42 USC 18032 - Consumer choice

U.S Code last checked for updates: May 04, 2024

§ 18032.

Consumer choice

(a)

Choice

(1)

Qualified individuals

(2)

Qualified employers

(A)

Employer may specify level

(B)

Employee may choose plans within a level

(b)

Payment of premiums by qualified individuals

(c)

Single risk pool

(1)

Individual market

(2)

Small group market

(3)

Merger of markets

(4)

State law

(d)

Empowering consumer choice

(1)

Continued operation of market outside Exchanges

Nothing in this title 1

 See References in Text note below.

shall be construed to prohibit—

(A)

a health insurance issuer from offering outside of an Exchange a health plan to a qualified individual or qualified employer; and

(B)

a qualified individual from enrolling in, or a qualified employer from selecting for its employees, a health plan offered outside of an Exchange.

(2)

Continued operation of State benefit requirements

(3)

Voluntary nature of an Exchange

(A)

Choice to enroll or not to enroll

(B)

Prohibition against compelled enrollment

(C)

Individuals allowed to enroll in any plan

(D)

Members of Congress in the Exchange

(i)

Requirement

Notwithstanding any other provision of law, after the effective date of this subtitle, the only health plans that the Federal Government may make available to Members of Congress and congressional staff with respect to their service as a Member of Congress or congressional staff shall be health plans that are—

(I)

created under this Act (or an amendment made by this Act); or

(II)

offered through an Exchange established under this Act (or an amendment made by this Act).

(ii)

Definitions

In this section:

(I)

Member of Congress

(II)

Congressional staff

(4)

No penalty for transferring to minimum essential coverage outside Exchange

(e)

Enrollment through agents or brokers

The Secretary shall establish procedures under which a State may allow agents or brokers—

(1)

to enroll individuals and employers in any qualified health plans in the individual or small group market as soon as the plan is offered through an Exchange in the State; and

(2)

to assist individuals in applying for premium tax credits and cost-sharing reductions for plans sold through an Exchange.

(f)

Qualified individuals and employers; access limited to citizens and lawful residents

(1)

Qualified individuals

In this title: ¹

(A)

In general

The term “qualified individual” means, with respect to an Exchange, an individual who—

(i)

is seeking to enroll in a qualified health plan in the individual market offered through the Exchange; and

(ii)

resides in the State that established the Exchange.

(B)

Incarcerated individuals excluded

(2)

Qualified employer

In this title: ¹

(A)

In general

(B)

Extension to large groups

(i)

In general

(ii)

Large employers eligible

(3)

Access limited to lawful residents

(Pub. L. 111–148, title I, § 1312, title X, § 10104(i), Mar. 23, 2010, 124 Stat. 182, 901.)

cite as: 42 USC 18032