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U.S. Code/Title 42/§ 18021

Title 42

42

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42 U.S.C. § 18021.Chapter 157

§ 18021

Qualified health plan defined

Title 42
4 min read
Subchapter: AVAILABLE COVERAGE CHOICES FOR ALL AMERICANS

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((a)) ** Qualified health plan** In this title:

((1)) ** In general** The term “qualified health plan” means a health plan that—

((A)) has in effect a certification (which may include a seal or other indication of approval) that such plan meets the criteria for certification described in issued or recognized by each Exchange through which such plan is offered;

((B)) provides the essential health benefits package described in ; and

((C)) is offered by a health insurance issuer that—

((i)) is licensed and in good standing to offer health insurance coverage in each State in which such issuer offers health insurance coverage under this title;

((ii)) agrees to offer at least one qualified health plan in the silver level and at least one plan in the gold level in each such Exchange;

((iii)) agrees to charge the same premium rate for each qualified health plan of the issuer without regard to whether the plan is offered through an Exchange or whether the plan is offered directly from the issuer or through an agent; and

((iv)) complies with the regulations developed by the Secretary under and such other requirements as an applicable Exchange may establish.

((2)) ** Inclusion of CO–OP plans and multi-State qualified health plans** Any reference in this title  to a qualified health plan shall be deemed to include a qualified health plan offered through the CO–OP program under , and a multi-State plan under , unless specifically provided for otherwise.section 18042 of this titlesection 18054 of this title1

((3)) ** Treatment of qualified direct primary care medical home plans** The Secretary of Health and Human Services shall permit a qualified health plan to provide coverage through a qualified direct primary care medical home plan that meets criteria established by the Secretary, so long as the qualified health plan meets all requirements that are otherwise applicable and the services covered by the medical home plan are coordinated with the entity offering the qualified health plan.

((4)) ** Variation based on rating area** A qualified health plan, including a multi-State qualified health plan, may as appropriate vary premiums by rating area (as defined in ).section 300gg(a)(2) of this title

((b)) ** Terms relating to health plans** In this title:

((1)) ** Health plan**

((A)) ** In general** The term “health plan” means health insurance coverage and a group health plan.

((B)) ** Exception for self-insured plans and MEWAs** Except to the extent specifically provided by this title, the term “health plan” shall not include a group health plan or multiple employer welfare arrangement to the extent the plan or arrangement is not subject to State insurance regulation under .section 1144 of title 291

((2)) ** Health insurance coverage and issuer** The terms “health insurance coverage” and “health insurance issuer” have the meanings given such terms by .section 300gg–91(b) of this title

((3)) ** Group health plan** The term “group health plan” has the meaning given such term by .section 300gg–91(a) of this title

Related Legislation

(13 bills)

Bills that would modify or reference this section of law.

HR-1

To provide for reconciliation pursuant to title II of H. Con. Res. 14.

Jodey Cook Arrington

Texas representative

  1. house
  2. senate
  3. president
5/20/2025
HR-3069

Medicare for All Act

Pramila Jayapal

Washington representative

  1. house
  2. senate
  3. president
4/29/2025
HR-3257

Bridge to Medicaid Act of 2025

Terri Sewell

Alabama representative

  1. house
  2. senate
  3. president
5/7/2025
HR-3911

Choose Medicare Act

Jimmy Gomez

California representative

  1. house
  2. senate
  3. president
6/11/2025
HR-4406

State-Based Universal Health Care Act of 2025

Ro Khanna

California representative

  1. house
  2. senate
  3. president
7/15/2025
HR-5925

HHS Reproductive and Sexual Health Ombuds Act of 2025

Nikema Williams

Georgia representative

  1. house
  2. senate
  3. president
11/4/2025
HR-6512

Putting Patients First Healthcare Freedom Act

Andrew S. Biggs

Arizona representative

  1. house
  2. senate
  3. president
12/9/2025
HR-7023

Affordable CHOICE Act

Janice D. Schakowsky

Illinois representative

  1. house
  2. senate
  3. president
1/12/2026
HR-8585

Community Multi-Share Coverage Program Act of 2026

John Moolenaar

Michigan representative

  1. house
  2. senate
  3. president
4/29/2026
S-2032

Choose Medicare Act

Jeff Merkley

Oregon senator

  1. senate
  2. house
  3. president
6/11/2025

And 3 more bills...

§ 18014

Release: pl-119-111 (2026-09-18)

§ 18023

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