§18044 — Title 42 The Public Health and Welfare | U.S. Code

Summary

If a qualified health plan sold through the Consumer Operated and Oriented Plan (CO-OP) program or a multi-State qualified health plan does not have to follow certain federal or state rules, then private health plans sold by a private insurance company also do not have to follow those same rules. Those rules cover 13 areas, including renewing coverage, how rates are set, preexisting conditions, discrimination, quality checks and reporting, fraud and abuse, financial stability, how companies act in the market, timely payments, appeals and complaints, privacy, licensing, and plan materials and information.

Title 42, §18044

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

(a)Notwithstanding any other provision of law, any health insurance coverage offered by a private health insurance issuer shall not be subject to any Federal or State law described in subsection (b) if a qualified health plan offered under the Consumer Operated and Oriented Plan program under section 18042 of this title, or a multi-State qualified health plan under section 18054 of this title, is not subject to such law.

(b)The Federal and State laws described in this subsection are those Federal and State laws relating to—

(1)guaranteed renewal;

(2)rating;

(3)preexisting conditions;

(4)non-discrimination;

(5)quality improvement and reporting;

(6)fraud and abuse;

(7)solvency and financial requirements;

(8)market conduct;

(9)prompt payment;

(10)appeals and grievances;

(11)privacy and confidentiality;

(12)licensure; and

(13)benefit plan material or information.

Notes & Related Subsidiaries

Editorial Notes

Amendments

2010—Subsec. (a). Pub. L. 111–148, § 10104(n), substituted “, or a multi-State qualified health plan under section 18054 of this title” for “, a community health insurance option under section 18043 of this title, or a nationwide qualified health plan under section 18053(b) of this title”.

§18044 Level Playing Field

Summary

Title 42, §18044

Notes & Related Subsidiaries

Editorial Notes

Amendments

Citations & Metadata