42 USC 1396e-1 - Premium assistance

U.S Code last checked for updates: Oct 16, 2024

§ 1396e–1.

Premium assistance

(a)

In general

(b)

Qualified employer-sponsored coverage

(1)

In general

Subject to paragraph (2)),1

 So in original. The second closing parenthesis probably should not appear.

in this paragraph, the term “qualified employer-sponsored coverage” means a group health plan or health insurance coverage offered through an employer—

(A)

that qualifies as creditable coverage as a group health plan under section 2701(c)(1) of the Public Health Service Act; 2

 See References in Text note below.

(B)

for which the employer contribution toward any premium for such coverage is at least 40 percent; and

(C)

that is offered to all individuals in a manner that would be considered a nondiscriminatory eligibility classification for purposes of paragraph (3)(A)(ii) of section 105(h) of the Internal Revenue Code of 1986 (but determined without regard to clause (i) of subparagraph (B) of such paragraph).

(2)

Exception

Such term does not include coverage consisting of—

(A)

benefits provided under a health flexible spending arrangement (as defined in section 106(c)(2) of the Internal Revenue Code of 1986); or

(B)

a high deductible health plan (as defined in section 223(c)(2) of such Code), without regard to whether the plan is purchased in conjunction with a health savings account (as defined under section 223(d) of such Code).

(3)

Treatment as third party liability

(c)

Premium assistance subsidy

(d)

Voluntary participation

(1)

Employers

(2)

Beneficiaries

(3)

Opt-out permitted for any month

(e)

Requirement to pay premiums and cost-sharing and provide supplemental coverage

(Aug. 14, 1935, ch. 531, title XIX, § 1906A, as added Pub. L. 111–3, title III, § 301(b), Feb. 4, 2009, 123 Stat. 61; amended Pub. L. 111–148, title II, § 2003(a), (b), title X, § 10203(b)(2), Mar. 23, 2010, 124 Stat. 282, 283, 927.)

cite as: 42 USC 1396e-1