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42 U.S.C. § 18021 — Qualified health plan defined
Federal law — U.S. Code and appendices · legal_authorities
**(a) Qualified health plan** In this title: 11 See References in Text note below.
(1) **In general** — The term “qualified health plan” means a health plan that—
(A) has in effect a certification (which may include a seal or other indication of approval) that such plan meets the criteria for certification described in [section 18031(c) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18031/c&num=0&edition=prelim) issued or recognized by each Exchange through which such plan is offered;
(B) provides the essential health benefits package described in [section 18022(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18022/a&num=0&edition=prelim); and
(C) is offered by a health insurance issuer that—
(i) is licensed and in good standing to offer health insurance coverage in each State in which such issuer offers health insurance coverage under this title; 1
(ii) agrees to offer at least one qualified health plan in the silver level and at least one plan in the gold level in each such Exchange;
(iii) agrees to charge the same premium rate for each qualified health plan of the issuer without regard to whether the plan is offered through an Exchange or whether the plan is offered directly from the issuer or through an agent; and
(iv) complies with the regulations developed by the Secretary under [section 18031(d) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18031/d&num=0&edition=prelim) and such other requirements as an applicable Exchange may establish.
(2) **Inclusion of CO–OP plans and multi-State qualified health plans** — Any reference in this title 1 to a qualified health plan shall be deemed to include a quali
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Stable record: federal_law:legal_authorities:record_usc_f3fd24ccc70a14631ada49a0
Source file: Laws/federal/codes/united-states-code/title-42/section-18021-qualified-health-plan-defined--5853dee1e8.md
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Source location: Title 42, Chapter 157, § 18021; chapter-157-quality-affordable-health-care-for-all-americans.md
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**(a) Qualified health plan** In this title: 11 See References in Text note below.
(1) **In general** — The term “qualified health plan” means a health plan that—
(A) has in effect a certification (which may include a seal or other indication of approval) that such plan meets the criteria for certification described in [section 18031(c) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18031/c&num=0&edition=prelim) issued or recognized by each Exchange through which such plan is offered;
(B) provides the essential health benefits package described in [section 18022(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18022/a&num=0&edition=prelim); and
(C) is offered by a health insurance issuer that—
(i) is licensed and in good standing to offer health insurance coverage in each State in which such issuer offers health insurance coverage under this title; 1
(ii) agrees to offer at least one qualified health plan in the silver level and at least one plan in the gold level in each such Exchange;
(iii) agrees to charge the same premium rate for each qualified health plan of the issuer without regard to whether the plan is offered through an Exchange or whether the plan is offered directly from the issuer or through an agent; and
(iv) complies with the regulations developed by the Secretary under [section 18031(d) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18031/d&num=0&edition=prelim) and such other requirements as an applicable Exchange may establish.
(2) **Inclusion of CO–OP plans and multi-State qualified health plans** — Any reference in this title 1 to a qualified health plan shall be deemed to include a qualified health plan offered through the CO–OP program under [section 18042 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18042&num=0&edition=prelim), and a multi-State plan under [section 18054 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18054&num=0&edition=prelim), unless specifically provided for otherwise.
(3) **Treatment of qualified direct primary care medical home plans** — The Secretary of Health and Human Services shall permit a qualified health plan to provide coverage through a qualified direct primary care medical home plan that meets criteria established by the Secretary, so long as the qualified health plan meets all requirements that are otherwise applicable and the services covered by the medical home plan are coordinated with the entity offering the qualified health plan.
(4) **Variation based on rating area** — A qualified health plan, including a multi-State qualified health plan, may as appropriate vary premiums by rating area (as defined in [section 300gg(a)(2) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg/a/2&num=0&edition=prelim)).
**(b) Terms relating to health plans** In this title: 1
(1) **Health plan**
(A) *In general* — The term “health plan” means health insurance coverage and a group health plan.
(B) *Exception for self-insured plans and MEWAs* — Except to the extent specifically provided by this title,1 the term “health plan” shall not include a group health plan or multiple employer welfare arrangement to the extent the plan or arrangement is not subject to State insurance regulation under [section 1144 of title 29](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1144&num=0&edition=prelim).
(2) **Health insurance coverage and issuer** — The terms “health insurance coverage” and “health insurance issuer” have the meanings given such terms by [section 300gg–91(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg–91/b&num=0&edition=prelim).
(3) **Group health plan** — The term “group health plan” has the meaning given such term by [section 300gg–91(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg–91/a&num=0&edition=prelim).
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Supersedure; effective date** Except as provided in subsection (b) of this section, the provisions of this subchapter and subchapter III shall supersede any and all State laws insofar as they may now or hereafter relate to any employee benefit plan described in [section 1003(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1003/a&num=0&edition=prelim) and not exempt under [section 1003(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1003/b&num=0&edition=prelim). This section shall take effect on January 1, 1975.
**(b) Construction and application**
(1) This section shall not apply with respect to any cause of action which arose, or any act or omission which occurred, before January 1, 1975.
(2)
(A) Except as provided in subparagraph (B), nothing in this subchapter shall be construed to exempt or relieve any person from any law of any State which regulates insurance, banking, or securities.
(B) Neither an employee benefit plan described in [section 1003(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1003/a&num=0&edition=prelim), which is not exempt under [section 1003(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1003/b&num=0&edition=prelim) (other than a plan established primarily for the purpose of providing death benefits), nor any trust established under such a plan, shall be deemed to be an insurance company or other insurer, bank, trust company, or investment company or to be engaged in the business of insurance or banking for purposes of any law of any State purporting to regulate insurance companies, insurance contracts, banks, trust companies, or investment compani
Source: Supplied U.S. Code snapshot — release unconfirmed · 29 U.S.C. § 1144
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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
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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
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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 9096
TITLE 42—THE PUBLIC HEALTH AND WELFARE
§ 18021
1 See References in Text note below.
L. 111–148, Mar. 23, 2010, 124 Stat. 119. Section 9010 of the
Act was set out as a note preceding section 4001 of Title
26, Internal Revenue Code, prior to repeal by Pub. L.
116–94, div. N, title I, § 502(a), Dec. 20, 2019, 133 Stat. 3119.
For complete classification of this Act to the Code, see
Short Title note set out under section 18001 of this title
and Tables.
The Health Care and Education Reconciliation Act of
2010, referred to in subsecs. (a) and (d)(2)(G), is Pub. L.
111–152, Mar. 30, 2010, 124 Stat. 1029. For complete classi-
fication of this Act to the Code, see Short Title of 2010
Amendment note set out under section 1305 of this title
and Tables.
Section 4980I of title 26, referred to in subsec. (b)(2),
was repealed by Pub. L. 116–94, div. N, title I, § 503(a),
Dec. 20, 2019, 133 Stat. 3119.
The Public Health Service Act, referred to in subsec.
(d)(2)(G), is act July 1, 1944, ch. 373, 58 Stat. 682, which
is classified generally to chapter 6A (§ 201 et seq.) of
this title. Title XXVII of the Act is classified generally
to subchapter XXV (§ 300gg et seq.) of chapter 6A. For
complete classification of this Act to the Code, see
Short Title note set out under section 201 of this title
and Tables.
The Employee Retirement Income Security Act of
1974, referred to in subsec. (d)(2)(G), is Pub. L. 93–406,
Sept. 2, 1974, 88 Stat. 832. Part 7 of subtitle B of title I
of the Act is classified generally to part 7 (§ 1181 et seq.)
of subtitle B of subchapter I of chapter 18 of Title 29,
Labor. For complete classification of this Act to the
Code, see Short Title note set out under section 1001 of
Title 29 and Tables.
This Act, referred to in subsecs.
Source: Supplied 2024 U.S. Code historical extraction · 42 U.S.C. § 18021
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