U.S Code last checked for updates: Jun 16, 2024
§ 18002.
Reinsurance for early retirees
In general
In this section:
Health benefits
Employment-based plan
The term “employment-based plan” means a group benefits plan providing health benefits that—
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
a multiemployer plan (as defined in section 1002(37) of title 29); and
provides health benefits to early retirees.
Early retirees
Employment-based plan eligibility
A participating employment-based plan is an employment-based plan that—
meets the requirements of paragraph (2) with respect to health benefits provided under the plan; and
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.
Employment-based health benefits
An employment-based plan meets the requirements of this paragraph if the plan—
implements programs and procedures to generate cost-savings with respect to participants with chronic and high-cost conditions;
provides documentation of the actual cost of medical claims involved; and
is certified by the Secretary.
Submission of claims
In general
Basis for claims
Program payments
Use of payments
Payments not treated as income
The Secretary shall establish—
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
procedures to protect against fraud, waste, and abuse under the program.
(Pub. L. 111–148, title I, § 1102, title X, § 10102(a), Mar. 23, 2010, 124 Stat. 143, 892.)
cite as: 42 USC 18002