Page:United States Statutes at Large Volume 124.djvu/181

 124 STAT. 155 PUBLIC LAW 111–148—MAR. 23, 2010 (I) by striking ‘‘(a)(1)(F)’’ and inserting ‘‘(a)(6)’’; (II) by striking ‘‘2701’’ and inserting ‘‘2704’’; and (III) by striking ‘‘2721(a)’’ and inserting ‘‘2735(a)’’; and (B) by transferring such section (as amended by subparagraph (A)) to appear after section 2705(a) as added by paragraph (4); and (4) by inserting after the subpart heading (as added by paragraph (1)) the following: ‘‘SEC. 2701. FAIR HEALTH INSURANCE PREMIUMS. ‘‘(a) PROHIBITING DISCRIMINATORY PREMIUM RATES.— ‘‘(1) IN GENERAL.—With respect to the premium rate charged by a health insurance issuer for health insurance cov- erage 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 indi- vidual 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 2707(c)); 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 par- ticular 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 subpara- graph (A) to ensure the adequacy of such areas for purposes of carrying out the requirements of this title. If the Sec- retary 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 consulta- tion 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 per- mitted under clauses (iii) and (iv) of paragraph (1)(A) shall be applied based on the portion of the premium that is attrib- utable to each family member covered under the plan or cov- erage. ‘‘(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 1312(f)(2)(B) Definition. 42 USC 300gg.