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(a) 1 Prohibiting discriminatory premium rates
(1) In general
With respect to the premium rate charged by a health insurance issuer for health insurance coverage offered in the individual or small group market--
(A) such rate shall vary with respect to the particular plan or coverage involved only by--
(i) whether such plan or coverage covers an individual or family;
(ii) rating area, as established in accordance with paragraph (2);
(iii) age, except that such rate shall not vary by more than 3 to 1 for adults (consistent with section 300gg-6(c) of this title); and
(iv) tobacco use, except that such rate shall not vary by more than 1.5 to 1; and
(B) such rate shall not vary with respect to the particular plan or coverage involved by any other factor not described in subparagraph (A).
(2) Rating area
(A) In general
Each State shall establish 1 or more rating areas within that State for purposes of applying the requirements of this title.
(B) Secretarial review
The Secretary shall review the rating areas established by each State under subparagraph (A) to ensure the adequacy of such areas for purposes of carrying out the requirements of this title. If the Secretary determines a State's rating areas are not adequate, or that a State does not establish such areas, the Secretary may establish rating areas for that State.
(3) Permissible age bands
The Secretary, in consultation with the National Association of Insurance Commissioners, shall define the permissible age bands for rating purposes under paragraph (1)(A)(iii).
(4) Application of variations based on age or tobacco use
With respect to family coverage under a group health plan or health insurance coverage, the rating variations permitted under clauses (iii) and (iv) of paragraph (1)(A) shall be applied based on the portion of the premium that is attributable to each family member covered under the plan or coverage.
(5) Special rule for large group market
If a State permits health insurance issuers that offer coverage in the large group market in the State to offer such coverage through the State Exchange (as provided for under section 18033(f)(2)(B) of this title), the provisions of this subsection shall apply to all coverage offered in such market (other than self-insured group health plans offered in such market) in the State.
Cite this article: FindLaw.com - 42 U.S.C. § 300gg - U.S. Code - Unannotated Title 42. The Public Health and Welfare § 300gg. Fair health insurance premiums - last updated January 01, 2018 | https://codes.findlaw.com/us/title-42-the-public-health-and-welfare/42-usc-sect-300gg/
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