PRIA, Government Policy, Made Personal

Summary

The Secretary must set up, by July 1, 2010, a way—including a website—so people and small businesses in any State can find affordable health coverage available in their State. The site must, as much as possible, show health insurance (not just single-disease plans), Medicaid (title XIX), the Children’s Health Insurance Program (title XXI), any State high-risk pools, the federal high-risk pool under section 18001, and small-group market options (including reinsurance for early retirees under section 18002 and tax credits under section 45R). Within 60 days after March 23, 2010, the Secretary must make a standard format for showing this information. The format must include the percent of premium revenue spent on nonclinical costs (reported under section 300gg–18(a)), who is eligible, whether a plan is available, premium rates, and cost sharing, and must follow the uniform explanation of coverage standards in section 300gg–15. The Secretary may use contracts with qualified groups to do this.

Title 42, §18003

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

(a)Internet portal to affordable coverage options

(1)Immediate establishment

Not later than July 1, 2010, the Secretary, in consultation with the States, shall establish a mechanism, including an Internet website, through which a resident of, or small business in, any State may identify affordable health insurance coverage options in that State.

(2)Connecting to affordable coverage

An Internet website established under paragraph (1) shall, to the extent practicable, provide ways for residents of, and small businesses in, any State to receive information on at least the following coverage options:

(A)Health insurance coverage offered by health insurance issuers, other than coverage that provides reimbursement only for the treatment or mitigation of—

(i)a single disease or condition; or

(ii)an unreasonably limited set of diseases or conditions (as determined by the Secretary).

(B)Medicaid coverage under title XIX of the Social Security Act [42 U.S.C. 1396 et seq.].

(C)Coverage under title XXI of the Social Security Act [42 U.S.C. 1397aa et seq.].

(D)A State health benefits high risk pool, to the extent that such high risk pool is offered in such State; and

(E)Coverage under a high risk pool under section 18001 of this title.

(F)Coverage within the small group market for small businesses and their employees, including reinsurance for early retirees under section 18002 of this title, tax credits available under section 45R of title 26 (as added by section 1421), and other information specifically for small businesses regarding affordable health care options.

(b)Enhancing comparative purchasing options

(1)In general

Not later than 60 days after March 23, 2010, the Secretary shall develop a standardized format to be used for the presentation of information relating to the coverage options described in subsection (a)(2). Such format shall, at a minimum, require the inclusion of information on the percentage of total premium revenue expended on nonclinical costs (as reported under section 300gg–18(a) of this title), eligibility, availability, premium rates, and cost sharing with respect to such coverage options and be consistent with the standards adopted for the uniform explanation of coverage as provided for in section 300gg–15 of this title.

(2)Use of format

The Secretary shall utilize the format developed under paragraph (1) in compiling information concerning coverage options on the Internet website established under subsection (a).

(c)Authority to contract

The Secretary may carry out this section through contracts entered into with qualified entities.

Notes & Related Subsidiaries

Editorial Notes

References in Text

The Social Security Act, referred to in subsec. (a)(2)(B), (C), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Titles XIX and XXI of the Act are classified generally to subchapters XIX (§ 1396 et seq.) and XXI (§ 1397aa et seq.), respectively, of chapter 7 of this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables. section 1421, referred to in subsec. (a)(2)(F), means section 1421 of Pub. L. 111–148.

Amendments

2010—Subsec. (a)(1). Pub. L. 111–148, § 10102(b)(1), which directed insertion of “, or small business in,” after “residents of any”, was executed by making the insertion after “resident of” to reflect the probable intent of Congress. Subsec. (a)(2). Pub. L. 111–148, § 10102(b)(2), added par. (2) and struck out former par. (2). Prior to amendment, text read as follows: “An Internet website established under paragraph (1) shall, to the extent practicable, provide ways for residents of any State to receive information on at least the following coverage options: “(A) Health insurance coverage offered by health insurance issuers, other than coverage that provides reimbursement only for the treatment or mitigation of— “(i) a single disease or condition; or “(ii) an unreasonably limited set of diseases or conditions (as determined by the Secretary); “(B) Medicaid coverage under title XIX of the Social Security Act. “(C) Coverage under title XXI of the Social Security Act. “(D) A State health benefits high risk pool, to the extent that such high risk pool is offered in such State; and “(E) Coverage under a high risk pool under section 18001 of this title.”

§18003 Immediate Information That Allows Consumers to Identify Affordable Coverage Options