- antitrust laws
has the meaning given the term in subsection (a) of section 12 of title 15.
- applicable reinsurance entity
means a not-for-profit organization—
- applicable State health subsidy program
means—
- congressional staff
means all full-time and part-time employees employed by the official office of a Member of Congress, whether in Washington, DC or outside of Washington, DC.
- cost-sharing
includes—
- early retirees
means individuals who are age 55 and older but are not eligible for coverage under title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.], 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.
- educated health care consumer
means an individual who is knowledgeable about the health care system, and has background or experience in making informed decisions regarding health, medical, and scientific matters.
- eligible entity
means—
- eligible individual
means, with respect to any State, an individual— Such term shall not include any individual who is not a qualified individual under section 18032 of this title who is eligible to be covered by a qualified health plan offered through an Exchange.
- eligible insured
means an individual— In the case of an individual described in section 36B(c)(1)(B) of title 26, the individual shall be treated as having household income equal to 100 percent for purposes of applying this section.
- employment-based plan
means a group benefits plan providing health benefits that—
- essential health benefits package
means, with respect to any health plan, coverage that—
- expatriate health insurance issuer
means a health insurance issuer that issues expatriate health plans.
- expatriate health plan
means a group health plan, health insurance coverage offered in connection with a group health plan, or health insurance coverage offered to a group of individuals described in paragraph (3)(C) (which may include spouses, dependents, and other individuals enrolled in the plan) that meets each of the following standards:
- Federal health care provision
means any provision of the Patient Protection and Affordable Care Act (Public Law 111–148), title I or subtitle B of title II of the Health Care and Education Reconciliation Act of 2010 (Public Law 111–152), or title XVIII or XIX of the Social Security Act (42 U.S.C. 1395 et seq., 42 U.S.C. 1396 et seq.).
- grandfathered health plan
means any group health plan or health insurance coverage to which this section applies.
- group health plan
has the meaning given such term by section 300gg–91(a) of this title.
- group market
means the health insurance market under which individuals obtain health insurance coverage (directly or through any arrangement) on behalf of themselves (and their dependents) through a group health plan maintained by an employer.
- health benefits
means medical, surgical, hospital, prescription drug, and such other benefits as shall be determined by the Secretary, whether self-funded, or delivered through the purchase of insurance or otherwise.
- health care entity
includes an individual physician or other health care professional, a hospital, a provider-sponsored organization, a health maintenance organization, a health insurance plan, or any other kind of health care facility, organization, or plan.
- health care provider
means any individual, group practice, corporation of health care professionals, or hospital—
- health plan
means health insurance coverage and a group health plan.
- individual market
means the market for health insurance coverage offered to individuals other than in connection with a group health plan.
- large employer
means, in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least 51 employees on business days during the preceding calendar year and who employs at least 1 employee on the first day of the plan year.
- medical malpractice or medical product liability action or claim
means a medical malpractice action or claim (as defined in section 11151(7) of this title) and includes a liability action or claim relating to a health care provider’s prescription or provision of a drug, device, or biological product (as such terms are defined in section 321 of title 21 or section 262 of this title).
- Member of Congress
means any member of the House of Representatives or the Senate.
- plain language
means language that the intended audience, including individuals with limited English proficiency, can readily understand and use because that language is concise, well-organized, and follows other best practices of plain language writing.
- qualified employer
means a small employer that elects to make all full-time employees of such employer eligible for 1 or more qualified health plans offered in the small group market through an Exchange that offers qualified health plans.
- qualified expatriate
means a primary insured, or individual otherwise described in subparagraph (C)—
- qualified health plan
means a health plan that—
- qualified individual
means, with respect to an Exchange, an individual who—
- qualified nonprofit health insurance issuer
means a health insurance issuer that is an organization—
- Secretary
means the Secretary of Health and Human Services.
- small employer
means, in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least 1 but not more than 50 employees on business days during the preceding calendar year and who employs at least 1 employee on the first day of the plan year.
- standard heath 1 plan
means a health benefits plan that the State contracts with under this section—
- State
means each of the 50 States and the District of Columbia.
- transfer
means an employer has transferred an employee to perform services for a branch of the same employer or a parent, affiliate, franchise, or subsidiary thereof.
- United States
means the 50 States, the District of Columbia, and Puerto Rico.