§300gg–93 — Title 42 The Public Health and Welfare | U.S. Code

Summary

The Secretary must give grants to States or the health insurance Exchanges in those States to start, grow, or support offices that help health insurance consumers or ombudsman programs. To get a grant, a State must set up an independent consumer assistance office or an ombudsman that handles questions and complaints about health insurance under federal and state rules and follow rules the Secretary sets. Those offices must help people file complaints and appeals (including internal appeals and information about external appeals), track and count problems and questions, teach consumers about their rights, help with enrollment, and fix problems getting premium tax credits under section 36B of title 26. The offices must send data on problems to the Secretary, who must use it to find where enforcement is needed and share it with state insurance regulators, the Secretary of Labor, and the Secretary of the Treasury. $30,000,000 is provided to the Secretary for the first fiscal year this applies, available without fiscal year limit, and more funds may be appropriated in later years as needed.

Title 42, §300gg–93

The Public Health and Welfare — Source: USLM XML via OLRC

(a)The Secretary shall award grants to States to enable such States (or the Exchanges operating in such States) to establish, expand, or provide support for—

(1)offices of health insurance consumer assistance; or

(2)health insurance ombudsman programs.

(b)(1)To be eligible to receive a grant, a State shall designate an independent office of health insurance consumer assistance, or an ombudsman, that, directly or in coordination with State health insurance regulators and consumer assistance organizations, receives and responds to inquiries and complaints concerning health insurance coverage with respect to Federal health insurance requirements and under State law.

(2)A State that receives a grant under this section shall comply with criteria established by the Secretary for carrying out activities under such grant.

(c)The office of health insurance consumer assistance or health insurance ombudsman shall—

(1)assist with the filing of complaints and appeals, including filing appeals with the internal appeal or grievance process of the group health plan or health insurance issuer involved and providing information about the external appeal process;

(2)collect, track, and quantify problems and inquiries encountered by consumers;

(3)educate consumers on their rights and responsibilities with respect to group health plans and health insurance coverage;

(4)assist consumers with enrollment in a group health plan or health insurance coverage by providing information, referral, and assistance; and

(5)resolve problems with obtaining premium tax credits under section 36B of title 26.

(d)As a condition of receiving a grant under subsection (a), an office of health insurance consumer assistance or ombudsman program shall be required to collect and report data to the Secretary on the types of problems and inquiries encountered by consumers. The Secretary shall utilize such data to identify areas where more enforcement action is necessary and shall share such information with State insurance regulators, the Secretary of Labor, and the Secretary of the Treasury for use in the enforcement activities of such agencies.

(e)(1)There is hereby appropriated to the Secretary, out of any funds in the Treasury not otherwise appropriated, $30,000,000 for the first fiscal year for which this section applies to carry out this section. Such amount shall remain available without fiscal year limitation.

(2)There is authorized to be appropriated to the Secretary for each fiscal year following the fiscal year described in paragraph (1), such sums as may be necessary to carry out this section.

Notes & Related Subsidiaries

Statutory Notes and Related Subsidiaries

Effective Date

Section effective for fiscal years beginning with fiscal year 2010, see section 1004(a) of Pub. L. 111–148, set out as a note under section 300gg–11 of this title. Section effective Mar. 23, 2010, see section 1004(b) of Pub. L. 111–148, set out as a note under section 300gg–11 of this title.

§300gg–93 Health insurance consumer information

Summary

Title 42, §300gg–93

Notes & Related Subsidiaries

Statutory Notes and Related Subsidiaries

Effective Date

Citations & Metadata