42 U.S.C. § 300gg: Fair health insurance premiums

whether such plan or coverage covers an individual or family; rating area, as established in accordance with paragraph (2); 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 tobacco use, except that such rate shall not vary by more than 1.5 to 1; and such rate shall not vary with respect to the particular plan or coverage involved by any other factor not described in subparagraph (A). Each State shall establish 1 or more rating areas within that State for purposes of applying the requirements of this subchapter. 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 subchapter. 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. 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). 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. 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 18032(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. section 1251 [enacting section 18011 of this title ] shall take effect on the date of enactment of this Act [ Mar. 23, 2010 ]; and the provisions of section 2704 of the Public Health Service Act [ 42 U.S.C. 300gg–3 ] (as amended by section 1201), as they apply to enrollees who are under 19 years of age, shall become effective for plan years beginning on or after the date that is 6 months after the date of enactment of this Act [ Mar. 23, 2010 ].. [sic]” Except as provided in this subsection, part A of title XXVII of the Public Health Service Act [ 42 U.S.C. 300gg et seq.] (as added by subsection (a)) shall apply with respect to group health plans, and health insurance coverage offered in connection with group health plans, for plan years beginning after June 30, 1997 . Subject to clause (ii), no period before July 1, 1996 , shall be taken into account under part A of title XXVII of the Public Health Service Act [ 42 U.S.C. 300gg et seq.] (as added by this section) in determining creditable coverage. The Secretary of Health and Human Services, consistent with section 104 [ 42 U.S.C. 300gg–92 note], shall provide for a process whereby individuals who need to establish creditable coverage for periods before July 1, 1996 , and who would have such coverage credited but for clause (i) may be given credit for creditable coverage for such periods through the presentation of documents or other means. Subject to clauses (ii) and (iii), subsection (e) of section 2701 [now 2704] of the Public Health Service Act [ 42 U.S.C. 300gg–3(e) ] (as added by this section) shall apply to events occurring after June 30, 1996 . In no case is a certification required to be provided under such subsection before June 1, 1997 . In the case of an event occurring after June 30, 1996 , and before October 1, 1996 , a certification is not required to be provided under such subsection unless an individual (with respect to whom the certification is otherwise required to be made) requests such certification in writing. the individual may present other credible evidence of such coverage in order to establish the period of creditable coverage; and a group health plan and a health insurance issuer shall not be subject to any penalty or enforcement action with respect to the plan’s or issuer’s crediting (or not crediting) such coverage if the plan or issuer has sought to comply in good faith with the applicable requirements under the amendments made by this section [enacting this section and sections 300gg–1, 300gg–11 to 300gg–13, 300gg–21 to 300gg–23, 300gg–91, and 300gg–92 of this title and amending sections 300e and 300bb–8 of this title]. the date on which the last of the collective bargaining agreements relating to the plan terminates (determined without regard to any extension thereof agreed to after the date of the enactment of this Act), or July 1, 1997 . The Secretary of Health and Human Services, consistent with section 104 [ 42 U.S.C. 300gg–92 note], shall first issue by not later than April 1, 1997 , such regulations as may be necessary to carry out the amendments made by this section [enacting this section and sections 300gg–1, 300gg–11 to 300gg–13, 300gg–21 to 300gg–23, 300gg–91, and 300gg–92 of this title and amending sections 300e and 300bb–8 of this title] and section 111 [enacting sections 300gg–41 to 300gg–44 and 300gg–61 to 300gg–63 of this title]. No enforcement action shall be taken, pursuant to the amendments made by this section, against a group health plan or health insurance issuer with respect to a violation of a requirement imposed by such amendments before January 1, 1998 , or, if later, the date of issuance of regulations referred to in paragraph (4), if the plan or issuer has sought to comply in good faith with such requirements.” Provisions in group health plans and health insurance coverage that impose certain preexisting condition exclusions impact the ability of employees to seek employment in interstate commerce, thereby impeding such commerce. Health insurance coverage is commercial in nature and is in and affects interstate commerce. It is a necessary and proper exercise of Congressional authority to impose requirements under this title on group health plans and health insurance coverage (including coverage offered to individuals previously covered under group health plans) in order to promote commerce among the States. Congress, however, intends to defer to States, to the maximum extent practicable, in carrying out such requirements with respect to insurers and health maintenance organizations that are subject to State regulation, consistent with the provisions of the Employee Retirement Income Security Act of 1974 [ 29 U.S.C. 1001 et seq.]. If any provision of this title or the application of such provision to any person or circumstance is held to be unconstitutional, the remainder of this title and the application of the provisions of such to any person or circumstance shall not be affected thereby.”