42 USC 18021 - Qualified health plan defined

U.S Code last checked for updates: Nov 22, 2024

§ 18021.

Qualified health plan defined

(a)

Qualified health plan

In this title: 1

 See References in Text note below.

(1)

In general

The term “qualified health plan” means a health plan that—

(A)

has in effect a certification (which may include a seal or other indication of approval) that such plan meets the criteria for certification described in section 18031(c) of this title issued or recognized by each Exchange through which such plan is offered;

(B)

provides the essential health benefits package described in section 18022(a) of this title; and

(C)

is offered by a health insurance issuer that—

(i)

is licensed and in good standing to offer health insurance coverage in each State in which such issuer offers health insurance coverage under this title; ¹

(ii)

agrees to offer at least one qualified health plan in the silver level and at least one plan in the gold level in each such Exchange;

(iii)

agrees to charge the same premium rate for each qualified health plan of the issuer without regard to whether the plan is offered through an Exchange or whether the plan is offered directly from the issuer or through an agent; and

(iv)

complies with the regulations developed by the Secretary under section 18031(d) of this title and such other requirements as an applicable Exchange may establish.

(2)

Inclusion of CO–OP plans and multi-State qualified health plans

(3)

Treatment of qualified direct primary care medical home plans

(4)

Variation based on rating area

(b)

Terms relating to health plans

In this title: ¹

(1)

Health plan

(A)

In general

(B)

Exception for self-insured plans and MEWAs

(2)

Health insurance coverage and issuer

(3)

Group health plan

(Pub. L. 111–148, title I, § 1301, title X, § 10104(a), Mar. 23, 2010, 124 Stat. 162, 896.)

cite as: 42 USC 18021