text>notifies the insurance
department of a nonadopting State (or other State agency), not later than 30
days prior to the offering of coverage described in this subparagraph, that the
issuer intends to offer small group health insurance coverage in that State
consistent with the Model Small Group Rating Rules, and provides with such
notice a copy of any insurance policy that it intends to offer in the State,
its most recent annual and quarterly financial reports, and any other
information required to be filed with the insurance department of the State (or
other State agency); and</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="ida6f33a03-217b-4f21-8cdb-bac000a50fbf" reported-display-style="italic"><enum>(C)</enum><text>includes in the terms of
the health insurance coverage offered in nonadopting States (including in the
terms of any individual certificates that may be offered to individuals in
connection with such group health coverage) and filed with the State pursuant
to subparagraph (B), a description in the insurer's contract of the Model Small
Group Rating Rules and an affirmation that such Rules are included in the terms
of such contract.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSHR00" id="id60ae3d35-9463-423b-87be-335899bfd8b7" reported-display-style="italic"><enum>(5)</enum><header>Health insurance
coverage</header><text>The term <term>health insurance coverage</term> means
any coverage issued in the small group health insurance market, except that
such term shall not include excepted benefits (as defined in section
2791(c)).</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="idE557F996110744D19E7475FCA24E5865" reported-display-style="italic"><enum>(6)</enum><header>Index
rate</header><text>The term <term>index rate</term> means for each class of
business with respect to the rating period for small employers with similar
case characteristics, the arithmetic average of the applicable base premium
rate and the corresponding highest premium rate.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id41380680-3965-44d7-80cc-a50ada4f14f7" reported-display-style="italic"><enum>(7)</enum><header> Model Small Group
Rating Rules</header><text>The term <term> Model Small Group Rating
Rules</term> means the rules set forth in subsection (b).</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id8fcb4e3c-cb0e-4347-a359-53e897c194c6" reported-display-style="italic"><enum>(8)</enum><header>Nonadopting
state</header><text>The term <term>nonadopting State</term> means a State that
is not an adopting State.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id3c9e3b13-2980-4948-bcfb-99dfb5d4ccf6" reported-display-style="italic"><enum>(9)</enum><header>Small group insurance
market</header><text>The term <term>small group insurance market</term> shall
have the meaning given the term <term>small group market</term> in section
2791(e)(5).</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="idac07b95f-c6c5-4be4-8a83-8526261295dd" reported-display-style="italic"><enum>(10)</enum><header>State
law</header><text>The term <term>State law</term> means all laws, decisions,
rules, regulations, or other State actions (including actions by a State
agency) having the effect of law, of any State.</text>
</paragraph></subsection><subsection changed="added" committee-id="SSHR00" id="idBE811E9F248E41BDB095E2434A18C0F5" reported-display-style="italic"><enum>(b)</enum><header>Definition relating to
Model Small Group Rating Rules</header><text>The term <term>Model Small Group
Rating Rules</term> means adapted rating rules drawn from the Adopted Small
Employer Health Insurance Availability Model Act of 1993 of the National
Association of Insurance Commissioners consisting of the following:</text>
<paragraph changed="added" committee-id="SSHR00" id="ID7db10ba5e98f48df91a329858f70057c" reported-display-style="italic"><enum>(1)</enum><header>Premium
rates</header><text>Premium rates for health benefit plans to which this title
applies shall be subject to the following provisions relating to
premiums:</text>
<subparagraph changed="added" committee-id="SSHR00" id="IDcd6a4a5cbefb4086a78be673b52c8c7a" reported-display-style="italic"><enum>(A)</enum><header>Index
rate</header><text>The index rate for a rating period for any class of business
shall not exceed the index rate for any other class of business by more than 20
percent.</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="IDc7985a75c8904e09815f04600f0d3b67" reported-display-style="italic"><enum>(B)</enum><header>Class of
businesses</header><text>With respect to a class of business, the premium rates
charged during a rating period to small employers with similar case
characteristics for the same or similar coverage or the rates that could be
charged to such employers under the rating system for that class of business,
shall not vary from the index rate by more than 25 percent of the index rate
under subparagraph (A).</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="IDd4565c1701174d23bdee33a2220449c3" reported-display-style="italic"><enum>(C)</enum><header>Increases for new
rating periods</header><text>The percentage increase in the premium rate
charged to a small employer for a new rating period may not exceed the sum of
the following:</text>
<clause changed="added" committee-id="SSHR00" id="ID02e8d8b9e2a0439ba1d52f56e4712133" reported-display-style="italic"><enum>(i)</enum><text>The percentage change in
the new business premium rate measured from the first day of the prior rating
period to the first day of the new rating period. In the case of a health
benefit plan into which the small employer carrier is no longer enrolling new
small employers, the small employer carrier shall use the percentage change in
the base premium rate, except that such change shall not exceed, on a
percentage basis, the change in the new business premium rate for the most
similar health benefit plan into which the small employer carrier is actively
enrolling new small employers.</text>
</clause><clause changed="added" committee-id="SSHR00" id="ID4a877f15c01741d987840269ca50ab1a" reported-display-style="italic"><enum>(ii)</enum><text>Any adjustment, not to
exceed 15 percent annually and adjusted pro rata for rating periods of less
then 1 year, due to the claim experience, health status or duration of coverage
of the employees or dependents of the small employer as determined from the
small employer carrier's rate manual for the class of business involved.</text>
</clause><clause changed="added" committee-id="SSHR00" id="IDe2af6db1756f4faab685ebe7666814c7" reported-display-style="italic"><enum>(iii)</enum><text>Any adjustment due to
change in coverage or change in the case characteristics of the small employer
as determined from the small employer carrier's rate manual for the class of
business.</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SSHR00" id="ID273adafd124b49dfb5a7f60c0f74ca31" reported-display-style="italic"><enum>(D)</enum><header>Uniform application of
adjustments</header><text>Adjustments in premium rates for claim experience,
health status, or duration of coverage shall not be charged to individual
employees or dependents. Any such adjustment shall be applied uniformly to the
rates charged for all employees and dependents of the small employer.</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="IDb6dcd2987a674739814016a1d1f0f0e9" reported-display-style="italic"><enum>(E)</enum><header>Use of industry as a
case characteristic</header><text>A small employer carrier may utilize industry
as a case characteristic in establishing premium rates, so long as the highest
rate factor associated with any industry classification does not exceed the
lowest rate factor associated with any industry classification by more than 15
percent.</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="ID6b9ded4d9cb749a1b15de5dbf57dcf80" reported-display-style="italic"><enum>(F)</enum><header>Consistent application
of factors</header><text>Small employer carriers shall apply rating factors,
including case characteristics, consistently with respect to all small
employers in a class of business. Rating factors shall produce premiums for
identical groups which differ only by the amounts attributable to plan design
and do not reflect differences due to the nature of the groups assumed to
select particular health benefit plans.</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="ID3c402ffcc2dd472989200d21d3f505e5" reported-display-style="italic"><enum>(G)</enum><header>Treatment of plans as
having same rating period</header><text>A small employer carrier shall treat
all health benefit plans issued or renewed in the same calendar month as having
the same rating period.</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="ID5f9f942cb00f434aab25fca5281dc92b" reported-display-style="italic"><enum>(H)</enum><header>Restricted network
provisions</header><text>For purposes of this subsection, a health benefit plan
that contains a restricted network provision shall not be considered similar
coverage to a health benefit plan that does not contain a similar provision if
the restriction of benefits to network providers results in substantial
differences in claims costs.</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="IDea2860f205bb47038bd185dd542deb74" reported-display-style="italic"><enum>(I)</enum><header>Prohibition on use of
certain case characteristics</header><text>The small employer carrier shall not
use case characteristics other than age, gender, industry, geographic area,
family composition, group size, and participation in wellness programs without
prior approval of the applicable State authority.</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="IDe7d733c4229b46fc869df13dd6aa02be" reported-display-style="italic"><enum>(J)</enum><header>Require
compliance</header><text>Premium rates for small business health benefit plans
shall comply with the requirements of this subsection notwithstanding any
assessments paid or payable by a small employer carrier as required by a
State's small employer carrier reinsurance program.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSHR00" id="ID427ad58786d448faa0d19af94c9f504c" reported-display-style="italic"><enum>(2)</enum><header>Establishment of
separate class of business</header><text>Subject to paragraph (3), a small
employer carrier may establish a separate class of business only to reflect
substantial differences in expected claims experience or administrative costs
related to the following:</text>
<subparagraph changed="added" committee-id="SSHR00" id="IDdb164e70d8b64e1f87e7e5a3d161af59" reported-display-style="italic"><enum>(A)</enum><text>The small employer
carrier uses more than one type of system for the marketing and sale of health
benefit plans to small employers.</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="IDf39e9a81d41b48f2b05d3f4d8b4ce09b" reported-display-style="italic"><enum>(B)</enum><text>The small employer
carrier has acquired a class of business from another small employer
carrier.</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="ID1be1fee78af140d8a93de53ca4803b0d" reported-display-style="italic"><enum>(C)</enum><text>The small employer
carrier provides coverage to one or more association groups that meet the
requirements of this title.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSHR00" id="IDe15c547818054362a584a3454c0f9501" reported-display-style="italic"><enum>(3)</enum><header>Limitation</header><text>A
small employer carrier may establish up to 9 separate classes of business under
paragraph (2), excluding those classes of business related to association
groups under this title.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="IDc192d4094faa45a695df73f1c46748e3" reported-display-style="italic"><enum>(4)</enum><header>Additional
groupings</header><text>The applicable State authority may approve the
establishment of additional distinct groupings by small employer carriers upon
the submission of an application to the applicable State authority and a
finding by the applicable State authority that such action would enhance the
efficiency and fairness of the small employer insurance marketplace.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="ID78ffddca458648f7bdf6d9bf921bc0aa" reported-display-style="italic"><enum>(5)</enum><header>Limitation on
transfers</header><text>A small employer carrier shall not transfer a small
employer involuntarily into or out of a class of business. A small employer
carrier shall not offer to transfer a small employer into or out of a class of
business unless such offer is made to transfer all small employers in the class
of business without regard to case characteristics, claim experience, health
status or duration of coverage since issue.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="ID7241fb9839b34d1cb1219488a5caf384" reported-display-style="italic"><enum>(6)</enum><header>Suspension of the
rules</header><text>The applicable State authority may suspend, for a specified
period, the application of paragraph (1) to the premium rates applicable to one
or more small employers included within a class of business of a small employer
carrier for one or more rating periods upon a filing by the small employer
carrier and a finding by the applicable State authority either that the
suspension is reasonable when considering the financial condition of the small
employer carrier or that the suspension would enhance the efficiency and
fairness of the marketplace for small employer health insurance.</text>
</paragraph></subsection></section><section changed="added" committee-id="SSHR00" id="id44e58251-57f7-483c-959a-0f061286ff84" reported-display-style="italic"><enum>2912.</enum><header>Rating rules</header>
<subsection changed="added" committee-id="SSHR00" id="IDacd9f53536624a5c8318eeb2e87a8d17" reported-display-style="italic"><enum>(a)</enum><header>Implementation of Model
Small Group Rating Rules</header><text>Not later than 6 months after the
enactment of this title, the Secretary shall promulgate regulations
implementing the Model Small Group Rating Rules pursuant to section
2911(b).</text>
</subsection><subsection changed="added" committee-id="SSHR00" id="ID2340cb12484d48ebb94624c02eeb2422" reported-display-style="italic"><enum>(b)</enum><header>Transitional Model
Small Group Rating Rules</header><text></text>
<paragraph changed="added" committee-id="SSHR00" id="IDb271cf6f098647549ba721ced4c27f1f" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>Not later than 6 months after the date of enactment of
this title and to the extent necessary to provide for a graduated transition to
the Model Small Group Rating Rules, the Secretary, in consultation with the
NAIC, shall promulgate Transitional Model Small Group Rating Rules in
accordance with this subsection, which shall be applicable with respect to
certain non-adopting States for a period of not to exceed 5 years from the date
of the promulgation of the Model Small Group Rating Rules pursuant to
subsection (a). After the expiration of such 5-year period, the transitional
model small group rating rules shall expire, and the Model Small Group Rating
Rules shall then apply with respect to all non-adopting States pursuant to the
provisions of this part.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="IDea66d476cd6b4ce4933cfc24bd213254" reported-display-style="italic"><enum>(2)</enum><header>Premium variation
during transition</header><text></text>
<subparagraph changed="added" committee-id="SSHR00" id="ID91d54941e62149b4a772da1b895d6245" reported-display-style="italic"><enum>(A)</enum><header>Transition
States</header><text>During the transition period described in paragraph (1),
small group health insurance coverage offered in a non-adopting State that had
in place premium rating band requirements or premium limits that varied by less
than 12.5 percent from the index rate within a class of business on the date of
enactment of this title, shall not be subject to the premium variation
provision of section 2911(b)(1) of the Model Small Group Rating Rules and shall
instead be subject to the Transitional Model Small Group Rating Rules as
promulgated by the Secretary pursuant to paragraph (1).</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="IDa8d605f2c675488e9df614c9e7e469eb" reported-display-style="italic"><enum>(B)</enum><header>Non-transition
States</header><text>During the transition period described in paragraph (1),
and thereafter, small group health insurance coverage offered in a non-adopting
State that had in place premium rating band requirements or premium limits that
varied by more than 12.5 percent from the index rate within a class of business
on the date of enactment of this title, shall not be subject to the
Transitional Model Small Group Rating Rules as promulgated by the Secretary
pursuant to paragraph (1), and instead shall be subject to the Model Small
Group Rating Rules effective beginning with the first plan year or calendar
year following the promulgation of such Rules, at the election of the eligible
insurer.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSHR00" id="ID07b14b9f98dc442b8c8751677bfb691d" reported-display-style="italic"><enum>(3)</enum><header>Transitioning of old
business</header><text>In developing the transitional model small group rating
rules under paragraph (1), the Secretary shall, after consultation with the
National Association of Insurance Commissioners and representatives of insurers
operating in the small group health insurance market, promulgate special
transition standards and timelines with respect to independent rating classes
for old and new business, to the extent reasonably necessary to protect health
insurance consumers and to ensure a stable and fair transition for old and new
market entrants.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="ID20fd91bdea434106991fc48af7cef763" reported-display-style="italic"><enum>(4)</enum><header>Other transitional
authority</header><text>In developing the Transitional Model Small Group Rating
Rules under paragraph (1), the Secretary shall provide for the application of
the Transitional Model Small Group Rating Rules in transition States as the
Secretary may determine necessary for a an effective transition.</text>
</paragraph></subsection><subsection changed="added" committee-id="SSHR00" id="idB0479DBF9B114075B0514F36529FF9FF" reported-display-style="italic"><enum>(c)</enum><header>Market
re-entry</header>
<paragraph changed="added" committee-id="SSHR00" id="id5B1C77EEDC4A48B49A97C349C859625A" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>Notwithstanding any other provision of law, a health
insurance issuer that has voluntarily withdrawn from providing coverage in the
small group market prior to the date of enactment of the
<short-title>Health Insurance Marketplace Modernization
and Affordability Act of 2006</short-title> shall not be excluded from
re-entering such market on a date that is more than 180 days after such date of
enactment.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id9912CF866B6742009B881CAA9938AE66" reported-display-style="italic"><enum>(2)</enum><header>Termination</header><text>The
provision of this subsection shall terminate on the date that is 24 months
after the date of enactment of the <short-title>Health
Insurance Marketplace Modernization and Affordability Act of
2006</short-title>.</text>
</paragraph></subsection></section><section changed="added" committee-id="SSHR00" id="idfcfea982-9f6a-4c49-8e6b-07eaebc91a8f" reported-display-style="italic"><enum>2913.</enum><header>Application and
preemption</header>
<subsection changed="added" committee-id="SSHR00" id="ide4696704-c0e1-467d-b146-d25a3e8a44c8" reported-display-style="italic"><enum>(a)</enum><header>Superseding of state
law</header><text></text>
<paragraph changed="added" committee-id="SSHR00" id="id2f77da04-68a3-4a01-a240-784a59d1fa36" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>This part shall supersede any and all State laws of a
non-adopting State insofar as such State laws (whether enacted prior to or
after the date of enactment of this subtitle) relate to rating in the small
group insurance market as applied to an eligible insurer, or small group health
insurance coverage issued by an eligible insurer, including with respect to
coverage issued to a small employer through a small business health plan, in a
State.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="idb46f9abd-0d1f-46a8-a292-667cd2bcd566" reported-display-style="italic"><enum>(2)</enum><header>Nonadopting
states</header><text>This part shall supersede any and all State laws of a
nonadopting State insofar as such State laws (whether enacted prior to or after
the date of enactment of this subtitle)—</text>
<subparagraph changed="added" committee-id="SSHR00" id="id0521b3a1-dcb7-41d1-ba16-8c186d9026a3" reported-display-style="italic"><enum>(A)</enum><text>prohibit an eligible
insurer from offering, marketing, or implementing small group health insurance
coverage consistent with the Model Small Group Rating Rules or transitional
model small group rating rules; or</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="ida558c388-f334-4f78-935e-c8fe3fcffe1d" reported-display-style="italic"><enum>(B)</enum><text>have the effect of
retaliating against or otherwise punishing in any respect an eligible insurer
for offering, marketing, or implementing small group health insurance coverage
consistent with the Model Small Group Rating Rules or transitional model small
group rating rules.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SSHR00" id="id095d3df9-cf5c-4b04-bb36-baf50bf855b5" reported-display-style="italic"><enum>(b)</enum><header>Savings clause and
construction</header>
<paragraph changed="added" committee-id="SSHR00" id="idc44f4e8b-f12b-445e-a011-5e34bc72048c" reported-display-style="italic"><enum>(1)</enum><header>Nonapplication to
adopting states</header><text>Subsection (a) shall not apply with respect to
adopting states.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id223cc07c-fb7a-4332-b865-0de9a2c93bbe" reported-display-style="italic"><enum>(2)</enum><header>Nonapplication to
certain insurers</header><text>Subsection (a) shall not apply with respect to
insurers that do not qualify as eligible insurers that offer small group health
insurance coverage in a nonadopting State.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id2af504b1-ac0e-4f9e-b958-10ba06732a24" reported-display-style="italic"><enum>(3)</enum><header>Nonapplication where
obtaining relief under state law</header><text>Subsection (a)(1) shall not
supercede any State law in a nonadopting State to the extent necessary to
permit individuals or the insurance department of the State (or other State
agency) to obtain relief under State law to require an eligible insurer to
comply with the Model Small Group Rating Rules or transitional model small
group rating rules.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="IDd0bfa57f69254bec865a16e070f9abd9" reported-display-style="italic"><enum>(4)</enum><header>No effect on
preemption</header><text>In no case shall this part be construed to limit or
affect in any manner the preemptive scope of sections 502 and 514 of the
Employee Retirement Income Security Act of 1974. In no case shall this part be
construed to create any cause of action under Federal or State law or enlarge
or affect any remedy available under the Employee Retirement Income Security
Act of 1974</text>
</paragraph></subsection><subsection changed="added" committee-id="SSHR00" id="id9b63daf3-6dac-45c5-9fb5-073e2acdd25a" reported-display-style="italic"><enum>(c)</enum><header>Effective
date</header><text>This section shall apply, at the election of the eligible
insurer, beginning in the first plan year or the first calendar year following
the issuance of the final rules by the Secretary under the Model Small Group
Rating Rules or, as applicable, the Transitional Model Small Group Rating
Rules, but in no event earlier than the date that is 12 months after the date
of enactment of this title.</text>
</subsection></section><section changed="added" committee-id="SSHR00" id="iddeed1770-44fb-46ef-a058-f8795fd6513a" reported-display-style="italic"><enum>2914.</enum><header>Civil actions and
jurisdiction</header>
<subsection changed="added" committee-id="SSHR00" id="id65919b61-7713-4e5f-8992-83fe76e6a29f" reported-display-style="italic"><enum>(a)</enum><header>In
general</header><text>The courts of the United States shall have exclusive
jurisdiction over civil actions involving the interpretation of this
part.</text>
</subsection><subsection changed="added" committee-id="SSHR00" id="ID6a503c223ee34d10a12aa9faa749655e" reported-display-style="italic"><enum>(b)</enum><header>Actions</header><text>An
eligible insurer may bring an action in the district courts of the United
States for injunctive or other equitable relief against any officials or agents
of a nonadopting State in connection with any conduct or action, or proposed
conduct or action, by such officials or agents which violates, or which would
if undertaken violate, section 2913.</text>
</subsection><subsection changed="added" committee-id="SSHR00" id="ID2382da7a3e214d4c99cae688f6b206ba" reported-display-style="italic"><enum>(c)</enum><header>Direct filing in Court
of Appeals</header><text>At the election of the eligible insurer, an action may
be brought under subsection (b) directly in the United States Court of Appeals
for the circuit in which the nonadopting State is located by the filing of a
petition for review in such Court.</text>
</subsection><subsection changed="added" committee-id="SSHR00" id="ID6df9f8f212d048f7b206f069ef52561d" reported-display-style="italic"><enum>(d)</enum><header>Expedited
review</header><text></text>
<paragraph changed="added" committee-id="SSHR00" id="ID1911f76c305848a0b23093397d1eaa19" reported-display-style="italic"><enum>(1)</enum><header>District
court</header><text>In the case of an action brought in a district court of the
United States under subsection (b), such court shall complete such action,
including the issuance of a judgment, prior to the end of the 120-day period
beginning on the date on which such action is filed, unless all parties to such
proceeding agree to an extension of such period.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="IDed8f114af4d946f09a02cefd5089d4c8" reported-display-style="italic"><enum>(2)</enum><header>Court of
Appeals</header><text>In the case of an action brought directly in a United
States Court of Appeal under subsection (c), or in the case of an appeal of an
action brought in a district court under subsection (b), such Court shall
complete all action on the petition, including the issuance of a judgment,
prior to the end of the 60-day period beginning on the date on which such
petition is filed with the Court, unless all parties to such proceeding agree
to an extension of such period.</text>
</paragraph></subsection><subsection changed="added" committee-id="SSHR00" id="ID9576a74f864e498d9854546793e439aa" reported-display-style="italic"><enum>(e)</enum><header>Standard of
review</header><text>A court in an action filed under this section, shall
render a judgment based on a review of the merits of all questions presented in
such action and shall not defer to any conduct or action, or proposed conduct
or action, of a nonadopting State.</text>
</subsection></section><section changed="added" committee-id="SSHR00" id="idea67208b-e5c4-46e2-898c-5fac591d8d9e" reported-display-style="italic"><enum>2915.</enum><header>Ongoing
review</header><text display-inline="no-display-inline">Not later than 5 years
after the date on which the Model Small Group Rating Rules are issued under
this part, and every 5 years thereafter, the Secretary, in consultation with
the National Association of Insurance Commissioners, shall prepare and submit
to the appropriate committees of Congress a report that assesses the effect of
the Model Small Group Rating Rules on access, cost, and market functioning in
the small group market. Such report may, if the Secretary, in consultation with
the National Association of Insurance Commissioners, determines such is
appropriate for improving access, costs, and market functioning, contain
legislative proposals for recommended modification to such Model Small Group
Rating Rules.</text>
</section></part><part changed="added" committee-id="SSHR00" id="id7dbc512c-db06-4f9e-90db-225f077e27cd" reported-display-style="italic"><enum>II</enum><header>Affordable
plans</header>
<section changed="added" committee-id="SSHR00" id="id10b353e7-6751-4863-bf9c-ba2f1a657c52" reported-display-style="italic"><enum>2921.</enum><header>Definitions</header><text display-inline="no-display-inline">In this part:</text>
<paragraph changed="added" committee-id="SSHR00" id="id05e82673-3334-43e9-a1b8-e5d39773cd44" reported-display-style="italic"><enum>(1)</enum><header>Adopting
state</header><text>The term <term>adopting State</term> means a State that has
enacted the Benefit Choice Standards in their entirety and as the exclusive
laws of the State that relate to benefit, service, and provider mandates in the
group and individual insurance markets.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="idd3655872-45c5-4edb-9115-404ec5f4cdd2" reported-display-style="italic"><enum>(2)</enum><header>Benefit Choice
Standards</header><text>The term <term>Benefit Choice Standards</term> means
the Standards issued under section 2922.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="idd7034dc9-4df1-44f4-b348-a162e95d6e07" reported-display-style="italic"><enum>(3)</enum><header>Eligible
insurer</header><text>The term <term>eligible insurer</term> means a health
insurance issuer that is licensed in a nonadopting State and that—</text>
<subparagraph changed="added" committee-id="SSHR00" id="idf91a1bd8-a748-4536-8ebd-a1ab4e6eec00" reported-display-style="italic"><enum>(A)</enum><text>notifies the Secretary,
not later than 30 days prior to the offering of coverage described in this
subparagraph, that the issuer intends to offer health insurance coverage
consistent with the Benefit Choice Standards in a nonadopting State;</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="id8aa53a97-6a32-4181-b0ab-5320ce38b7c1" reported-display-style="italic"><enum>(B)</enum><text>notifies the insurance
department of a nonadopting State (or other State agency), not later than 30
days prior to the offering of coverage described in this subparagraph, that the
issuer intends to offer health insurance coverage in that State consistent with
the Benefit Choice Standards, and provides with such notice a copy of any
insurance policy that it intends to offer in the State, its most recent annual
and quarterly financial reports, and any other information required to be filed
with the insurance department of the State (or other State agency) by the
Secretary in regulations; and</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="id3c2a492f-837e-4932-8fd0-fae77e44d94b" reported-display-style="italic"><enum>(C)</enum><text>includes in the terms of
the health insurance coverage offered in nonadopting States (including in the
terms of any individual certificates that may be offered to individuals in
connection with such group health coverage) and filed with the State pursuant
to subparagraph (B), a description in the insurer's contract of the Benefit
Choice Standards and that adherence to such Standards is included as a term of
such contract.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSHR00" id="ide8c135c5-535b-43e3-814d-a400fbbd403a" reported-display-style="italic"><enum>(4)</enum><header>Health insurance
coverage</header><text>The term <term>health insurance coverage</term> means
any coverage issued in the group or individual health insurance markets, except
that such term shall not include excepted benefits (as defined in section
2791(c)).</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id517d465b-4108-4f64-8f9d-b5586053e32a" reported-display-style="italic"><enum>(5)</enum><header>Nonadopting
state</header><text>The term <term>nonadopting State</term> means a State that
is not an adopting State.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id571539ABBAE441E49C06372D3BCB7BE5" reported-display-style="italic"><enum>(6)</enum><header>Small group insurance
market</header><text>The term <term>small group insurance market</term> shall
have the meaning given the term <term>small group market</term> in section
2791(e)(5).</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="ida702a4ff-7567-42e3-aba8-7198ab0ba84d" reported-display-style="italic"><enum>(7)</enum><header>State
law</header><text>The term <term>State law</term> means all laws, decisions,
rules, regulations, or other State actions (including actions by a State
agency) having the effect of law, of any State.</text>
</paragraph></section><section changed="added" commented="no" committee-id="SSHR00" display-inline="no-display-inline" id="ide3aed3be-d9e5-4917-a7c3-e7fdda4def87" reported-display-style="italic" section-type="subsequent-section"><enum>2922.</enum><header>Offering affordable
plans</header>
<subsection changed="added" committee-id="SSHR00" id="IDad0915a66ffe4811a0552062ae29c5c7" reported-display-style="italic"><enum>(a)</enum><header>Benefit choice
options</header><text></text>
<paragraph changed="added" committee-id="SSHR00" id="IDe68b393356ca4cf49a5ffdde3352f846" reported-display-style="italic"><enum>(1)</enum><header>Development</header><text>Not
later than 6 months after the date of enactment of this title, the Secretary
shall issue, by interim final rule, Benefit Choice Standards that implement the
standards provided for in this part.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="ID4fea4a4b33794bd1813cdbeb836eb8e5" reported-display-style="italic"><enum>(2)</enum><header>Basic
options</header><text>The Benefit Choice Standards shall provide that a health
insurance issuer in a State, may offer a coverage plan or plan in the small
group market, individual market, large group market, or through a small
business health plan, that does not comply with one or more mandates regarding
covered benefits, services, or category of provider as may be in effect in such
State with respect to such market or markets (either prior to or following the
date of enactment of this title), if such issuer also offers in such market or
markets an enhanced option as provided for in paragraph (3).</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="ID10da156dee4e4e16bf601e972c54bd3d" reported-display-style="italic"><enum>(3)</enum><header>Enhanced
option</header><text>A health insurance issuer issuing a basic option as
provided for in paragraph (2) shall also offer to purchasers (including, with
respect to a small business health plan, the participating employers of such
plan) an enhanced option, which shall at a minimum include such covered
benefits, services, and categories of providers as are covered by a State
employee coverage plan in one of the 5 most populous States as are in effect in
the calendar year in which such enhanced option is offered.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="IDab9226a4541540caadf9af670e0272e1" reported-display-style="italic"><enum>(4)</enum><header>Publication of
benefits</header><text>Not later than 3 months after the date of enactment of
this title, and on the first day of every calendar year thereafter, the
Secretary shall publish in the Federal Register such covered benefits,
services, and categories of providers covered in that calendar year by the
State employee coverage plans in the 5 most populous States.</text>
</paragraph></subsection><subsection changed="added" committee-id="SSHR00" id="IDf88f9cce184f4a3ca9f19945c8ff01f9" reported-display-style="italic"><enum>(b)</enum><header>Effective
dates</header><text></text>
<paragraph changed="added" committee-id="SSHR00" id="ID8fb7aba25cc141af801f0b10a0d16f24" reported-display-style="italic"><enum>(1)</enum><header>Small business health
plans</header><text>With respect to health insurance provided to participating
employers of small business health plans, the requirements of this part
(concerning lower cost plans) shall apply beginning on the date that is 12
months after the date of enactment of this title.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="ID0c8289135d004a9d8b9299e7c233bc5f" reported-display-style="italic"><enum>(2)</enum><header>Non-association
coverage</header><text>With respect to health insurance provided to groups or
individuals other than participating employers of small business health plans,
the requirements of this part shall apply beginning on the date that is 15
months after the date of enactment of this title.</text>
</paragraph></subsection></section><section changed="added" committee-id="SSHR00" id="id19d4ef67-caaf-483a-97e4-16aa7c561e32" reported-display-style="italic"><enum>2923.</enum><header>Application and
preemption</header>
<subsection changed="added" committee-id="SSHR00" id="id28a7e8b2-713f-4529-990c-bc99af8eb2bd" reported-display-style="italic"><enum>(a)</enum><header>Superceding of state
law</header><text></text>
<paragraph changed="added" committee-id="SSHR00" id="id352ad27b-1069-45b4-8609-515d5cbf336b" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>This part shall supersede any and all State laws insofar
as such laws relate to mandates relating to covered benefits, services, or
categories of provider in the health insurance market as applied to an eligible
insurer, or health insurance coverage issued by an eligible insurer, including
with respect to coverage issued to a small business health plan, in a
nonadopting State.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id3ab8b307-ac95-4aa9-9b00-264e0b9c2204" reported-display-style="italic"><enum>(2)</enum><header>Nonadopting
states</header><text>This part shall supersede any and all State laws of a
nonadopting State (whether enacted prior to or after the date of enactment of
this title) insofar as such laws—</text>
<subparagraph changed="added" committee-id="SSHR00" id="ide095745a-0a64-4e6c-8843-9e3af650ebc4" reported-display-style="italic"><enum>(A)</enum><text>prohibit an eligible
insurer from offering, marketing, or implementing health insurance coverage
consistent with the Benefit Choice Standards, as provided for in section
2922(a); or</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="id9EF0F31382B24EAB8068514392AA7AFD" reported-display-style="italic"><enum>(B)</enum><text>have the effect of
retaliating against or otherwise punishing in any respect an eligible insurer
for offering, marketing, or implementing health insurance coverage consistent
with the Benefit Choice Standards.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SSHR00" id="idb26bd58e-10b5-478f-89b7-744a89adfe8c" reported-display-style="italic"><enum>(b)</enum><header>Savings clause and
construction</header><text></text>
<paragraph changed="added" committee-id="SSHR00" id="id5b593b0d-d2bf-4c6c-9aba-a1179a37aa3f" reported-display-style="italic"><enum>(1)</enum><header>Nonapplication to
adopting states</header><text>Subsection (a) shall not apply with respect to
adopting States.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id62d896d6-dccc-4a56-a5b2-9a261d457eb3" reported-display-style="italic"><enum>(2)</enum><header>Nonapplication to
certain insurers</header><text>Subsection (a) shall not apply with respect to
insurers that do not qualify as eligible insurers who offer health insurance
coverage in a nonadopting State.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id7ce8d081-d7f5-49bf-862a-f55ed195d85b" reported-display-style="italic"><enum>(3)</enum><header>Nonapplication where
obtaining relief under state law</header><text>Subsection (a)(1) shall not
supercede any State law of a nonadopting State to the extent necessary to
permit individuals or the insurance department of the State (or other State
agency) to obtain relief under State law to require an eligible insurer to
comply with the Benefit Choice Standards.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="IDfeadb6a897b8415a98edd74a3882ad5f" reported-display-style="italic"><enum>(4)</enum><header>No effect on
preemption</header><text>In no case shall this part be construed to limit or
affect in any manner the preemptive scope of sections 502 and 514 of the
Employee Retirement Income Security Act of 1974. In no case shall this part be
construed to create any cause of action under Federal or State law or enlarge
or affect any remedy available under the Employee Retirement Income Security
Act of 1974</text>
</paragraph></subsection></section><section changed="added" committee-id="SSHR00" id="id6bb54cf1-bf08-4289-b1c2-2d726776aa46" reported-display-style="italic"><enum>2924.</enum><header>Civil actions and
jurisdiction</header>
<subsection changed="added" committee-id="SSHR00" id="id580c8c81-5467-4bb5-80a2-a736aebd9a68" reported-display-style="italic"><enum>(a)</enum><header>In
general</header><text>The courts of the United States shall have exclusive
jurisdiction over civil actions involving the interpretation of this
part.</text>
</subsection><subsection changed="added" committee-id="SSHR00" id="idF0C3B21B110C40B1BEB7EF12179713EA" reported-display-style="italic"><enum>(b)</enum><header>Actions</header><text>An
eligible insurer may bring an action in the district courts of the United
States for injunctive or other equitable relief against any officials or agents
of a nonadopting State in connection with any conduct or action, or proposed
conduct or action, by such officials or agents which violates, or which would
if undertaken violate, section 2923.</text>
</subsection><subsection changed="added" committee-id="SSHR00" id="idA894CDF675754AD98E7BB4C40AF38ABB" reported-display-style="italic"><enum>(c)</enum><header>Direct filing in Court
of Appeals</header><text>At the election of the eligible insurer, an action may
be brought under subsection (b) directly in the United States Court of Appeals
for the circuit in which the nonadopting State is located by the filing of a
petition for review in such Court.</text>
</subsection><subsection changed="added" committee-id="SSHR00" id="idA86E516F92064F7EB01D720BC581D224" reported-display-style="italic"><enum>(d)</enum><header>Expedited
review</header><text></text>
<paragraph changed="added" committee-id="SSHR00" id="id995A935B92C846139AADCDD9FE0D2E94" reported-display-style="italic"><enum>(1)</enum><header>District
court</header><text>In the case of an action brought in a district court of the
United States under subsection (b), such court shall complete such action,
including the issuance of a judgment, prior to the end of the 120-day period
beginning on the date on which such action is filed, unless all parties to such
proceeding agree to an extension of such period.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id1B8B4A4B33E74BC2B0D39F2700CA4B5F" reported-display-style="italic"><enum>(2)</enum><header>Court of
Appeals</header><text>In the case of an action brought directly in a United
States Court of Appeal under subsection (c), or in the case of an appeal of an
action brought in a district court under subsection (b), such Court shall
complete all action on the petition, including the issuance of a judgment,
prior to the end of the 60-day period beginning on the date on which such
petition is filed with the Court, unless all parties to such proceeding agree
to an extension of such period.</text>
</paragraph></subsection><subsection changed="added" committee-id="SSHR00" id="idFB9BA1C03504402DB95762CED3C6979B" reported-display-style="italic"><enum>(e)</enum><header>Standard of
review</header><text>A court in an action filed under this section, shall
render a judgment based on a review of the merits of all questions presented in
such action and shall not defer to any conduct or action, or proposed conduct
or action, of a nonadopting State.</text>
</subsection></section><section changed="added" commented="no" committee-id="SSHR00" id="id3ED17E0D08AB48D7984C442ECE28A1BE" reported-display-style="italic"><enum>2925.</enum><header>Rules of
construction</header>
<subsection changed="added" commented="no" committee-id="SSHR00" id="id055E6E90BC4A4A36BBF262E5BFA4981F" reported-display-style="italic"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Notwithstanding any
other provision of Federal or State law, a health insurance issuer in an
adopting State or an eligible insurer in a non-adopting State may amend its
existing policies to be consistent with the terms of this subtitle (concerning
rating and benefits).</text>
</subsection><subsection changed="added" commented="no" committee-id="SSHR00" id="id9AC1190E1F2048D3BC214C9C027399AF" reported-display-style="italic"><enum>(b)</enum><header>Health savings
accounts</header><text display-inline="yes-display-inline">Nothing in this
subtitle shall be construed to inhibit the development of health savings
accounts pursuant to section 223 of the Internal Revenue Code of
1986.</text>
</subsection></section></part></subtitle>.
<enum>III</enum><header>Harmonization of health
insurance standards</header>
<section changed="added" committee-id="SSHR00" id="id9748a00a-c826-4a8b-9052-97261e973436" reported-display-style="italic"><enum>301.</enum><header>Health Insurance
Standards Harmonization</header><text display-inline="no-display-inline">Title
XXIX of the Public Health Service Act (as added by section 201) is amended by
adding at the end the following:</text>
<quoted-block changed="added" committee-id="SSHR00" display-inline="no-display-inline" id="id5e319cdb-7a85-4339-afeb-319e10a60d07" reported-display-style="italic" style="OLC">
<subtitle changed="added" committee-id="SSHR00" id="id4abd0440-cf41-4ca2-9a9f-70701dec156f" reported-display-style="italic"><enum>B</enum><header>Standards
harmonization</header>
<section changed="added" committee-id="SSHR00" id="id5cb7c1a2-610d-4adf-9193-fe9383771317" reported-display-style="italic"><enum>2931.</enum><header>Definitions</header><text display-inline="no-display-inline">In this subtitle:</text>
<paragraph changed="added" committee-id="SSHR00" id="id98bb3c32-9f74-4224-bcdc-3603ac5a0ffb" reported-display-style="italic"><enum>(1)</enum><header>Adopting
state</header><text>The term <term>adopting State</term> means a State that has
enacted the harmonized standards adopted under this subtitle in their entirety
and as the exclusive laws of the State that relate to the harmonized
standards.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id39c61e47-6996-46cf-a181-9240dae90f14" reported-display-style="italic"><enum>(2)</enum><header>Eligible
insurer</header><text>The term <term>eligible insurer</term> means a health
insurance issuer that is licensed in a nonadopting State and that—</text>
<subparagraph changed="added" committee-id="SSHR00" id="idCCDFF92C4B9F4D2AB9DFE9B08B690051" reported-display-style="italic"><enum>(A)</enum><text>notifies the Secretary,
not later than 30 days prior to the offering of coverage described in this
subparagraph, that the issuer intends to offer health insurance coverage
consistent with the harmonized standards in a nonadopting State;</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="id03aea133-4c61-4885-912e-ce3baec1e3e8" reported-display-style="italic"><enum>(B)</enum><text>notifies the insurance
department of a nonadopting State (or other State agency), not later than 30
days prior to the offering of coverage described in this subparagraph, that the
issuer intends to offer health insurance coverage in that State consistent with
the harmonized standards published pursuant to section 2932(d), and provides
with such notice a copy of any insurance policy that it intends to offer in the
State, its most recent annual and quarterly financial reports, and any other
information required to be filed with the insurance department of the State (or
other State agency) by the Secretary in regulations; and</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="id17337fb5-158e-4f13-bebc-fd75e8ef5006" reported-display-style="italic"><enum>(C)</enum><text>includes in the terms of
the health insurance coverage offered in nonadopting States (including in the
terms of any individual certificates that may be offered to individuals in
connection with such health coverage) and filed with the State pursuant to
subparagraph (B), a description of the harmonized standards published pursuant
to section 2932(g)(2) and an affirmation that such standards are a term of the
contract.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSHR00" id="id54f15f2f-c446-4f9f-89fd-14a2d9bddb45" reported-display-style="italic"><enum>(3)</enum><header>Harmonized
standards</header><text>The term <term>harmonized standards</term> means the
standards certified by the Secretary under section 2932(d).</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id6aa2ed84-6d0c-41fe-8f48-1091430c1e56" reported-display-style="italic"><enum>(4)</enum><header>Health insurance
coverage</header><text>The term <term>health insurance coverage</term> means
any coverage issued in the health insurance market, except that such term shall
not include excepted benefits (as defined in section 2791(c).</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="ida3192190-2916-4880-9f1e-5427b88d19fc" reported-display-style="italic"><enum>(5)</enum><header>Nonadopting
state</header><text>The term <term>nonadopting State</term> means a State that
fails to enact, within 18 months of the date on which the Secretary certifies
the harmonized standards under this subtitle, the harmonized standards in their
entirety and as the exclusive laws of the State that relate to the harmonized
standards.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="idcd41908c-6a2b-45f1-bfbe-92ad4728ac94" reported-display-style="italic"><enum>(6)</enum><header>State
law</header><text>The term <term>State law</term> means all laws, decisions,
rules, regulations, or other State actions (including actions by a State
agency) having the effect of law, of any State.</text>
</paragraph></section><section changed="added" committee-id="SSHR00" id="idc09af15d-c88e-46dc-b879-558f334a02d6" reported-display-style="italic"><enum>2932.</enum><header>Harmonized
standards</header>
<subsection changed="added" committee-id="SSHR00" id="id86f0fcee-b26a-42f1-a382-0d3dc6f8836d" reported-display-style="italic"><enum>(a)</enum><header>Board</header>
<paragraph changed="added" committee-id="SSHR00" id="id23e1f327-9b42-4138-bd31-580987cb1769" reported-display-style="italic"><enum>(1)</enum><header>Establishment</header><text>Not
later than 3 months after the date of enactment of this title, the Secretary,
in consultation with the NAIC, shall establish the Health Insurance Consensus
Standards Board (referred to in this subtitle as the <quote>Board</quote>) to
develop recommendations that harmonize inconsistent State health insurance laws
in accordance with the procedures described in subsection (b).</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id17601c5a-6cde-45f7-ba84-1caffb46c6c9" reported-display-style="italic"><enum>(2)</enum><header>Composition</header>
<subparagraph changed="added" committee-id="SSHR00" id="id5407F39DCC1F409ABE8050DDFC813457" reported-display-style="italic"><enum>(A)</enum><header>In
general</header><text>The Board shall be composed of the following voting
members to be appointed by the Secretary after considering the recommendations
of professional organizations representing the entities and constituencies
described in this paragraph:</text>
<clause changed="added" committee-id="SSHR00" id="id40b4d5ca-9fd6-43b3-8779-3691025488cd" reported-display-style="italic"><enum>(i)</enum><text>Four State insurance
commissioners as recommended by the National Association of Insurance
Commissioners, of which 2 shall be Democrats and 2 shall be Republicans, and of
which one shall be designated as the chairperson and one shall be designated as
the vice chairperson.</text>
</clause><clause changed="added" committee-id="SSHR00" id="id92ce4afd-a5b3-45e0-89e1-c3ae7c38d4f6" reported-display-style="italic"><enum>(ii)</enum><text>Four representatives of
State government, two of which shall be governors of States and two of which
shall be State legislators, and two of which shall be Democrats and two of
which shall be Republicans.</text>
</clause><clause changed="added" committee-id="SSHR00" id="ID029a0025d179434f9809bc984214486d" reported-display-style="italic"><enum>(iii)</enum><text>Four representatives of
health insurers, of which one shall represent insurers that offer coverage in
the small group market, one shall represent insurers that offer coverage in the
large group market, one shall represent insurers that offer coverage in the
individual market, and one shall represent carriers operating in a regional
market.</text>
</clause><clause changed="added" committee-id="SSHR00" id="idb117cf94-4f93-4736-bb27-f3e06db670ad" reported-display-style="italic"><enum>(iv)</enum><text>Two representatives of
insurance agents and brokers.</text>
</clause><clause changed="added" committee-id="SSHR00" id="id6e4a223c-d56d-4a1a-ad5c-69438939afe9" reported-display-style="italic"><enum>(v)</enum><text>Two independent
representatives of the American Academy of Actuaries who have familiarity with
the actuarial methods applicable to health insurance.</text>
</clause></subparagraph><subparagraph changed="added" commented="no" committee-id="SSHR00" id="id6c358103-87a0-4271-9197-8f42520b734c" reported-display-style="italic"><enum>(B)</enum><header>Ex officio
member</header><text>A representative of the Secretary shall serve as an ex
officio member of the Board.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSHR00" id="id8A290D4DAEF948A7866AA321DBB0BABA" reported-display-style="italic"><enum>(3)</enum><header>Advisory
panel</header><text>The Secretary shall establish an advisory panel to provide
advice to the Board, and shall appoint its members after considering the
recommendations of professional organizations representing the entities and
constituencies identified in this paragraph:</text>
<subparagraph changed="added" committee-id="SSHR00" id="id3A77DB60D22F4A4A8D09C80B49DD0F3E" reported-display-style="italic"><enum>(A)</enum><text>Two representatives of
small business health plans.</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="idA38DB983FEF448E583694F5CF26CF339" reported-display-style="italic"><enum>(B)</enum><text>Two representatives of
employers, of which one shall represent small employers and one shall represent
large employers.</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="id31D80D842857439FA831010CC2E2FB64" reported-display-style="italic"><enum>(C)</enum><text>Two representatives of
consumer organizations.</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="idC348D3BC7A244AF0930C28D01F912B2C" reported-display-style="italic"><enum>(D)</enum><text>Two representatives of
health care providers.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSHR00" id="id12D352285166495CB872F5591877D2D6" reported-display-style="italic"><enum>(4)</enum><header>Qualifications</header><text>The
membership of the Board shall include individuals with national recognition for
their expertise in health finance and economics, actuarial science, health
plans, providers of health services, and other related fields, who provide a
mix of different professionals, broad geographic representation, and a balance
between urban and rural representatives.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="ID416CA5F26FA041CDB0DEE5C1610CE5E2" reported-display-style="italic"><enum>(5)</enum><header>Ethical
disclosure</header><text>The Secretary shall establish a system for public
disclosure by members of the Board of financial and other potential conflicts
of interest relating to such members. Members of the Board shall be treated as
employees of Congress for purposes of applying title I of the Ethics in
Government Act of 1978 (Public Law 95–521).</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="ID32F33CF3D669452694B175699B56BB13" reported-display-style="italic"><enum>(6)</enum><header>Director and
staff</header><text>Subject to such review as the Secretary deems necessary to
assure the efficient administration of the Board, the chair and vice-chair of
the Board may—</text>
<subparagraph changed="added" committee-id="SSHR00" id="ID4D2902F84AB34A9B90F4194E5DCBF373" reported-display-style="italic"><enum>(A)</enum><text>employ and fix the
compensation of an Executive Director (subject to the approval of the
Comptroller General) and such other personnel as may be necessary to carry out
its duties (without regard to the provisions of title 5, United States Code,
governing appointments in the competitive service);</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="IDB97A3569574742AFA400C84F7A3B6E25" reported-display-style="italic"><enum>(B)</enum><text>seek such assistance and
support as may be required in the performance of its duties from appropriate
Federal departments and agencies;</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="ID223C8CFB14BD4D1FB53DDF5825E92C24" reported-display-style="italic"><enum>(C)</enum><text>enter into contracts or
make other arrangements, as may be necessary for the conduct of the work of the
Board (without regard to section 3709 of the Revised Statutes (41 U.S.C.
5));</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="ID3FB1B6EB792F48C69A022C9548D940CB" reported-display-style="italic"><enum>(D)</enum><text>make advance, progress,
and other payments which relate to the work of the Board;</text>
</subparagraph><subparagraph changed="added" commented="no" committee-id="SSHR00" id="ID06CDC2C491534BBF9CABF01C7D511948" reported-display-style="italic"><enum>(E)</enum><text>provide transportation
and subsistence for persons serving without compensation; and</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="ID5C6618A4EFDE4FE2B2768CD2643E5D78" reported-display-style="italic"><enum>(F)</enum><text>prescribe such rules as
it deems necessary with respect to the internal organization and operation of
the Board.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSHR00" id="id4ba763ea-b8dc-4024-aaaf-ede6cf159fc9" reported-display-style="italic"><enum>(7)</enum><header>Terms</header><text>The
members of the Board shall serve for the duration of the Board. Vacancies in
the Board shall be filled as needed in a manner consistent with the composition
described in paragraph (2).</text>
</paragraph></subsection><subsection changed="added" committee-id="SSHR00" id="IDdb4cf1ed0df54de28152d0f07409f016" reported-display-style="italic"><enum>(b)</enum><header>Development of
harmonized standards</header><text></text>
<paragraph changed="added" committee-id="SSHR00" id="ID5d9217d4efb54524b18d5b86fd682e28" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>In accordance with the process described in subsection
(c), the Board shall identify and recommend nationally harmonized standards for
each of the following process categories:</text>
<subparagraph changed="added" committee-id="SSHR00" id="ID7db4f77eff2f446b87b5811d8e6a3666" reported-display-style="italic"><enum>(A)</enum><header>Form filing and rate
filing</header><text>Form and rate filing standards shall be established which
promote speed to market and include the following defined areas for States that
require such filings:</text>
<clause changed="added" committee-id="SSHR00" id="ID5cbbc55a3dcb4555955275038492448f" reported-display-style="italic"><enum>(i)</enum><text>Procedures for form and
rate filing pursuant to a streamlined administrative filing process.</text>
</clause><clause changed="added" committee-id="SSHR00" id="ID0a3e561b7ac641d68c30a24d5b131b08" reported-display-style="italic"><enum>(ii)</enum><text>Timeframes for filings
to be reviewed by a State if review is required before they are deemed
approved.</text>
</clause><clause changed="added" committee-id="SSHR00" id="ID0067be900d6443adbe34090d47309d51" reported-display-style="italic"><enum>(iii)</enum><text>Timeframes for an
eligible insurer to respond to State requests following its review.</text>
</clause><clause changed="added" committee-id="SSHR00" id="IDf2ebb05a4cc54bc69889052c6df1c5eb" reported-display-style="italic"><enum>(iv)</enum><text>A process for an
eligible insurer to self-certify.</text>
</clause><clause changed="added" committee-id="SSHR00" id="ID901baa75675e4f04a3b19efc51e466e3" reported-display-style="italic"><enum>(v)</enum><text>State development of form
and rate filing templates that include only non-preempted State law and Federal
law requirements for eligible insurers with timely updates.</text>
</clause><clause changed="added" committee-id="SSHR00" id="IDfb899b288c184dca9be28d5a01678e94" reported-display-style="italic"><enum>(vi)</enum><text>Procedures for the
resubmission of forms and rates.</text>
</clause><clause changed="added" committee-id="SSHR00" id="IDd897c9ab97174113ac2bd076db46b5e8" reported-display-style="italic"><enum>(vii)</enum><text>Disapproval rationale
of a form or rate filing based on material omissions or violations of
non-preempted State law or Federal law with violations cited and
explained.</text>
</clause><clause changed="added" committee-id="SSHR00" id="ID8b73305dd0ae4488bb13e672aa4c064a" reported-display-style="italic"><enum>(viii)</enum><text>For States that may
require a hearing, a rationale for hearings based on violations of
non-preempted State law or insurer requests.</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SSHR00" id="IDf1e0af51e2c345c0a99b71276cd2386d" reported-display-style="italic"><enum>(B)</enum><header>Market conduct
review</header><text>Market conduct review standards shall be developed which
provide for the following:</text>
<clause changed="added" committee-id="SSHR00" id="ID685a67194d4642b6a352c5c987c0c73a" reported-display-style="italic"><enum>(i)</enum><text>Mandatory participation
in national databases.</text>
</clause><clause changed="added" committee-id="SSHR00" id="IDdbf270ed023f47e5a8ef4c89102782af" reported-display-style="italic"><enum>(ii)</enum><text>The confidentiality of
examination materials.</text>
</clause><clause changed="added" committee-id="SSHR00" id="ID7573227ef65f4663ba135c3b5fa2d6b9" reported-display-style="italic"><enum>(iii)</enum><text>The identification of
the State agency with primary responsibility for examinations.</text>
</clause><clause changed="added" committee-id="SSHR00" id="ID5cdd69edf3e24cccbfe404fede8d72ba" reported-display-style="italic"><enum>(iv)</enum><text>Consultation and
verification of complaint data with the eligible insurer prior to State
actions.</text>
</clause><clause changed="added" committee-id="SSHR00" id="ID7185b0f463ab479a98fad5337de24dbb" reported-display-style="italic"><enum>(v)</enum><text>Consistency of reporting
requirements with the recordkeeping and administrative practices of the
eligible insurer.</text>
</clause><clause changed="added" committee-id="SSHR00" id="ID2cfd612a8e6d4e76b883ac80cf302a26" reported-display-style="italic"><enum>(vi)</enum><text>Examinations that seek
to correct material errors and harmful business practices rather than
infrequent errors.</text>
</clause><clause changed="added" committee-id="SSHR00" id="ID38f88047809c434d88d13b0da4618dac" reported-display-style="italic"><enum>(vii)</enum><text>Transparency and
publishing of the State's examination standards.</text>
</clause><clause changed="added" committee-id="SSHR00" id="ID5f8c9b41c02445019b36e2730b4d965a" reported-display-style="italic"><enum>(viii)</enum><text>Coordination of market
conduct analysis.</text>
</clause><clause changed="added" committee-id="SSHR00" id="ID279a0659760342468b611425ac90f075" reported-display-style="italic"><enum>(ix)</enum><text>Coordination and
nonduplication between State examinations of the same eligible insurer.</text>
</clause><clause changed="added" committee-id="SSHR00" id="ID0c18414eb4d542b2b60e2b01a5803df5" reported-display-style="italic"><enum>(x)</enum><text>Rationale and protocols
to be met before a full examination is conducted.</text>
</clause><clause changed="added" committee-id="SSHR00" id="IDdc522a0540f1429eaa8a7ed11a821594" reported-display-style="italic"><enum>(xi)</enum><text>Requirements on
examiners prior to beginning examinations such as budget planning and work
plans.</text>
</clause><clause changed="added" committee-id="SSHR00" id="IDd2a83d67284c4bac975cf30ccaebe9f0" reported-display-style="italic"><enum>(xii)</enum><text>Consideration of
methods to limit examiners' fees such as caps, competitive bidding, or other
alternatives.</text>
</clause><clause changed="added" committee-id="SSHR00" id="ID165411b4e7964fdfa2b30f6340cd9e25" reported-display-style="italic"><enum>(xiii)</enum><text>Reasonable fines and
penalties for material errors and harmful business practices.</text>
</clause></subparagraph><subparagraph changed="added" committee-id="SSHR00" id="IDeeaad07d6b52403595e468e9648f1367" reported-display-style="italic"><enum>(C)</enum><header>Prompt payment of
claims</header><text>The Board shall establish prompt payment standards for
eligible insurers based on standards similar to those applicable to the Social
Security Act as set forth in section 1842(c)(2) of such Act (42 U.S.C.
1395u(c)(2)). Such prompt payment standards shall be consistent with the timing
and notice requirements of the claims procedure rules to be specified under
subparagraph (D), and shall include appropriate exceptions such as for fraud,
nonpayment of premiums, or late submission of claims.</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="IDee587ff1283e4fa7b8ef9e4c3f0bfc89" reported-display-style="italic"><enum>(D)</enum><header>Internal
review</header><text>The Board shall establish standards for claims procedures
for eligible insurers that are consistent with the requirements relating to
initial claims for benefits and appeals of claims for benefits under the
Employee Retirement Income Security Act of 1974 as set forth in section 503 of
such Act (29 U.S.C. 1133) and the regulations thereunder.</text>
</subparagraph></paragraph><paragraph changed="added" committee-id="SSHR00" id="ID3b60041f72bf477397cf9966737e4064" reported-display-style="italic"><enum>(2)</enum><header>Recommendations</header><text>The
Board shall recommend harmonized standards for each element of the categories
described in subparagraph (A) through (D) of paragraph (1) within each such
market. Notwithstanding the previous sentence, the Board shall not recommend
any harmonized standards that disrupt, expand, or duplicate the benefit,
service, or provider mandate standards provided in the Benefit Choice Standards
pursuant to section 2922(a).</text>
</paragraph></subsection><subsection changed="added" committee-id="SSHR00" id="IDad939a151e9b4189a0c610e32e991428" reported-display-style="italic"><enum>(c)</enum><header>Process for identifying
harmonized standards</header><text></text>
<paragraph changed="added" committee-id="SSHR00" id="ID663df3b12c584f2fbfc941a0bbcf2c8a" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>The Board shall develop recommendations to harmonize
inconsistent State insurance laws with respect to each of the process
categories described in subparagraphs (A) through (D) of subsection
(b)(1).</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="ID0a7834dfdbe547b5ab7165d9d05824b3" reported-display-style="italic"><enum>(2)</enum><header>Requirements</header><text>In
adopting standards under this section, the Board shall consider the
following:</text>
<subparagraph changed="added" committee-id="SSHR00" id="ID535736c6ca2b4022b89e5f83e3830feb" reported-display-style="italic"><enum>(A)</enum><text>Any model acts or
regulations of the National Association of Insurance Commissioners in each of
the process categories described in subparagraphs (A) through (D) of subsection
(b)(1).</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="ID13766b1753f844ee8523d4488bd5bf4e" reported-display-style="italic"><enum>(B)</enum><text>Substantially similar
standards followed by a plurality of States, as reflected in existing State
laws, relating to the specific process categories described in subparagraphs
(A) through (D) of subsection (b)(1).</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="ID6e5ec97f30784c0c99ca666e6921f8d2" reported-display-style="italic"><enum>(C)</enum><text>Any Federal law
requirement related to specific process categories described in subparagraphs
(A) through (D) of subsection (b)(1).</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="ID18692233231042c6933b682ecad19702" reported-display-style="italic"><enum>(D)</enum><text>In the case of the
adoption of any standard that differs substantially from those referred to in
subparagraphs (A), (B), or (C), the Board shall provide evidence to the
Secretary that such standard is necessary to protect health insurance consumers
or promote speed to market or administrative efficiency.</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="ID907687a014b34cb4b63d0d5f67dd65d1" reported-display-style="italic"><enum>(E)</enum><text>The criteria specified in
clauses (i) through (iii) of subsection (d)(2)(B).</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SSHR00" id="idb972262c-5ebe-407a-8309-06fb0b3a5950" reported-display-style="italic"><enum>(d)</enum><header>Recommendations and
certification by Secretary</header>
<paragraph changed="added" committee-id="SSHR00" id="id4558255a-9805-4582-8c03-e54c478afa81" reported-display-style="italic"><enum>(1)</enum><header>Recommendations</header><text>Not
later than 18 months after the date on which all members of the Board are
selected under subsection (a), the Board shall recommend to the Secretary the
certification of the harmonized standards identified pursuant to subsection
(c).</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id5ba528ff-5804-4a28-8f3a-c07bdcecbd9a" reported-display-style="italic"><enum>(2)</enum><header>Certification</header>
<subparagraph changed="added" committee-id="SSHR00" id="idE5AAA5E786D44AD489BB8CF0089BBD27" reported-display-style="italic"><enum>(A)</enum><header>In
general</header><text>Not later than 120 days after receipt of the Board's
recommendations under paragraph (1), the Secretary shall certify the
recommended harmonized standards as provided for in subparagraph (B), and issue
such standards in the form of an interim final regulation.</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="ID085f63432c964fda9c6fa718bdd6865d" reported-display-style="italic"><enum>(B)</enum><header>Certification
process</header><text>The Secretary shall establish a process for certifying
the recommended harmonized standard, by category, as recommended by the Board
under this section. Such process shall—</text>
<clause changed="added" committee-id="SSHR00" id="IDb283daa08d0f4617824f1f25478ab02b" reported-display-style="italic"><enum>(i)</enum><text>ensure that the certified
standards for a particular process area achieve regulatory harmonization with
respect to health plans on a national basis;</text>
</clause><clause changed="added" committee-id="SSHR00" id="IDb9032e5d51a9402c8b7e142c560a7393" reported-display-style="italic"><enum>(ii)</enum><text>ensure that the approved
standards are the minimum necessary, with regard to substance and quantity of
requirements, to protect health insurance consumers and maintain a competitive
regulatory environment; and</text>
</clause><clause changed="added" committee-id="SSHR00" id="ID85f1bc7020c14f198e9d34aaccda8278" reported-display-style="italic"><enum>(iii)</enum><text>ensure that the
approved standards will not limit the range of group health plan designs and
insurance products, such as catastrophic coverage only plans, health savings
accounts, and health maintenance organizations, that might otherwise be
available to consumers.</text>
</clause></subparagraph></paragraph><paragraph changed="added" committee-id="SSHR00" id="id31169f6d-3864-4fff-bbf7-6f2521b5ff3f" reported-display-style="italic"><enum>(3)</enum><header>Effective
date</header><text>The standards certified by the Secretary under paragraph (2)
shall be effective on the date that is 18 months after the date on which the
Secretary certifies the harmonized standards.</text>
</paragraph></subsection><subsection changed="added" committee-id="SSHR00" id="id312c0bfb-5581-4892-8e7f-b5882dbb8784" reported-display-style="italic"><enum>(e)</enum><header>Termination</header><text>The
Board shall terminate and be dissolved after making the recommendations to the
Secretary pursuant to subsection (d)(1).</text>
</subsection><subsection changed="added" commented="no" committee-id="SSHR00" id="ID903f659fc08742fb97a1cb1c4798ecc6" reported-display-style="italic"><enum>(f)</enum><header>Ongoing
review</header><text>Not earlier than 3 years after the termination of the
Board under subsection (e), and not earlier than every 3 years thereafter, the
Secretary, in consultation with the National Association of Insurance
Commissioners and the entities and constituencies represented on the Board and
the Advisory Panel, shall prepare and submit to the appropriate committees of
Congress a report that assesses the effect of the harmonized standards on
access, cost, and health insurance market functioning. The Secretary may, based
on such report and applying the process established for certification under
subsection (d)(2)(B), in consultation with the National Association of
Insurance Commissioners and the entities and constituencies represented on the
Board and the Advisory Panel, update the harmonized standards through notice
and comment rulemaking.</text>
</subsection><subsection changed="added" committee-id="SSHR00" id="id2a07ccfc-a037-41e9-85fd-cad55a872a1d" reported-display-style="italic"><enum>(g)</enum><header>Publication</header>
<paragraph changed="added" committee-id="SSHR00" id="id8e5577e6-8156-45c7-b797-1f9c049c9ca3" reported-display-style="italic"><enum>(1)</enum><header>Listing</header><text>The
Secretary shall maintain an up to date listing of all harmonized standards
certified under this section on the Internet website of the Department of
Health and Human Services.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="idd30672be-78bb-4ab5-8913-76661ffab516" reported-display-style="italic"><enum>(2)</enum><header>Sample contract
language</header><text>The Secretary shall publish on the Internet website of
the Department of Health and Human Services sample contract language that
incorporates the harmonized standards certified under this section, which may
be used by insurers seeking to qualify as an eligible insurer. The types of
harmonized standards that shall be included in sample contract language are the
standards that are relevant to the contractual bargain between the insurer and
insured.</text>
</paragraph></subsection><subsection changed="added" committee-id="SSHR00" id="ided60baed-0a2f-4016-8953-575eea43344b" reported-display-style="italic"><enum>(h)</enum><header>State adoption and
enforcement</header><text>Not later than 18 months after the certification by
the Secretary of harmonized standards under this section, the States may adopt
such harmonized standards (and become an adopting State) and, in which case,
shall enforce the harmonized standards pursuant to State law.</text>
</subsection></section><section changed="added" committee-id="SSHR00" id="id81fc331f-82de-4f58-9012-ea302544a9aa" reported-display-style="italic"><enum>2933.</enum><header>Application and
preemption</header>
<subsection changed="added" committee-id="SSHR00" id="id0cb67a82-63bf-4e6c-b2e5-219242e76cc8" reported-display-style="italic"><enum>(a)</enum><header>Superceding of state
law</header>
<paragraph changed="added" committee-id="SSHR00" id="id67562031-df0c-466f-ac6d-1a674f77808d" reported-display-style="italic"><enum>(1)</enum><header>In
general</header><text>The harmonized standards certified under this subtitle
shall supersede any and all State laws of a non-adopting State insofar as such
State laws relate to the areas of harmonized standards as applied to an
eligible insurer, or health insurance coverage issued by a eligible insurer,
including with respect to coverage issued to a small business health plan, in a
nonadopting State.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="idb1a5e3fe-d794-43f9-86f2-37c6fa68b8ce" reported-display-style="italic"><enum>(2)</enum><header>Nonadopting
states</header><text>This subtitle shall supersede any and all State laws of a
nonadopting State (whether enacted prior to or after the date of enactment of
this title) insofar as they may—</text>
<subparagraph changed="added" committee-id="SSHR00" id="idfd8e1577-93d8-4497-a71d-7369dda6017e" reported-display-style="italic"><enum>(A)</enum><text>prohibit an eligible
insurer from offering, marketing, or implementing health insurance coverage
consistent with the harmonized standards; or</text>
</subparagraph><subparagraph changed="added" committee-id="SSHR00" id="id24E1563AE7074E5685B9142A4C07B277" reported-display-style="italic"><enum>(B)</enum><text>have the effect of
retaliating against or otherwise punishing in any respect an eligible insurer
for offering, marketing, or implementing health insurance coverage consistent
with the harmonized standards under this subtitle.</text>
</subparagraph></paragraph></subsection><subsection changed="added" committee-id="SSHR00" id="ida28a91eb-e1b9-4dc6-82df-ba5c68e1ffc6" reported-display-style="italic"><enum>(b)</enum><header>Savings clause and
construction</header>
<paragraph changed="added" committee-id="SSHR00" id="idcfb3f26d-e1bd-42c7-996e-ac0c9c94fcb3" reported-display-style="italic"><enum>(1)</enum><header>Nonapplication to
adopting states</header><text>Subsection (a) shall not apply with respect to
adopting States.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="idbe0c0c13-b089-4796-a311-b889a97186bd" reported-display-style="italic"><enum>(2)</enum><header>Nonapplication to
certain insurers</header><text>Subsection (a) shall not apply with respect to
insurers that do not qualify as eligible insurers who offer health insurance
coverage in a nonadopting State.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="ide411aaf8-14f1-4a9d-8e48-0502c69560a3" reported-display-style="italic"><enum>(3)</enum><header>Nonapplication where
obtaining relief under state law</header><text>Subsection (a)(1) shall not
supercede any State law of a nonadopting State to the extent necessary to
permit individuals or the insurance department of the State (or other State
agency) to obtain relief under State law to require an eligible insurer to
comply with the harmonized standards under this subtitle.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="ID431ab2a6d35b4fbeb5b7699a098a9fa3" reported-display-style="italic"><enum>(4)</enum><header>No effect on
preemption</header><text>In no case shall this subtitle be construed to limit
or affect in any manner the preemptive scope of sections 502 and 514 of the
Employee Retirement Income Security Act of 1974. In no case shall this subtitle
be construed to create any cause of action under Federal or State law or
enlarge or affect any remedy available under the Employee Retirement Income
Security Act of 1974.</text>
</paragraph></subsection><subsection changed="added" committee-id="SSHR00" id="id794f1f20-d37c-40f3-affb-0affdd43d936" reported-display-style="italic"><enum>(c)</enum><header>Effective
date</header><text>This section shall apply beginning on the date that is 18
months after the date on harmonized standards are certified by the Secretary
under this subtitle.</text>
</subsection></section><section changed="added" committee-id="SSHR00" id="ida81d13ae-3716-40e5-a645-3070065621a6" reported-display-style="italic"><enum>2934.</enum><header>Civil actions and
jurisdiction</header>
<subsection changed="added" committee-id="SSHR00" id="id76185bda-c199-4afc-a969-025049704d53" reported-display-style="italic"><enum>(a)</enum><header>In
general</header><text>The district courts of the United States shall have
exclusive jurisdiction over civil actions involving the interpretation of this
subtitle.</text>
</subsection><subsection changed="added" committee-id="SSHR00" id="id037B54C6DE6E479BB41AC9C6334461F2" reported-display-style="italic"><enum>(b)</enum><header>Actions</header><text>An
eligible insurer may bring an action in the district courts of the United
States for injunctive or other equitable relief against any officials or agents
of a nonadopting State in connection with any conduct or action, or proposed
conduct or action, by such officials or agents which violates, or which would
if undertaken violate, section 2933.</text>
</subsection><subsection changed="added" committee-id="SSHR00" id="idCBA94DEEBA8F482085E8376A3029DB66" reported-display-style="italic"><enum>(c)</enum><header>Direct filing in Court
of Appeals</header><text>At the election of the eligible insurer, an action may
be brought under subsection (b) directly in the United States Court of Appeals
for the circuit in which the nonadopting State is located by the filing of a
petition for review in such Court.</text>
</subsection><subsection changed="added" committee-id="SSHR00" id="idB7C27E2396B44F80B6619CBE1B9CADF0" reported-display-style="italic"><enum>(d)</enum><header>Expedited
review</header><text></text>
<paragraph changed="added" committee-id="SSHR00" id="id118173365C584AE0BE44DE8E3A32CEEB" reported-display-style="italic"><enum>(1)</enum><header>District
court</header><text>In the case of an action brought in a district court of the
United States under subsection (b), such court shall complete such action,
including the issuance of a judgment, prior to the end of the 120-day period
beginning on the date on which such action is filed, unless all parties to such
proceeding agree to an extension of such period.</text>
</paragraph><paragraph changed="added" committee-id="SSHR00" id="id08C49E2C0F034FFE9604FFEF1409D968" reported-display-style="italic"><enum>(2)</enum><header>Court of
Appeals</header><text>In the case of an action brought directly in a United
States Court of Appeal under subsection (c), or in the case of an appeal of an
action brought in a district court under subsection (b), such Court shall
complete all action on the petition, including the issuance of a judgment,
prior to the end of the 60-day period beginning on the date on which such
petition is filed with the Court, unless all parties to such proceeding agree
to an extension of such period.</text>
</paragraph></subsection><subsection changed="added" committee-id="SSHR00" id="id6294E9E5DB7C4E1EB594169FC833175C" reported-display-style="italic"><enum>(e)</enum><header>Standard of
review</header><text>A court in an action filed under this section, shall
render a judgment based on a review of the merits of all questions presented in
such action and shall not defer to any conduct or action, or proposed conduct
or action, of a nonadopting State.</text>
</subsection></section><section changed="added" commented="no" committee-id="SSHR00" display-inline="no-display-inline" id="id08695378-0d65-49bf-9c43-a8109cab5ec0" reported-display-style="italic" section-type="subsequent-section"><enum>2935.</enum><header>Authorization of
appropriations; rule of construction</header>
<subsection changed="added" commented="no" committee-id="SSHR00" display-inline="no-display-inline" id="id39DEB48765DE496495CC1BF03435FB62" reported-display-style="italic"><enum>(a)</enum><header>Authorization of
appropriations</header><text display-inline="yes-display-inline">There are
authorized to be appropriated such sums as may be necessary to carry out this
subtitle.</text>
</subsection><subsection changed="added" commented="no" committee-id="SSHR00" display-inline="no-display-inline" id="id0F12E7DF15F24C99BBECFDE1BEEEC5E7" reported-display-style="italic"><enum>(b)</enum><header>Health savings
accounts</header><text display-inline="yes-display-inline">Nothing in this
subtitle shall be construed to inhibit the development of health savings
accounts pursuant to section 223 of the Internal Revenue Code of
1986.</text>
</subsection></section></subtitle><after-quoted-block>.</after-quoted-block></quoted-block>
</section>
April 27, 2006
Reported with an amendment