Collapse to view only § 4375. Health insurance
§ 4375. Health insurance
(a) Imposition of fee
(b) Liability for fee
(c) Specified health insurance policy
For purposes of this section:
(1) In general
(2) Exemption for certain policies
(3) Treatment of prepaid health coverage arrangements
(A) In general
(B) Description of arrangements
(d) Adjustments for increases in health care spending
In the case of any policy year ending in any fiscal year beginning after September 30, 2014, the dollar amount in effect under subsection (a) for such policy year shall be equal to the sum of such dollar amount for policy years ending in the previous fiscal year (determined after the application of this subsection), plus an amount equal to the product of—
(1) such dollar amount for policy years ending in the previous fiscal year, multiplied by
(2) the percentage increase in the projected per capita amount of National Health Expenditures, as most recently published by the Secretary before the beginning of the fiscal year.
(e) Termination
(Added Pub. L. 111–148, title VI, § 6301(e)(2)(A), Mar. 23, 2010, 124 Stat. 743; amended Pub. L. 116–94, div. N, title I, § 104(b), Dec. 20, 2019, 133 Stat. 3098.)
§ 4376. Self-insured health plans
(a) Imposition of fee
(b) Liability for fee
(1) In general
(2) Plan sponsorFor purposes of paragraph (1) the term “plan sponsor” means—
(A) the employer in the case of a plan established or maintained by a single employer,
(B) the employee organization in the case of a plan established or maintained by an employee organization,
(C) in the case of—
(i) a plan established or maintained by 2 or more employers or jointly by 1 or more employers and 1 or more employee organizations,
(ii) a multiple employer welfare arrangement, or
(iii) a voluntary employees’ beneficiary association described in section 501(c)(9), the association, committee, joint board of trustees, or other similar group of representatives of the parties who establish or maintain the plan, or
(D) the cooperative or association described in subsection (c)(2)(F) in the case of a plan established or maintained by such a cooperative or association.
(c) Applicable self-insured health planFor purposes of this section, the term “applicable self-insured health plan” means any plan for providing accident or health coverage if—
(1) any portion of such coverage is provided other than through an insurance policy, and
(2) such plan is established or maintained—
(A) by 1 or more employers for the benefit of their employees or former employees,
(B) by 1 or more employee organizations for the benefit of their members or former members,
(C) jointly by 1 or more employers and 1 or more employee organizations for the benefit of employees or former employees,
(D) by a voluntary employees’ beneficiary association described in section 501(c)(9),
(E) by any organization described in section 501(c)(6), or
(F) in the case of a plan not described in the preceding subparagraphs, by a multiple employer welfare arrangement (as defined in section 3(40) of Employee Retirement Income Security Act of 1974), a rural electric cooperative (as defined in section 3(40)(B)(iv) of such Act), or a rural telephone cooperative association (as defined in section 3(40)(B)(v) of such Act).
(d) Adjustments for increases in health care spendingIn the case of any plan year ending in any fiscal year beginning after September 30, 2014, the dollar amount in effect under subsection (a) for such plan year shall be equal to the sum of such dollar amount for plan years ending in the previous fiscal year (determined after the application of this subsection), plus an amount equal to the product of—
(1) such dollar amount for plan years ending in the previous fiscal year, multiplied by
(2) the percentage increase in the projected per capita amount of National Health Expenditures, as most recently published by the Secretary before the beginning of the fiscal year.
(e) Termination
(Added Pub. L. 111–148, title VI, § 6301(e)(2)(A), Mar. 23, 2010, 124 Stat. 744; amended Pub. L. 116–94, div. N, title I, § 104(c), Dec. 20, 2019, 133 Stat. 3098.)
§ 4377. Definitions and special rules
(a) Definitions
For purposes of this subchapter—
(1) Accident and health coverage
(2) Insurance policy
(3) United States
(b) Treatment of governmental entities
(1) In general
For purposes of this subchapter—
(A) the term “person” includes any governmental entity, and
(B) notwithstanding any other law or rule of law, governmental entities shall not be exempt from the fees imposed by this subchapter except as provided in paragraph (2).
(2) Treatment of exempt governmental programs
(3) Exempt governmental program defined
For purposes of this subchapter, the term “exempt governmental program” means—
(A) any insurance program established under title XVIII of the Social Security Act,
(B) the medical assistance program established by title XIX or XXI of the Social Security Act,
(C) any program established by Federal law for providing medical care (other than through insurance policies) to individuals (or the spouses and dependents thereof) by reason of such individuals being members of the Armed Forces of the United States or veterans, and
(D) any program established by Federal law for providing medical care (other than through insurance policies) to members of Indian tribes (as defined in section 4(d) of the Indian Health Care Improvement Act).
(c) Treatment as tax
(d) No cover over to possessions
(Added Pub. L. 111–148, title VI, § 6301(e)(2)(A), Mar. 23, 2010, 124 Stat. 746.)