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42 U.S.C. § 18044 — Level playing field
Federal law — U.S. Code and appendices · legal_authorities
**(a) In general** 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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18042&num=0&edition=prelim), or a multi-State qualified health plan under [section 18054 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18054&num=0&edition=prelim), is not subject to such law.
**(b) Laws described** 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.
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 18044
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Stable record: federal_law:legal_authorities:record_usc_b3c6f6f2661af2c9e3533a77
Source file: Laws/federal/codes/united-states-code/title-42/section-18044-level-playing-field--a580e83e95.md
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Source location: Title 42, Chapter 157, § 18044; chapter-157-quality-affordable-health-care-for-all-americans.md
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**(a) In general** 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](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18042&num=0&edition=prelim), or a multi-State qualified health plan under [section 18054 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18054&num=0&edition=prelim), is not subject to such law.
**(b) Laws described** 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.
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Establishment of program**
(1) **In general** — The Secretary shall establish a program to carry out the purposes of this section to be known as the Consumer Operated and Oriented Plan (CO–OP) program.
(2) **Purpose** — It is the purpose of the CO–OP program to foster the creation of qualified nonprofit health insurance issuers to offer qualified health plans in the individual and small group markets in the States in which the issuers are licensed to offer such plans.
**(b) Loans and grants under the CO–OP program**
(1) **In general** — The Secretary shall provide through the CO–OP program for the awarding to persons applying to become qualified nonprofit health insurance issuers of—
(A) loans to provide assistance to such person in meeting its start-up costs; and
(B) grants to provide assistance to such person in meeting any solvency requirements of States in which the person seeks to be licensed to issue qualified health plans.
(2) **Requirements for awarding loans and grants**
(A) *In general* — In awarding loans and grants under the CO–OP program, the Secretary shall—
(i) take into account the recommendations of the advisory board established under paragraph (3);
(ii) give priority to applicants that will offer qualified health plans on a Statewide basis, will utilize integrated care models, and have significant private support; and
(iii) ensure that there is sufficient funding to establish at least 1 qualified nonprofit health insurance issuer in each State, except that nothing in this clause shall prohibit the Secretary from funding the establishment of multiple qualified nonprofit health insurance issuers in any State if the funding is sufficient to do so.
(B) *States without issuers in program* — If no health insurance issue
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 18042
Stored review status: release_metadata_unconfirmed. Explicit cross-reference supplied in source Markdown; currentness and applicability require review.
Federal law — U.S. Code and appendices · legal_authorities
**(a) Oversight by the Office of Personnel Management**
(1) **In general** — The Director of the Office of Personnel Management (referred to in this section as the “Director”) shall enter into contracts with health insurance issuers (which may include a group of health insurance issuers affiliated either by common ownership and control or by the common use of a nationally licensed service mark), without regard to [section 6101 of title 41](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title41-section6101&num=0&edition=prelim) or other statutes requiring competitive bidding, to offer at least 2 multi-State qualified health plans through each Exchange in each State. Such plans shall provide individual, or in the case of small employers, group coverage.
(2) **Terms** — Each contract entered into under paragraph (1) shall be for a uniform term of at least 1 year, but may be made automatically renewable from term to term in the absence of notice of termination by either party. In entering into such contracts, the Director shall ensure that health benefits coverage is provided in accordance with the types of coverage provided for under section 2701(a)(1)(A)(i) of the Public Health Service Act [[42 U.S.C. 300gg(a)(1)(A)(i)](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg/a/1/A/i&num=0&edition=prelim)].
(3) **Non-profit entities** — In entering into contracts under paragraph (1), the Director shall ensure that at least one contract is entered into with a non-profit entity.
(4) **Administration** — The Director shall implement this subsection in a manner similar to the manner in which the Director implements the contracting provisions with respect to carriers under the Federal employees health benefit program 11 So in original
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 18054
Stored review status: release_metadata_unconfirmed. Explicit cross-reference supplied in source Markdown; currentness and applicability require review.
Federal law — U.S. Code and appendices · legal_authorities
**(a) In general** A territory that—
(1) elects consistent with subsection (b) to establish an Exchange in accordance with part B of this subchapter and establishes such an Exchange in accordance with such part shall be treated as a State for purposes of such part and shall be entitled to payment from the amount allocated to the territory under subsection (c); or
(2) does not make such election shall be entitled to an increase in the dollar limitation applicable to the territory under subsections (f) and (g) of section 1108 of the Social Security Act ([42 U.S.C. 1308](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section1308&num=0&edition=prelim)) for such period in such amount for such territory and such increase shall not be taken into account in computing any other amount under such subsections.
**(b) Terms and conditions** An election under subsection (a)(1) shall—
(1) not be effective unless the election is consistent with [section 18041 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18041&num=0&edition=prelim) and is received not later than October 1, 2013; and
(2) be contingent upon entering into an agreement between the territory and the Secretary that requires that—
(A) funds provided under the agreement shall be used only to provide premium and cost-sharing assistance to residents of the territory obtaining health insurance coverage through the Exchange; and
(B) the premium and cost-sharing assistance provided under such agreement shall be structured in such a manner so as to prevent any gap in assistance for individuals between the income level at which medical assistance is available through the territory’s Medicaid plan under title XIX of the Social Security Act [[42 U.S.C. 1396](
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 18043
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Federal law — U.S. Code and appendices · legal_authorities
Page 9117
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 18044
advisory board, except that section 14 of such Act’’ in
text.
2010—Subsec. (b)(3), (4). Pub. L. 111–148, § 10104(l),
added par. (3) and redesignated former par. (3) as (4).
Statutory Notes and Related Subsidiaries
CONSUMER OPERATED AND ORIENTED PLAN PROGRAM
CONTINGENCY FUND
Pub. L. 112–240, title VI, § 644, Jan. 2, 2013, 126 Stat.
2362, provided that:
‘‘(a) ESTABLISHMENT.—The Secretary of Health and
Human Services shall establish a fund to be used to
provide assistance and oversight to qualified nonprofit
health insurance issuers that have been awarded loans
or grants under section 1322 of the Patient Protection
and Affordable Care Act (42 U.S.C. 18042) prior to the
date of enactment of this Act [Jan. 2, 2013].
‘‘(b) TRANSFER AND RESCISSION.—
‘‘(1) TRANSFER.—From the unobligated balance of
funds appropriated under section 1322(g) of the Pa-
tient Protection and Affordable Care Act (42 U.S.C.
18042(g)), 10 percent of such sums are hereby trans-
ferred to the fund established under subsection (a) to
remain available until expended.
‘‘(2) RESCISSION.—Except as provided for in para-
graph (1), amounts appropriated under section 1322(g)
of the Patient Protection and Affordable Care Act (42
U.S.C. 18042(g)) that are unobligated as of the date of
enactment of this Act [Jan. 2, 2013] are rescinded.’’
§ 18043. Funding for the territories
(a) In general
A territory that—
(1) elects consistent with subsection (b) to
establish an Exchange in accordance with part
B of this subchapter and establishes such an
Exchange in accordance with such part shall
be treated as a State for purposes of such part
and shall be entitled to payment from the
amount allocated to the territory under sub-
section (c); o
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 18044
Stored review status: historical_2024_not_currentness_verified. Same stored citation; legal effect and authority still require review.