PPACA Sec. 2203

(Back to HRN 2010 Ins Chart)

SEC. 2203. PREMIUMS.
 `(a) Amount of Monthly Premiums-

    `(1) IN GENERAL- The Secretary shall, during September of each year (beginning with 2009), establish a monthly MediKids premium for the following year. Subject to paragraph (2), the monthly MediKids premium for a year is equal to 1/12 of the annual premium rate computed under subsection (b).

    `(2) ELIMINATION OF MONTHLY PREMIUM FOR DEMONSTRATION OF EQUIVALENT COVERAGE (INCLUDING COVERAGE UNDER LOW-INCOME PROGRAMS)- The amount of the monthly premium imposed under this section for an individual for a month shall be zero in the case of an individual who demonstrates to the satisfaction of the Secretary that the individual has basic health insurance coverage for that month. For purposes of the previous sentence enrollment in a medicaid plan under title XIX, a State child health insurance plan under title XXI, or under the medicare program under title XVIII is deemed to constitute basic health insurance coverage described in such sentence.

`(b) Annual Premium-

    `(1) NATIONAL PER CAPITA AVERAGE- The Secretary shall estimate the average, annual per capita amount that would be payable under this title with respect to individuals residing in the United States who meet the requirement of section 2201(a)(1) as if all such individuals were eligible for (and enrolled) under this title during the entire year (and assuming that section 1862(b)(2)(A)(i) did not apply).

    `(2) ANNUAL PREMIUM- Subject to subsection (d), the annual premium under this subsection for months in a year is equal to 25 percent of the average, annual per capita amount estimated under paragraph (1) for the year.

`(c) Payment of Monthly Premium-

    `(1) PERIOD OF PAYMENT- In the case of an individual who participates in the program established by this title, subject to subsection (d), the monthly premium shall be payable for the period commencing with the first month of the individual's coverage period and ending with the month in which the individual's coverage under this title terminates.

    `(2) COLLECTION THROUGH TAX RETURN- For provisions providing for the payment of monthly premiums under this subsection, see section 59B of the Internal Revenue Code of 1986.
       
`    (3) PROTECTIONS AGAINST FRAUD AND ABUSE- The Secretary shall develop, in coordination with States and other health insurance issuers, administrative systems to ensure that claims which are submitted to more than one payor are coordinated and duplicate payments are not made.

`(d) Reduction in Premium for Certain Low-Income Families- For provisions reducing the premium under this section for certain low-income families, see section 59B(d) of the Internal Revenue Code of 1986.
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