42 USC 18023 - Special rules

U.S Code last checked for updates: May 03, 2024

§ 18023.

Special rules

(a)

State opt-out of abortion coverage

(1)

In general

(2)

Termination of opt out

(b)

Special rules relating to coverage of abortion services

(1)

Voluntary choice of coverage of abortion services

(A)

In general

Notwithstanding any other provision of this title 1

 See References in Text note below.

(or any amendment made by this title)— 1

(i)

nothing in this title ¹ (or any amendment made by this title),¹ shall be construed to require a qualified health plan to provide coverage of services described in subparagraph (B)(i) or (B)(ii) as part of its essential health benefits for any plan year; and

(ii)

subject to subsection (a), the issuer of a qualified health plan shall determine whether or not the plan provides coverage of services described in subparagraph (B)(i) or (B)(ii) as part of such benefits for the plan year.

(B)

Abortion services

(i)

Abortions for which public funding is prohibited

(ii)

Abortions for which public funding is allowed

(2)

Prohibition on the use of Federal funds

(A)

In general

If a qualified health plan provides coverage of services described in paragraph (1)(B)(i), the issuer of the plan shall not use any amount attributable to any of the following for purposes of paying for such services:

(i)

The credit under section 36B of title 26 (and the amount (if any) of the advance payment of the credit under section 18082 of this title).

(ii)

Any cost-sharing reduction under section 18071 of this title (and the amount (if any) of the advance payment of the reduction under section 18082 of this title).

(B)

Establishment of allocation accounts

In the case of a plan to which subparagraph (A) applies, the issuer of the plan shall—

(i)

collect from each enrollee in the plan (without regard to the enrollee’s age, sex, or family status) a separate payment for each of the following:

(I)

an amount equal to the portion of the premium to be paid directly by the enrollee for coverage under the plan of services other than services described in paragraph (1)(B)(i) (after reduction for credits and cost-sharing reductions described in subparagraph (A)); and

(II)

an amount equal to the actuarial value of the coverage of services described in paragraph (1)(B)(i), and

(ii)

shall 2

 So in original. The word “shall” probably should not appear.

deposit all such separate payments into separate allocation accounts as provided in subparagraph (C).

In the case of an enrollee whose premium for coverage under the plan is paid through employee payroll deposit, the separate payments required under this subparagraph shall each be paid by a separate deposit.

(C)

Segregation of funds

(i)

In general

(ii)

Allocation accounts

The issuer of a plan to which subparagraph (A) applies shall deposit—

(I)

all payments described in subparagraph (B)(i)(I) into a separate account that consists solely of such payments and that is used exclusively to pay for services other than services described in paragraph (1)(B)(i); and

(II)

all payments described in subparagraph (B)(i)(II) into a separate account that consists solely of such payments and that is used exclusively to pay for services described in paragraph (1)(B)(i).

(D)

Actuarial value

(i)

In general

(ii)

Considerations

In making such estimate, the issuer—

(I)

may take into account the impact on overall costs of the inclusion of such coverage, but may not take into account any cost reduction estimated to result from such services, including prenatal care, delivery, or postnatal care;

(II)

shall estimate such costs as if such coverage were included for the entire population covered; and

(III)

may not estimate such a cost at less than $1 per enrollee, per month.

(E)

Ensuring compliance with segregation requirements

(i)

In general

(ii)

Clarification

(3)

(A)

Notice

(B)

Rules relating to payments

(4)

No discrimination on basis of provision of abortion

(c)

Application of State and Federal laws regarding abortion

(1)

No preemption of State laws regarding abortion

(2)

No effect on Federal laws regarding abortion

(A)

 So in original. There is no subpar. (B).

In general

Nothing in this Act shall be construed to have any effect on Federal laws regarding—

(i)

conscience protection;

(ii)

willingness or refusal to provide abortion; and

(iii)

discrimination on the basis of the willingness or refusal to provide, pay for, cover, or refer for abortion or to provide or participate in training to provide abortion.

(3)

No effect on Federal civil rights law

(d)

Application of emergency services laws

(Pub. L. 111–148, title I, § 1303, title X, § 10104(c), Mar. 23, 2010, 124 Stat. 168, 896.)

cite as: 42 USC 18023