42 USC 18062 - Establishment of risk corridors for plans in individual and small group markets

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

§ 18062.

Establishment of risk corridors for plans in individual and small group markets

(a)

In general

(b)

Payment methodology

(1)

Payments out

The Secretary shall provide under the program established under subsection (a) that if—

(A)

a participating plan’s allowable costs for any plan year are more than 103 percent but not more than 108 percent of the target amount, the Secretary shall pay to the plan an amount equal to 50 percent of the target amount in excess of 103 percent of the target amount; and

(B)

a participating plan’s allowable costs for any plan year are more than 108 percent of the target amount, the Secretary shall pay to the plan an amount equal to the sum of 2.5 percent of the target amount plus 80 percent of allowable costs in excess of 108 percent of the target amount.

(2)

Payments in

The Secretary shall provide under the program established under subsection (a) that if—

(A)

a participating plan’s allowable costs for any plan year are less than 97 percent but not less than 92 percent of the target amount, the plan shall pay to the Secretary an amount equal to 50 percent of the excess of 97 percent of the target amount over the allowable costs; and

(B)

a participating plan’s allowable costs for any plan year are less than 92 percent of the target amount, the plan shall pay to the Secretary an amount equal to the sum of 2.5 percent of the target amount plus 80 percent of the excess of 92 percent of the target amount over the allowable costs.

(c)

Definitions

In this section:

(1)

Allowable costs

(A)

In general

(B)

Reduction for risk adjustment and reinsurance payments

(2)

Target amount

(Pub. L. 111–148, title I, § 1342, Mar. 23, 2010, 124 Stat. 211.)

cite as: 42 USC 18062