Page:United States Statutes at Large Volume 124.djvu/170

 124 STAT. 144 PUBLIC LAW 111–148—MAR. 23, 2010 whether self-funded, or delivered through the purchase of insurance or otherwise. (B) EMPLOYMENT-BASED PLAN.—The term ‘‘employ- ment-based plan’’ means a group health benefits plan that— (i) is— (I) maintained by one or more current or former employers (including without limitation any State or local government or political subdivision thereof), employee organization, a voluntary employees’ beneficiary association, or a committee or board of individuals appointed to administer such plan; or (II) a multiemployer plan (as defined in section 3(37) of the Employee Retirement Income Security Act of 1974); and (ii) provides health benefits to early retirees. (C) EARLY RETIREES.—The term ‘‘early retirees’’ means individuals who are age 55 and older but are not eligible for coverage under title XVIII of the Social Security Act, and who are not active employees of an employer maintaining, or currently contributing to, the employment- based plan or of any employer that has made substantial contributions to fund such plan. (b) PARTICIPATION.— (1) EMPLOYMENT-BASED PLAN ELIGIBILITY.—A participating employment-based plan is an employment-based plan that— (A) meets the requirements of paragraph (2) with respect to health benefits provided under the plan; and (B) submits to the Secretary an application for partici- pation in the program, at such time, in such manner, and containing such information as the Secretary shall require. (2) EMPLOYMENT-BASED HEALTH BENEFITS.—An employ- ment-based plan meets the requirements of this paragraph if the plan— (A) implements programs and procedures to generate cost-savings with respect to participants with chronic and high-cost conditions; (B) provides documentation of the actual cost of medical claims involved; and (C) is certified by the Secretary. (c) PAYMENTS.— (1) SUBMISSION OF CLAIMS.— (A) IN GENERAL.—A participating employment-based plan shall submit claims for reimbursement to the Sec- retary which shall contain documentation of the actual costs of the items and services for which each claim is being submitted. (B) BASIS FOR CLAIMS.—Claims submitted under subparagraph (A) shall be based on the actual amount expended by the participating employment-based plan involved within the plan year for the health benefits pro- vided to an early retiree or the spouse, surviving spouse, or dependent of such retiree. In determining the amount of a claim for purposes of this subsection, the participating Certification.