U.S Code last checked for updates: Jun 16, 2024
§ 18002.
Reinsurance for early retirees
(a)
Administration
(1)
In general
(2)
Reference
In this section:
(A)
Health benefits
(B)
Employment-based plan
The term “employment-based plan” means a group benefits plan providing health benefits that—
(i)
is—
(I)
maintained by one or more current or former employers (including without limitation any State or local government or political subdivision thereof or any agency or instrumentality of any of the foregoing), employee organization, a voluntary employees’ beneficiary association, or a committee or board of individuals appointed to administer such plan; or
(II)
a multiemployer plan (as defined in section 1002(37) of title 29); and
(ii)
provides health benefits to early retirees.
(C)
Early retirees
(b)
Participation
(1)
Employment-based plan eligibility
A participating employment-based plan is an employment-based plan that—
(A)
meets the requirements of paragraph (2) with respect to health benefits provided under the plan; and
(B)
submits to the Secretary an application for participation in the program, at such time, in such manner, and containing such information as the Secretary shall require.
(2)
Employment-based health benefits
An employment-based plan meets the requirements of this paragraph if the plan—
(A)
implements programs and procedures to generate cost-savings with respect to participants with chronic and high-cost conditions;
(B)
provides documentation of the actual cost of medical claims involved; and
(C)
is certified by the Secretary.
(c)
Payments
(1)
Submission of claims
(A)
In general
(B)
Basis for claims
(2)
Program payments
(3)
Limit
(4)
Use of payments
(5)
Payments not treated as income
(6)
Appeals
The Secretary shall establish—
(A)
an appeals process to permit participating employment-based plans to appeal a determination of the Secretary with respect to claims submitted under this section; and
(B)
procedures to protect against fraud, waste, and abuse under the program.
(d)
Audits
(e)
Funding
(f)
Limitation
(Pub. L. 111–148, title I, § 1102, title X, § 10102(a), Mar. 23, 2010, 124 Stat. 143, 892.)
cite as: 42 USC 18002