42 U.S.C. § 18053 — Provisions relating to offering of plans in more than one State

submitted 16 years ago by Pub. L. 111-148 to r/title-42-THE-PUBLIC-HEALTH-AND-WELFARE · 435 words · no verdicts yet

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States can join together in "health care choice compacts," letting insurers sell individual-market plans across state lines under mostly one state's insurance law, while still following the buyer's home-state consumer-protection and licensing rules. The Secretary must approve compacts only if they match or exceed this law's coverage, cost protection, and enrollment, without increasing the federal deficit; compacts cannot start before 2016, and subsection (b) was repealed.

(a) Health care choice compacts By July 1, 2013, the Secretary, working with the National Association of Insurance Commissioners, must issue regulations letting two or more states form "health care choice compacts." Under a compact, qualified plans can be sold in the individual market across all the compact states, but, except as noted below, only the laws of the state where the plan was written or issued apply to it. The insurer must still follow the market-conduct, unfair-trade-practice, network-adequacy, and consumer-protection rules, including rating rules and dispute-resolution rules, of the state where the buyer actually lives; it must be licensed in every state where it sells under the compact, or submit to that state's jurisdiction on those specific rules, including letting that state inspect records as if the insurer were licensed there; and it must clearly warn buyers that the policy might not follow all the laws of their home state. A state can only join a compact if it passes a law after March 23, 2010, specifically allowing it to. The Secretary can only approve a compact if it will: cover at least as much as this law's essential benefits and Exchange coverage; protect against excessive out-of-pocket costs at least as well as this law does; cover at least as many residents as this law would; not add to the federal deficit; and not weaken enforcement of the buyer's-home-state rules described above. A compact cannot start before January 1, 2016. (b) Repealed. This subsection was repealed by the same law that created it, Public Law 111-148, section 10104(p), enacted March 23, 2010.

the actual law source: uscode.house.gov ↗public domain

(a) Health care choice compacts

(1) In general

Not later than July 1, 2013, the Secretary shall, in consultation with the National Association of Insurance Commissioners, issue regulations for the creation of health care choice compacts under which 2 or more States may enter into an agreement under which—

(A)

1 or more qualified health plans could be offered in the individual markets in all such States but, except as provided in subparagraph (B), only be subject to the laws and regulations of the State in which the plan was written or issued;

(B)

the issuer of any qualified health plan to which the compact applies—

(i)

would continue to be subject to market conduct, unfair trade practices, network adequacy, and consumer protection standards (including standards relating to rating), including addressing disputes as to the performance of the contract, of the State in which the purchaser resides;

(ii)

would be required to be licensed in each State in which it offers the plan under the compact or to submit to the jurisdiction of each such State with regard to the standards described in clause (i) (including allowing access to records as if the insurer were licensed in the State); and

(iii)

must clearly notify consumers that the policy may not be subject to all the laws and regulations of the State in which the purchaser resides.

(2) State authority

A State may not enter into an agreement under this subsection unless the State enacts a law after March 23, 2010, that specifically authorizes the State to enter into such agreements.

(3) Approval of compacts

The Secretary may approve interstate health care choice compacts under paragraph (1) only if the Secretary determines that such health care choice compact—

(A)

will provide coverage that is at least as comprehensive as the coverage defined in section 18022(b) of this title and offered through Exchanges established under this title; 1

(B)

will provide coverage and cost sharing protections against excessive out-of-pocket spending that are at least as affordable as the provisions of this title ¹ would provide;

(C)

will provide coverage to at least a comparable number of its residents as the provisions of this title ¹ would provide;

(D)

will not increase the Federal deficit; and

(E)

will not weaken enforcement of laws and regulations described in paragraph (1)(B)(i) in any State that is included in such compact.

(4) Effective date

A health care choice compact described in paragraph (1) shall not take effect before January 1, 2016.

(b) Repealed. Pub. L. 111–148, title X, § 10104(p), Mar. 23, 2010, 124 Stat. 902

Source credit: (Pub. L. 111–148, title I, § 1333, title X, § 10104(p), Mar. 23, 2010, 124 Stat. 206, 902.)

history & why it existsrecord from the source credit

2010Enacted · Pub. L. 111-148 · 124 Stat. 206, 902

A history note hasn’t been published yet. The record shows enactment by Pub. L. 111-148 on 2010-03-23.

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