<section xmlns="http://xml.house.gov/schemas/uslm/1.0" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:dcterms="http://purl.org/dc/terms/" style="-uslm-lc:I80" id="ida5b805b4-09a0-11eb-a85b-f5cef3d06f4d" identifier="/us/usc/t42/s300gg"><num value="300gg">§ 300gg.</num><heading> Fair health insurance premiums</heading><subsection style="-uslm-lc:I19" class="indent2 firstIndent-2" id="ida5b805b5-09a0-11eb-a85b-f5cef3d06f4d" identifier="/us/usc/t42/s300gg/a"><num value="a" class="bold">(a)</num><heading class="bold"> <ref class="footnoteRef" idref="fn002426">1</ref><note type="footnote" id="fn002426"><num>1</num> So in original. No subsec. (b) has been enacted.</note> Prohibiting discriminatory premium rates</heading><paragraph style="-uslm-lc:I79" class="indent3 firstIndent-2" id="ida5b805b6-09a0-11eb-a85b-f5cef3d06f4d" identifier="/us/usc/t42/s300gg/a/1"><num value="1" class="bold">(1)</num><heading class="bold"> In general</heading><chapeau style="-uslm-lc:I12" class="indent1">With respect to the premium rate charged by a health insurance issuer for health insurance coverage offered in the individual or small group market—</chapeau><subparagraph style="-uslm-lc:I13" class="indent2" id="ida5b805b7-09a0-11eb-a85b-f5cef3d06f4d" identifier="/us/usc/t42/s300gg/a/1/A"><num value="A">(A)</num><chapeau> such rate shall vary with respect to the particular plan or coverage involved only by—</chapeau><clause style="-uslm-lc:I14" class="indent3" id="ida5b805b8-09a0-11eb-a85b-f5cef3d06f4d" identifier="/us/usc/t42/s300gg/a/1/A/i"><num value="i">(i)</num><content> whether such plan or coverage covers an individual or family;</content>
</clause>
<clause style="-uslm-lc:I14" class="indent3" id="ida5b805b9-09a0-11eb-a85b-f5cef3d06f4d" identifier="/us/usc/t42/s300gg/a/1/A/ii"><num value="ii">(ii)</num><content> rating area, as established in accordance with paragraph (2);</content>
</clause>
<clause style="-uslm-lc:I14" class="indent3" id="ida5b805ba-09a0-11eb-a85b-f5cef3d06f4d" identifier="/us/usc/t42/s300gg/a/1/A/iii"><num value="iii">(iii)</num><content> age, except that such rate shall not vary by more than 3 to 1 for adults (consistent with <ref href="/us/usc/t42/s300gg–6/c">section 300gg–6(c) of this title</ref>); and</content>
</clause>
<clause style="-uslm-lc:I14" class="indent3" id="ida5b805bb-09a0-11eb-a85b-f5cef3d06f4d" identifier="/us/usc/t42/s300gg/a/1/A/iv"><num value="iv">(iv)</num><content> tobacco use, except that such rate shall not vary by more than 1.5 to 1; and</content>
</clause>
</subparagraph>
<subparagraph style="-uslm-lc:I13" class="indent2" id="ida5b805bc-09a0-11eb-a85b-f5cef3d06f4d" identifier="/us/usc/t42/s300gg/a/1/B"><num value="B">(B)</num><content> such rate shall not vary with respect to the particular plan or coverage involved by any other factor not described in subparagraph (A).</content>
</subparagraph>
</paragraph>
<paragraph style="-uslm-lc:I79" class="indent3 firstIndent-2" id="ida5b805bd-09a0-11eb-a85b-f5cef3d06f4d" identifier="/us/usc/t42/s300gg/a/2"><num value="2" class="bold">(2)</num><heading class="bold"> Rating area</heading><subparagraph style="-uslm-lc:I18" class="indent4 firstIndent-2" id="ida5b805be-09a0-11eb-a85b-f5cef3d06f4d" identifier="/us/usc/t42/s300gg/a/2/A"><num value="A" class="bold">(A)</num><heading class="bold"> In general</heading><content><p style="-uslm-lc:I13" class="indent2">Each State shall establish 1 or more rating areas within that State for purposes of applying the requirements of this subchapter.</p>
</content>
</subparagraph>
<subparagraph style="-uslm-lc:I18" class="indent4 firstIndent-2" id="ida5b805bf-09a0-11eb-a85b-f5cef3d06f4d" identifier="/us/usc/t42/s300gg/a/2/B"><num value="B" class="bold">(B)</num><heading class="bold"> Secretarial review</heading><content><p style="-uslm-lc:I13" class="indent2">The Secretary shall review the rating areas established by each State under subparagraph (A) to ensure the adequacy of such areas for purposes of carrying out the requirements of this subchapter. If the Secretary determines a State’s rating areas are not adequate, or that a State does not establish such areas, the Secretary may establish rating areas for that State.</p>
</content>
</subparagraph>
</paragraph>
<paragraph style="-uslm-lc:I79" class="indent3 firstIndent-2" id="ida5b805c0-09a0-11eb-a85b-f5cef3d06f4d" identifier="/us/usc/t42/s300gg/a/3"><num value="3" class="bold">(3)</num><heading class="bold"> Permissible age bands</heading><content><p style="-uslm-lc:I12" class="indent1">The Secretary, in consultation with the National Association of Insurance Commissioners, shall define the permissible age bands for rating purposes under paragraph (1)(A)(iii).</p>
</content>
</paragraph>
<paragraph style="-uslm-lc:I79" class="indent3 firstIndent-2" id="ida5b805c1-09a0-11eb-a85b-f5cef3d06f4d" identifier="/us/usc/t42/s300gg/a/4"><num value="4" class="bold">(4)</num><heading class="bold"> Application of variations based on age or tobacco use</heading><content><p style="-uslm-lc:I12" class="indent1">With respect to family coverage under a group health plan or health insurance coverage, the rating variations permitted under clauses (iii) and (iv) of paragraph (1)(A) shall be applied based on the portion of the premium that is attributable to each family member covered under the plan or coverage.</p>
</content>
</paragraph>
<paragraph style="-uslm-lc:I79" class="indent3 firstIndent-2" id="ida5b805c2-09a0-11eb-a85b-f5cef3d06f4d" identifier="/us/usc/t42/s300gg/a/5"><num value="5" class="bold">(5)</num><heading class="bold"> Special rule for large group market</heading><content><p style="-uslm-lc:I12" class="indent1">If a State permits health insurance issuers that offer coverage in the large group market in the State to offer such coverage through the State Exchange (as provided for under <ref href="/us/usc/t42/s18032/f/2/B">section 18032(f)(2)(B) of this title</ref>), the provisions of this subsection shall apply to all coverage offered in such market (other than self-insured group health plans offered in such market) in the State.</p>
</content>
</paragraph>
</subsection>
<sourceCredit id="ida5b82cd3-09a0-11eb-a85b-f5cef3d06f4d">(<ref href="/us/act/1944-07-01/ch373">July 1, 1944, ch. 373</ref>, title XXVII, § 2701, as added and amended <ref href="/us/pl/111/148/tI/s1201/4">Pub. L. 111–148, title I, § 1201(4)</ref>, title X, § 10103(a), <date date="2010-03-23">Mar. 23, 2010</date>, <ref href="/us/stat/124/155">124 Stat. 155</ref>, 892.)</sourceCredit>
<notes type="uscNote" id="ida5b82cd4-09a0-11eb-a85b-f5cef3d06f4d">
<note style="-uslm-lc:I74" topic="priorProvisions" id="ida5b82cd5-09a0-11eb-a85b-f5cef3d06f4d"><heading class="centered smallCaps">Prior Provisions</heading><p style="-uslm-lc:I21" class="indent0">A prior section 300gg, <ref href="/us/act/1944-07-01/ch373/tXXVII/s2701">act July 1, 1944, ch. 373, title XXVII, § 2701</ref>, as added <ref href="/us/pl/104/191/tI/s102/a">Pub. L. 104–191, title I, § 102(a)</ref>, <date date="1996-08-21">Aug. 21, 1996</date>, <ref href="/us/stat/110/1955">110 Stat. 1955</ref>; amended <ref href="/us/pl/111/3/tIII/s311/b/2">Pub. L. 111–3, title III, § 311(b)(2)</ref>, <date date="2009-02-04">Feb. 4, 2009</date>, <ref href="/us/stat/123/70">123 Stat. 70</ref>; <ref href="/us/pl/111/5/dB/tI/s1899D/c">Pub. L. 111–5, div. B, title I, § 1899D(c)</ref>, <date date="2009-02-17">Feb. 17, 2009</date>, <ref href="/us/stat/123/426">123 Stat. 426</ref>; <ref href="/us/pl/111/344/tI/s114/c">Pub. L. 111–344, title I, § 114(c)</ref>, <date date="2010-12-29">Dec. 29, 2010</date>, <ref href="/us/stat/124/3615">124 Stat. 3615</ref>; <ref href="/us/pl/112/40/tII/s242/a/3">Pub. L. 112–40, title II, § 242(a)(3)</ref>, <date date="2011-10-21">Oct. 21, 2011</date>, <ref href="/us/stat/125/419">125 Stat. 419</ref>, which related to increased portability through limitation on preexisting condition exclusions, was renumbered section 2704 of act <date date="1944-07-01">July 1, 1944</date>, effective for plan years beginning on or after <date date="2014-01-01">Jan. 1, 2014</date>, with certain exceptions, and amended, by <ref href="/us/pl/111/148/tI">Pub. L. 111–148, title I</ref>, §§ 1201(2), 1563(c)(1), formerly § 1562(c)(1), title X, § 10107(b)(1), <date date="2010-03-23">Mar. 23, 2010</date>, <ref href="/us/stat/124/154">124 Stat. 154</ref>, 264, 911, and was transferred to <ref href="/us/usc/t42/s300gg–3">section 300gg–3 of this title</ref>.</p>
<p style="-uslm-lc:I21" class="indent0">Another prior section 2701 of act <date date="1944-07-01">July 1, 1944</date>, was successively renumbered by subsequent acts and transferred, see <ref href="/us/usc/t42/s238">section 238 of this title</ref>.</p>
</note>
<note style="-uslm-lc:I74" topic="amendments" id="ida5b82cd6-09a0-11eb-a85b-f5cef3d06f4d"><heading class="centered smallCaps">Amendments</heading><p style="-uslm-lc:I21" class="indent0">2010—Subsec. (a)(5). <ref href="/us/pl/111/148/s10103/a">Pub. L. 111–148, § 10103(a)</ref>, inserted “(other than self-insured group health plans offered in such market)” after “such market”.</p>
</note>
<note style="-uslm-lc:I74" topic="effectiveDate" id="ida5b82cd7-09a0-11eb-a85b-f5cef3d06f4d"><heading class="centered smallCaps">Effective Date</heading><p><ref href="/us/pl/111/148/tI/s1255">Pub. L. 111–148, title I, § 1255</ref>, formerly § 1253, title X, § 10103(e), (f)(1), <date date="2010-03-23">Mar. 23, 2010</date>, <ref href="/us/stat/124/162">124 Stat. 162</ref>, 895, provided that: <quotedContent origin="/us/pl/111/148/tI/s1255">
<inline>“This subtitle [subtitle C (§§ 1201–1255) of title I of <ref href="/us/pl/111/148">Pub. L. 111–148</ref>, enacting subchapter II of chapter 157 of this title and sections 300gg to 300gg–2 and 300gg–4 to 300gg–7 of this title, and amending sections 300gg–1 and 300gg–4 of this title and transferring former <ref href="/us/usc/t42/s300gg">section 300gg of this title</ref> to <ref href="/us/usc/t42/s300gg–3">section 300gg–3 of this title</ref>] (and the amendments made by this subtitle) shall become effective for plan years beginning on or after <date date="2014-01-01">January 1, 2014</date>, except that—</inline>
<paragraph style="-uslm-lc:I22" class="indent1"><num value="1">“(1)</num><content> section 1251 [enacting <ref href="/us/usc/t42/s18011">section 18011 of this title</ref>] shall take effect on the date of enactment of this Act [<date date="2010-03-23">Mar. 23, 2010</date>]; and</content>
</paragraph>
<paragraph style="-uslm-lc:I22" class="indent1"><num value="2">“(2)</num><content> the provisions of section 2704 of the Public Health Service Act [<ref href="/us/usc/t42/s300gg–3">42 U.S.C. 300gg–3</ref>] (as amended by section 1201), as they apply to enrollees who are under 19 years of age, shall become effective for plan years beginning on or after the date that is 6 months after the date of enactment of this Act [<date date="2010-03-23">Mar. 23, 2010</date>].. [sic]”</content>
</paragraph>
</quotedContent>
</p>
<p><ref href="/us/pl/104/191/tI/s102/c">Pub. L. 104–191, title I, § 102(c)</ref>, <date date="1996-08-21">Aug. 21, 1996</date>, <ref href="/us/stat/110/1976">110 Stat. 1976</ref>, provided that:<quotedContent origin="/us/pl/104/191/tI/s102/c">
<paragraph style="-uslm-lc:I21" class="indent0"><num value="1">“(1)</num><heading> <inline class="small-caps">In general</inline>.—</heading><content>Except as provided in this subsection, part A of title XXVII of the Public Health Service Act [<ref href="/us/usc/t42/s300gg">42 U.S.C. 300gg</ref> et seq.] (as added by subsection (a)) shall apply with respect to group health plans, and health insurance coverage offered in connection with group health plans, for plan years beginning after <date date="1997-06-30">June 30, 1997</date>.</content>
</paragraph>
<paragraph style="-uslm-lc:I21" class="indent0"><num value="2">“(2)</num><heading> <inline class="small-caps">Determination of creditable coverage.—</inline></heading><subparagraph style="-uslm-lc:I22" class="indent1"><num value="A">“(A)</num><heading> <inline class="small-caps">Period of coverage.—</inline></heading><clause style="-uslm-lc:I23" class="indent2"><num value="i">“(i)</num><heading> <inline class="small-caps">In general</inline>.—</heading><content>Subject to clause (ii), no period before <date date="1996-07-01">July 1, 1996</date>, shall be taken into account under part A of title XXVII of the Public Health Service Act [<ref href="/us/usc/t42/s300gg">42 U.S.C. 300gg</ref> et seq.] (as added by this section) in determining creditable coverage.</content>
</clause>
<clause style="-uslm-lc:I23" class="indent2"><num value="ii">“(ii)</num><heading> <inline class="small-caps">Special rule for certain periods</inline>.—</heading><content>The Secretary of Health and Human Services, consistent with section 104 [<ref href="/us/usc/t42/s300gg–92">42 U.S.C. 300gg–92</ref> note], shall provide for a process whereby individuals who need to establish creditable coverage for periods before <date date="1996-07-01">July 1, 1996</date>, and who would have such coverage credited but for clause (i) may be given credit for creditable coverage for such periods through the presentation of documents or other means.</content>
</clause>
</subparagraph>
<subparagraph style="-uslm-lc:I22" class="indent1"><num value="B">“(B)</num><heading> <inline class="small-caps">Certifications, etc.—</inline></heading><clause style="-uslm-lc:I23" class="indent2"><num value="i">“(i)</num><heading> <inline class="small-caps">In general</inline>.—</heading><content>Subject to clauses (ii) and (iii), subsection (e) of section 2701 [now 2704] of the Public Health Service Act [<ref href="/us/usc/t42/s300gg–3/e">42 U.S.C. 300gg–3(e)</ref>] (as added by this section) shall apply to events occurring after <date date="1996-06-30">June 30, 1996</date>.</content>
</clause>
<clause style="-uslm-lc:I23" class="indent2"><num value="ii">“(ii)</num><heading> <inline class="small-caps">No certification required to be provided before <date date="1997-06-01">june 1, 1997</date></inline>.—</heading><content>In no case is a certification required to be provided under such subsection before <date date="1997-06-01">June 1, 1997</date>.</content>
</clause>
<clause style="-uslm-lc:I23" class="indent2"><num value="iii">“(iii)</num><heading> <inline class="small-caps">Certification only on written request for events occurring before <date date="1996-10-01">october 1, 1996</date></inline>.—</heading><content>In the case of an event occurring after <date date="1996-06-30">June 30, 1996</date>, and before <date date="1996-10-01">October 1, 1996</date>, a certification is not required to be provided under such subsection unless an individual (with respect to whom the certification is otherwise required to be made) requests such certification in writing.</content>
</clause>
</subparagraph>
<subparagraph style="-uslm-lc:I22" class="indent1"><num value="C">“(C)</num><heading> <inline class="small-caps">Transitional rule</inline>.—</heading><chapeau>In the case of an individual who seeks to establish creditable coverage for any period for which certification is not required because it relates to an event occurring before <date date="1996-06-30">June 30, 1996</date>—</chapeau><clause style="-uslm-lc:I23" class="indent2"><num value="i">“(i)</num><content> the individual may present other credible evidence of such coverage in order to establish the period of creditable coverage; and</content>
</clause>
<clause style="-uslm-lc:I23" class="indent2"><num value="ii">“(ii)</num><content> a group health plan and a health insurance issuer shall not be subject to any penalty or enforcement action with respect to the plan’s or issuer’s crediting (or not crediting) such coverage if the plan or issuer has sought to comply in good faith with the applicable requirements under the amendments made by this section [enacting this section and sections 300gg–1, 300gg–11 to 300gg–13, 300gg–21 to 300gg–23, 300gg–91, and 300gg–92 of this title and amending sections 300e and 300bb–8 of this title].</content>
</clause>
</subparagraph>
</paragraph>
<paragraph style="-uslm-lc:I21" class="indent0"><num value="3">“(3)</num><heading> <inline class="small-caps">Special rule for collective bargaining agreements</inline>.—</heading><chapeau>Except as provided in paragraph (2)(B), in the case of a group health plan maintained pursuant to 1 or more collective bargaining agreements between employee representatives and one or more employers ratified before the date of the enactment of this Act [<date date="1996-08-21">Aug. 21, 1996</date>], part A of title XXVII of the Public Health Service Act [<ref href="/us/usc/t42/s300gg">42 U.S.C. 300gg</ref> et seq.] (other than section 2701(e) [now 2704(e)] thereof [<ref href="/us/usc/t42/s300gg–3/e">42 U.S.C. 300gg–3(e)</ref>]) shall not apply to plan years beginning before the later of—</chapeau><subparagraph style="-uslm-lc:I22" class="indent1"><num value="A">“(A)</num><content> the date on which the last of the collective bargaining agreements relating to the plan terminates (determined without regard to any extension thereof agreed to after the date of the enactment of this Act), or</content>
</subparagraph>
<subparagraph style="-uslm-lc:I22" class="indent1"><num value="B">“(B)</num><content> <date date="1997-07-01">July 1, 1997</date>.</content>
</subparagraph>

<continuation style="-uslm-lc:I33" class="indent0 firstIndent0">For purposes of subparagraph (A), any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement of such part shall not be treated as a termination of such collective bargaining agreement.</continuation>
</paragraph>
<paragraph style="-uslm-lc:I21" class="indent0"><num value="4">“(4)</num><heading> <inline class="small-caps">Timely regulations</inline>.—</heading><content>The Secretary of Health and Human Services, consistent with section 104 [<ref href="/us/usc/t42/s300gg–92">42 U.S.C. 300gg–92</ref> note], shall first issue by not later than <date date="1997-04-01">April 1, 1997</date>, such regulations as may be necessary to carry out the amendments made by this section [enacting this section and sections 300gg–1, 300gg–11 to 300gg–13, 300gg–21 to 300gg–23, 300gg–91, and 300gg–92 of this title and amending sections 300e and 300bb–8 of this title] and section 111 [enacting sections 300gg–41 to 300gg–44 and 300gg–61 to 300gg–63 of this title].</content>
</paragraph>
<paragraph style="-uslm-lc:I21" class="indent0"><num value="5">“(5)</num><heading> <inline class="small-caps">Limitation on actions</inline>.—</heading><content>No enforcement action shall be taken, pursuant to the amendments made by this section, against a group health plan or health insurance issuer with respect to a violation of a requirement imposed by such amendments before <date date="1998-01-01">January 1, 1998</date>, or, if later, the date of issuance of regulations referred to in paragraph (4), if the plan or issuer has sought to comply in good faith with such requirements.”</content>
</paragraph>
</quotedContent>
</p>
</note>
<note style="-uslm-lc:I74" topic="miscellaneous" id="ida5b853e8-09a0-11eb-a85b-f5cef3d06f4d"><heading class="centered smallCaps">Congressional Findings Relating to Exercise of Commerce Clause Authority; Severability</heading><p><ref href="/us/pl/104/191/tI/s195">Pub. L. 104–191, title I, § 195</ref>, <date date="1996-08-21">Aug. 21, 1996</date>, <ref href="/us/stat/110/1991">110 Stat. 1991</ref>, provided that:<quotedContent origin="/us/pl/104/191/tI/s195">
<subsection style="-uslm-lc:I21" class="indent0"><num value="a">“(a)</num><heading> <inline class="small-caps">Findings Relating to Exercise of Commerce Clause Authority</inline>.—</heading><chapeau>Congress finds the following in relation to the provisions of this title [enacting this subchapter and sections 1181 to 1183 and 1191 to 1191c of Title 29, Labor, amending sections 233, 300e, and 300bb–8 of this title and sections 1003, 1021, 1022, 1024, 1132, 1136, and 1144 of Title 29, and enacting provisions set out as notes under this section, <ref href="/us/usc/t42/s300gg–92">section 300gg–92 of this title</ref>, and <ref href="/us/usc/t29/s1181">section 1181 of Title 29</ref>]:</chapeau><paragraph style="-uslm-lc:I22" class="indent1"><num value="1">“(1)</num><content> Provisions in group health plans and health insurance coverage that impose certain preexisting condition exclusions impact the ability of employees to seek employment in interstate commerce, thereby impeding such commerce.</content>
</paragraph>
<paragraph style="-uslm-lc:I22" class="indent1"><num value="2">“(2)</num><content> Health insurance coverage is commercial in nature and is in and affects interstate commerce.</content>
</paragraph>
<paragraph style="-uslm-lc:I22" class="indent1"><num value="3">“(3)</num><content> It is a necessary and proper exercise of Congressional authority to impose requirements under this title on group health plans and health insurance coverage (including coverage offered to individuals previously covered under group health plans) in order to promote commerce among the States.</content>
</paragraph>
<paragraph style="-uslm-lc:I22" class="indent1"><num value="4">“(4)</num><content> Congress, however, intends to defer to States, to the maximum extent practicable, in carrying out such requirements with respect to insurers and health maintenance organizations that are subject to State regulation, consistent with the provisions of the Employee Retirement Income Security Act of 1974 [<ref href="/us/usc/t29/s1001">29 U.S.C. 1001</ref> et seq.].</content>
</paragraph>
</subsection>
<subsection style="-uslm-lc:I21" class="indent0"><num value="b">“(b)</num><heading> <inline class="small-caps">Severability</inline>.—</heading><content>If any provision of this title or the application of such provision to any person or circumstance is held to be unconstitutional, the remainder of this title and the application of the provisions of such to any person or circumstance shall not be affected thereby.”</content>
</subsection>
</quotedContent>
</p>
</note>
<note style="-uslm-lc:I74" topic="miscellaneous" id="ida5b87af9-09a0-11eb-a85b-f5cef3d06f4d"><heading class="centered smallCaps">Health Coverage Availability Studies</heading><p style="-uslm-lc:I21" class="indent0"><ref href="/us/pl/104/191/tI/s191">Pub. L. 104–191, title I, § 191</ref>, <date date="1996-08-21">Aug. 21, 1996</date>, <ref href="/us/stat/110/1987">110 Stat. 1987</ref>, directed the Secretary of Health and Human Services to provide for a study on the effectiveness of the provisions of title I of <ref href="/us/pl/104/191">Pub. L. 104–191</ref> and the various State laws, in ensuring the availability of reasonably priced health coverage to employers and individuals and a study on access to, and choice of, health care providers and the cost and cost-effectiveness to health insurance issuers of providing access to out-of-network providers, and the potential impact of providing such access on the cost and quality of health insurance coverage, and to report to the appropriate committees of Congress on each of such studies not later than <date date="2000-01-01">Jan. 1, 2000</date>.</p>
</note>
</notes>
</section>