Day 12

Sec. 1323 page 75

Community Health Ins. Option: Health care providers need not join; nor do individuals need to participate.

definition: ins. coverage that is a qualified health plan (already defined way back).

-provides high value for the premium charged

- reduces administrative costs and simplifies administration

- promotes high quality clinical care

- provides high quality customer service

- choice of providers

- complies with State laws

- for essential health benefits only

- States may offer additional benefits if the State pays for it

- Premiums established geographically to cover costs (claims and admin. costs)

- Secretary will put these people in a national pool

- Tax payer monies will be used as a start up fund which will be repaid

Provider of community health insurance must be a non-profit

Other rules...

Section 1324 level playing field

information about current health insurance coverage and Consumer Operated & Oriented Plan (remember those? - section 1322)

PART IV - STATE FLEXIBILITY TO ESTABLISH ALTERNATIVE PROGRAMS

Section 1331

States may establish basic health programs for low-income individuals not eligible for medicaid.

Section 1332

Waiver for state innovation.

Section 1333

Provisions relating to offering of plans in more than one state

Secretary will issue regulations for the creation of health care choice compacts with two or more states.

- a qualified health plan

- rules

PART V - REINSURANCE AND RISK ADJUSTMENT

Section 1341. Transitional reinsurance program for individual & small group markets in each state

- establish entities to carry out reinsurance program

- health ins. issuers make payments to the entity for 2014, 2015, 2016.

- the entity takes the money and pays the health ins. issuers

- rules

Section 1342 - establishment of risk corridors for plans in individual and small group markets

- Secretary will establish & administer a program of risk corridors for 2014, 2015, 2016.

- apparently they are payment adjustments

- definitions and rules

Section 1343 - Risk adjustment

- allows health ins. issuers to adjust for low risk and high risk enrollees.

yeah... another 20 pages: pg. 95