Page:United States Statutes at Large Volume 111 Part 1.djvu/335

 PUBLIC LAW 105-33—AUG. 5, 1997 111 STAT. 311 "(A) the actuarial value of the deductibles, coinsurance, and copayments applicable on average to individuals enrolled under this part with such a plan of an organization with respect to required benefits described in section 1852(a)(1), exceed "(B) the actuarial value of the deductibles, coinsurance, and copa3anents that would be applicable on average to individuals entitled to benefits under part A and enrolled under part B if they were not members of a Medicare+Choice organization for the year. " (f) REQUIREMENT FOR ADDITIONAL BENEFITS.— " (1) REQUIREMENT.— "(A) IN GENERAL.— Each Medicare+Choice organization (in relation to a Medicare+Choice plan, other than an MSA plan, it offers) shall provide that if there is an excess amount (as defined in subparagraph (B)) for the plan for a contract year, subject to the succeeding provisions of this subsection, the organization shall provide to individuals such additional benefits (as the organization may specify) in a value which the Secretary determines is at least equal to the adjusted excess amount (as defined in subparagraph (O). "(B) EXCESS AMOUNT.—For purposes of this paragraph, the 'excess amount', for an organization for a plan, is the amount (if any) by which— "(i) the average of the capitation payments made to the organization under section 1853 for the plan at the beginning of contract year, exceeds "(ii) the actuarial value of the required benefits described in section 1852(a)(1)(A) under the plan for individuals under this part, as determined based upon an adjusted community rate described in paragraph (3) (as reduced for the actuarial value of the coinsurance, copayments, and deductibles under parts A and B). "(C) ADJUSTED EXCESS AMOUNT. —For purposes of this paragraph, the 'adjusted excess amount', for an organization for a plan, is the excess amount reduced to reflect any amount withheld and reserved for the organization for the year under paragraph (2). "(D) UNIFORM APPLICATION.— Th is paragraph shall be applied uniformly for all enrollees for a plan. "(E) CONSTRUCTION.— Nothing in this subsection shall be construed as preventing a Medicare+Choice organization from providing supplemental benefits (described in section 1852(a)(3)) that are in addition to the health care benefits otherwise required to be provided under this paragraph and from imposing a premium for such supplemental benefits. "(2) STABILIZATION FUND. —A Medicare+Choice organization may provide that a part of the value of an excess amount described in paragraph (1) be withheld and reserved in the Federal Hospital Insurance Trust Fund and in the Federal Supplementary Medical Insurance Trust Fund (in such proportions as the Secretary determines to be appropriate) by the Secretary for subsequent suinual contract periods, to the extent required to stabilize and prevent undue fluctuations in the

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