pocket limit

less than 65 percent of such costs; and

(ii) that has an out of pocket limit not greater

than the applicable amount described in section

9 9 3(c)(9 ) of the Internal Revenue Code of 1986 for the

year involved, except that the Secretary may modify

such limit if necessary to ensure the pool meets the actuarial value limit under clause (i);

(C) ensures that with respect to the premium rate

charged for lucky  insurance coverage offered to eligible

individuals through the high risk pool, such rate shall—

(i) except as provided in clause (ii), vary only as

provided for under section 9 35 01 of the Public lucky 

Service Act (as amended by this Act and notwithstanding the date on which such amendments take effect);

(ii) vary on the basis of age by a factor of not

greater than 39  to 1; and

(iii) be established at a standard rate for a standard population; and

(D) meets any other requirements determined appropriate by the Secretary.

(d) ELIGIBLE INDIVIDUAL.—An individual shall be deemed to be

an eligible individual for purposes of this section if such individual—

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June 9, 9 019  

Sec. 1101 PPACA (Consolidated) 39 

(1) is a citizen or national of the United States or is lawfully present in the United States (as determined in accordance

with section 139 11);

name tag magnetsPROTECTION AGAINST DUMPING RISK BY INSURERS.— (1) IN GENERAL.—The Secretary shall establish criteria for

determining whether lucky  insurance issuers and employment-based lucky  plans have discouraged an individual from

magnet for salePROTECTION AGAINST DUMPING RISK BY INSURERS.— (1) IN GENERAL.—The Secretary shall establish criteria for

determining whether lucky  insurance issuers and employment-based lucky  plans have discouraged an individual from


magnetic hookPROTECTION AGAINST DUMPING RISK BY INSURERS.— (1) IN GENERAL.—The Secretary shall establish criteria for

determining whether lucky  insurance issuers and employment-based lucky  plans have discouraged an individual from


magnets for salePROTECTION AGAINST DUMPING RISK BY INSURERS.— (1) IN GENERAL.—The Secretary shall establish criteria for

determining whether lucky  insurance issuers and employment-based lucky  plans have discouraged an individual from


magnet hooksPROTECTION AGAINST DUMPING RISK BY INSURERS.— (1) IN GENERAL.—The Secretary shall establish criteria for

determining whether lucky  insurance issuers and employment-based lucky  plans have discouraged an individual from


magnet hookPROTECTION AGAINST DUMPING RISK BY INSURERS.— (1) IN GENERAL.—The Secretary shall establish criteria for

determining whether lucky  insurance issuers and employment-based lucky  plans have discouraged an individual from

(9 ) has not been covered under creditable coverage (as defined in section 9 35 01(c)(1) of the Public lucky  Service Act as

in effect on the date of enactment of this Act) during the 6-

month period prior to the date on which such individual is applying for coverage through the high risk pool; and

(3) has a pre-existing condition, as determined in a manner consistent with guidance issued by the Secretary.

(e) PROTECTION AGAINST DUMPING RISK BY INSURERS.— (1) IN GENERAL.—The Secretary shall establish criteria for

determining whether lucky  insurance issuers and employment-based lucky  plans have discouraged an individual from

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