.

Here ya' go JimBo . . .

When you get done 'xplaining each and every jot an' tittle in the following sections of this lawyerized pretzel Senate bill to everyone here maybe someone might agree with ya'.

==========================

TITLE I--HEALTHY AMERICANS PRIVATE INSURANCE PLANS

Subtitle A--Guaranteed Private Coverage

SEC. 101. GUARANTEE OF HEALTHY AMERICANS PRIVATE INSURANCE COVERAGE.

Not later than the date that is 2 years after the date of enactment of this Act, each adult individual shall have the opportunity to purchase a Healthy Americans Private Insurance plan that meets the requirements of subtitle B (referred to in this Act as `HAPI plan'), for such individual and the dependent children of such individual.

SEC. 102. INDIVIDUAL RESPONSIBILITY TO ENROLL IN A HEALTHY AMERICANS PRIVATE INSURANCE PLAN.

(a) Individual Responsibility-

(1) ADULT INDIVIDUALS- Each adult individual shall have the responsibility to enroll in a HAPI plan, unless the adult
individual--

(A) provides evidence of receipt of coverage under, or enrollment in a health plan offered through--

(i) the Medicare program under title XVIII of the Social Security Act;

(ii) a health insurance plan offered by the Department of Defense;

(iii) an employee benefit plan through a former employer;

(iv) a qualified collective bargaining agreement;

(v) the Department of Veterans Affairs; or

(vi) the Indian Health Service; or

(B) is opposed to health plan coverage for
religious reasons, including an individual who declines health plan
coverage due to a reliance on healing using spiritual means through
prayer alone.

(2) DEPENDENT CHILDREN- Each adult individual shall
have the responsibility to enroll each dependent child of the adult
individual in a HAPI plan, unless the adult individual--

(A) provides evidence that the dependent child is
enrolled in a health plan offered through a program described in
paragraph (1)(A); or

(B) is described in paragraph (1)(B).

(3) VERIFICATION OF RELIGIOUS EXCEPTION- Each State
shall develop guidelines for determining and verifying the individuals
who qualify for the exception under paragraph (1)(B).

(b) Penalty for Failure To Purchase Coverage-

(1) PENALTY-

(A) IN GENERAL- In the case of an individual
described in subparagraph (B), such individual shall be subject to a
late enrollment penalty in an amount determined under subparagraph (C).

(B) INDIVIDUALS SUBJECT TO PENALTY- An individual
described in this subparagraph is an adult individual for whom there is
a continuous period of 63 days or longer, beginning on the applicable
date (as defined in subparagraph (E)) and ending on the date of
enrollment in a HAPI plan, during all of which the individual--

(i) was not covered under a HAPI plan or a
health plan offered through a program described in paragraph (1)(A) of
subsection (a); and

(ii) was not described in paragraph (1)(B) of such section.

(C) AMOUNT OF PENALTY-

(i) IN GENERAL- The amount determined under this subparagraph for an individual is an amount equal to the sum of--

(I) the number of uncovered months
multiplied by the weighted average of the monthly premium for HAPI
plans of the same class of coverage as the individual's in the
applicable coverage area (determined without regard to any subsidy
under section 121); and

(II) 15 percent of the amount determined under subclause (I).

(ii) UNCOVERED MONTH DEFINED- For purposes of
this subsection, the term `uncovered month' means, with respect to an
individual, any month beginning on or after the applicable date (as
defined in subparagraph (E)) unless the individual can demonstrate that
the individual--

(I) was covered under a HAPI plan or a
health plan offered through a program described in paragraph (1)(A) of
subsection (a) for any portion of such month; or

(II) was described in paragraph (1)(B) of such section for any portion of such month.

A month shall not be treated as an uncovered
month if the individual has already paid a late enrollment penalty
under this subsection for such month or if the individual was
incarcerated for the entire month.

(D) PAYMENT- Payment of any late enrollment penalty
by an individual under this subsection shall be made to the HHA of the
individual's State of residence under procedures established by the
State.

(E) APPLICABLE DATE- In this paragraph, the term `applicable date' means the earlier of--

(i) the day after the end of the State's first
open enrollment period for HAPI plans (during which all adult
individuals are eligible to enroll); and

(ii) the day after the end of the first enrollment period for a fallback HAPI plan in the State.

(2) WAIVER- An HHA of a State may reduce or waive the
amount of any late enrollment penalty applicable to an individual under
this subsection if payment of such penalty would constitute a hardship
(determined under procedures established by the State).

(3) ENFORCEMENT- Each State shall determine appropriate
mechanisms, which may not include revocation or ineligibility for
coverage under a HAPI plan, to enforce the responsibility of each adult
individual to purchase HAPI plan coverage for such individual and any
dependent children of such individual under subsection (a).

(c) Other Insurance Coverage- Nothing in this Act shall be
construed to prohibit an individual from enrolling in a health
insurance plan that is not a HAPI plan.

(a) Plan Requirements-

(1) IN GENERAL- A health coverage plan described in
section 105(h)(6) of the Internal Revenue Code of 1986 (relating to
self-insured plans) that is offered by an employer shall be subject to--

(A) the requirements of subtitle B (except for subsections (a), (d)(2), and (d)(4) of section 111); and

(B) a risk-adjustment mechanism used to spread risk across all health plans.

(2) OTHER PLANS- A health coverage plan that is not
described in section 105(h)(6) of the Internal Revenue Code of 1986
that is offered by an employer shall be subject to the requirements of
subtitle B (except for subsection (a) of section 111).

(b) Distribution of Information- Employers that offer an
employer-sponsored health coverage plan shall distribute to employees
standardized, unbiased information on HAPI plans and supplemental
health insurance options provided by the State HHA under section 502(b).

(c) Plans Offered Through Employers- An employer-sponsored
health coverage plan shall be offered by an employer and not through
the applicable State HHA.

(a) Assurance of Supplemental Coverage- Subject to section
631(d), the Secretary, States, and health insurance issuers shall
ensure that any nondisabled, nonelderly adult individual eligible under
title XIX of the Social Security Act (including any nondisabled,
nonelderly adult individual eligible under a waiver under such title or
under section 1115 of such Act (42 U.S.C. 1315)) covered under a HAPI
plan provided through the State HHA receives medical assistance under
State Medicaid plans in a manner that--

(1) is provided in coordination with, and as a
supplement to, the coverage provided the nondisabled, nonelderly adult
individual under the HAPI plan in which the individual is enrolled;

(2) does not supplant the nondisabled, nonelderly adult individual's coverage under a HAPI plan;

(3) ensures that the nondisabled, nonelderly adult
individual receives all items or services that are not available (or
are otherwise limited) under the HAPI plan in which they are enrolled
but that is provided under the State plan (or provided to a greater
extent or in a less restrictive manner) under title XIX of the Social
Security Act (including any waiver under such title or under section
1115 of such Act (42 U.S.C. 1315)) of the State in which the
nondisabled, nonelderly adult individual resides; and

(4) ensures that the family of the nondisabled,
nonelderly adult individual is not charged premiums, deductibles, or
other cost-sharing that is greater than would have been charged under
the State plan under title XIX of the Social Security Act of the State
in which the nondisabled, nonelderly adult individual resides if such
coverage was not provided as a supplement to the coverage provided the
child under the HAPI plan in which the nondisabled, nonelderly adult
individual is enrolled.

(b) Guidance to States and Health Insurance Issuers- The
Secretary shall issue regulations and guidance to States and health
insurance issuers implementing this section not later than 6 months
prior to the date on which coverage under a HAPI plan first begins.

(a) Options- A State HHA--

(1) shall require that at least 2 HAPI plans that
comply with the requirements of subsection (b), be offered through the
HHA to each individual in the State;

(2) may require the offering of 1 or more HAPI plans
that include coverage for benefits, items, or services required by the
State in addition to the standardized benefits, items, or services
required under subsection (b) for HAPI plans if--

(A) such additional benefits, items, and services build upon the standardized benefits package;

(B) a list of such additional benefits, items, or
services, and the prices applicable to such additional benefits, items,
and services, is displayed in a manner that is separate from the
description of the standardized benefits, items, or services required
under the plan under this section (and consistent with the manner in
which such items are displayed by medigap policies) and that enables a
consumer to identify such additional benefits, items, and services and
the cost associated with such; and

(C) no premium subsidies are available under
subtitle C for any portion of the premiums for a HAPI plan that are
attributable to such additional benefits, items, or services; and

(3) may permit the offering of 1 or more actuarially equivalent HAPI plans through the HHA as provided for in subsection (c).

(b) Standardized Coverage Requirements for HAPI Plans-

(1) IN GENERAL- Each HAPI plan offered through an HHA shall--

(A) provide benefits for health care items and
services that are actuarially equivalent or greater in value than the
benefits offered as of January 1, 2009, under the Blue Cross/Blue
Shield Standard Plan provided under the Federal Employees Health
Benefit Program under chapter 89 of title 5, United States Code,
including coverage of an initial primary care assessment and annual
physical examinations;

(B) provide benefits for wellness programs and incentives to promote the use of such programs;

(C) provide coverage for catastrophic medical
events that result in out-of-pocket costs for an individual or family
if lifetime limits are exhausted;

(D) designate a health care provider, such as a
primary care physician, nurse practitioner, or other qualified health
provider, to monitor the health and health care of a covered
individuals (such provider shall be known as the `health home' of the
covered individual);

(E) ensure that, as part of the first visit with a
primary care physician or the health home of a covered individual, such
provider and individual determine a care plan to maximize the health of
the individual through wellness and activities prevention;

(F) provide benefits for comprehensive disease
prevention, early detection, disease management, and chronic condition
management that meets minimum standards developed by the Secretary;

(G) provide for the application of personal
responsibility contribution requirements with respect to covered
benefits in a manner that may be similar to the cost sharing
requirements applied as of January 1, 2009, under the Blue Cross/Blue
Shield Standard Plan provided under the Federal Employees Health
Benefit Program under chapter 89 of title 5, United States Code, except
that no contributions shall be required for--

(i) preventive items or services; and

(ii) early detection, disease management, or chronic pain treatment items or services; and

(H) comply with the requirements of section 112.

(2) DETERMINATION OF BENEFITS BY SECRETARY- Not later
than 1 year after the date of enactment of this Act, the Secretary
shall promulgate guidelines concerning the benefits, items, and
services that are covered under paragraph (1).

(3) COVERAGE FOR FAMILY PLANNING-

(A) IN GENERAL- Except as provided in subparagraph
(B), a health insurance issuer shall make available supplemental
coverage for abortion services that may be purchased in conjunction
with enrollment in a HAPI plan or an actuarially equivalent healthy
American plan.

(B) RELIGIOUS AND MORAL EXCEPTION- Nothing in this
paragraph shall be construed to require a health insurance issuer
affiliated with a religious institution to provide the coverage
described in subparagraph (A).

(4) RULE OF CONSTRUCTION- Nothing in this subsection
shall be construed to prohibit a HAPI plan from providing coverage for
benefits, items, and services in addition to the coverage required
under this subsection. No premium subsidies shall be available under
subtitle C for any portion of the premiums for a HAPI plan that are
attributable to such additional benefits, items, or services.

(c) Actuarially Equivalent Healthy American Plans- Each
actuarially equivalent healthy American plan offered through an HHA
shall--

(1) cover all treatments, items, services, and providers at least to the same extent as those covered under a HAPI plan that--

(A) shall include coverage for--

(i) preventive items or services (including
well baby care and well child care and appropriate immunizations) and
disease management services;

(ii) inpatient and outpatient hospital services;

(iii) physicians' surgical and medical services; and

(iv) laboratory and x-ray services; and

(B) may include additional supplemental benefits to
the extent approved by the State and provided for in advance in the
plan contract; and

(2) ensure that no personal responsibility contribution
requirements are applied for benefits, items, or services and chronic
disease management prevention.

(d) Premiums and Rating Requirements-

(1) CLASSES OF COVERAGE- With respect to a HAPI plan, a
health insurance issuer shall provide for the following classes of
coverage:

(A) Coverage of an individual.

(B) Coverage of a married couple or domestic partnership (as determined by a State) without dependent children.

(C) Coverage of an adult individual with 1 or more dependent children.

(D) Coverage of a married couple or domestic partnership (as determined by a State) with 1 or more dependent children.

(2) DETERMINATIONS OF PREMIUMS- With respect to each
class of coverage described in paragraph (1), a health insurance issuer
shall determine the premium amount for a HAPI plan using adjusted
community rating principals (including a risk-adjustment mechanism), as
described in paragraphs (3) and (4) established by the State. States
may permit premium variations based only on geography, tobacco use, and
family size. A State may determine to have no variation.

(3) REWARDS- A State shall permit a health insurance
issuer to provide premium discounts and other incentives to enrollees
based on the participation of such enrollees in wellness, chronic
disease management, and other programs designed to improve the health
of the enrollees.

(4) LIMITATION- A health insurance issuer shall not
consider age, gender, industry, health status, or claims experience in
determining premiums under this subsection.

(e) Application of State Mandate Laws- State benefit
mandate laws that would otherwise be applicable to HAPI plans shall be
preempted.

(f) Definition of Preventive Items or Services- In this
section, the term `preventive items or services' means clinical
activities that help prevent or detect disease, illness, or disability
and may include--

(1) immunizations and preventive physical examinations;

(2) screening tests for blood pressure, high cholesterol, diabetes, cancer, and mental illness; and

(3) other services that the Secretary determines to be
reasonable and necessary for the prevention or early detection of a
disease, illness, or disability.

(a) In General- Each HAPI plan offered through a HHA shall--

(1) provide for increased portability through
limitations on the application of preexisting condition exclusions,
consistent with that provided for under section 2701 of the Public
Health Service Act (42 U.S.C. 300gg), as such section existed on the
day before the date of enactment of this Act, except that the State
shall develop procedures to ensure that preexisting exclusion
limitations do not apply to new enrollees who had no applicable
creditable coverage immediately prior to the first enrollment period;

(2) provide for the guaranteed availability of coverage
to prospective enrollees in a manner similar to that provided for under
section 2711 of the Public Health Service Act (42 U.S.C. 300gg-11), as
such section existed on the day before the date of enactment of this
Act;

(3) provide for the guaranteed renewability of coverage
in a manner similar to that provided for under section 2712 of the
Public Health Service Act (42 U.S.C. 300gg-12), as such section existed
on the day before the date of enactment of this Act, except that the
prohibition on market reentry provided for under such section shall be
deemed to be 2 years;

(4) prohibit discrimination against individual
enrollees and prospective enrollees based on health status in a manner
similar to that provided for under section 2702 of the Public Health
Service Act (42 U.S.C. 300gg-1), as such section existed on the day
before the date of enactment of this Act;

(5) provide coverage protections for enrollees who are
mothers and newborns in a manner similar to that provided for under
section 2704 of the Public Health Service Act (42 U.S.C. 300gg-3), as
such section existed on the day before the date of enactment of this
Act;

(6) provide for full parity in the application of
certain limits to mental health benefits in a manner similar to that
provided for under section 2705 of the Public Health Service Act (42
U.S.C. 300gg-4), as such section existed on the day before the date of
enactment of this Act;

(7) provide coverage for reconstructive surgery
following a mastectomy in a manner similar to that provided for under
section 2706 of the Public Health Service Act (42 U.S.C. 300gg-5), as
such section existed on the day before the date of enactment of this
Act; and

(8) prohibit discrimination on the basis of genetic
information, as provided for under the amendments made by the Genetic
Information Nondiscrimination Act of 2008 (Public Law 110-233).

(b) Guidelines- Not later than 1 year after the date of
enactment of this Act, the Secretary shall develop guidelines for the
application of the requirements of this section.

(a) In General- The Secretary shall establish the Healthy
America Advisory Committee (referred to in this section as the
`Advisory Committee') to provide annual recommendations to the
Secretary and Congress concerning modifications to the benefits, items,
and services required under section 111(a)(1).

(b) Composition-

(1) IN GENERAL- The Advisory Committee shall be composed of 15 members to be appointed by the Comptroller General, of which--

(A) at least 1 such member shall be a health economist;

(B) at least 1 such member shall be an ethicist;

(C) at least 1 such member shall be a
representative of health care providers, including nurses and other
nonphysician providers;

(D) at least 1 such member shall be a representative of health insurance issuers;

(E) at least 1 such member shall be a health care consumer;

(F) at least 1 such member shall be a representative of the United States Preventive Services Task Force; and

(G) at least 1 such member shall be an actuary.

(2) GEOGRAPHIC BALANCE- The Comptroller General shall
ensure the geographic diversity of the members appointed under
paragraph (1).

(c) Terms, Vacancies- Members of the Advisory Committee
shall be appointed for a term of 3 years and may be reappointed for 1
additional term. In appointing members, the Comptroller General shall
stagger the terms of the initial members so that the terms of one-third
of the members expire each year. Vacancies in the membership of the
Advisory Committee shall not affect the Committee's ability to carry
out its functions. The Comptroller General shall appoint an individual
to fill the remaining term of a vacant member within 2 months of being
notified of such vacancy.

(d) Compensation and Expenses- Each member of the Advisory
Committee who is not otherwise employed by the United States Government
shall receive compensation at a rate equal to the daily rate prescribed
for GS-18 under the General Schedule under section 5332 of title 5,
United States Code, for each day, including travel time, such member is
engaged in the actual performance of duties as a member of the
Committee. A member of the Advisory Committee who is an officer or
employee of the United States Government shall serve without additional
compensation. All members of the Advisory Committee shall be reimbursed
for travel, subsistence, and other necessary expenses incurred by them
in the performance of their duties.

(e) Action by Secretary- Not later than December 31 of the
second full calendar year following the date of enactment of this Act,
and each December 31 thereafter, the Advisory Committee shall provide
to Congress and the Secretary a report that--

(1) describes any recommendations for modifications to
the benefits, items, and services that are required to be covered under
a HAPI plan; and

(2) includes any recommendations to modify HAPI plans
to improve the quality of life for United States citizens and to ensure
that benefits in such plans are medically- and cost-effective.

(f) Application of FACA- The Federal Advisory Committee Act
(5 U.S.C. App.) shall apply to the Advisory Committee, except that
section 14 of such Act shall not apply.

(a) Individuals and Families At or Below the Poverty Line-
For any calendar year, in the case of a covered individual who is
determined to have a modified adjusted gross income that is at or below
100 percent of the poverty line, as applicable to a family of the size
involved, the covered individual is entitled under this section to an
income-related premium subsidy equal to the basic premium subsidy
amount.

(b) Partial Subsidy for Other Individuals and Families-

(1) IN GENERAL- For any calendar year, in the case of a
covered individual who is determined to have a modified adjusted gross
income that is greater than 100 percent of the poverty line, as
applicable to a family of the size involved, but below the applicable
percentage of the poverty line, as applicable to a family of the size
involved, the covered individual is entitled under this section to an
income-related premium subsidy equal to the basic premium subsidy
amount reduced by the amount determined under paragraph (2).

(2) AMOUNT OF REDUCTION- The amount of the reduction
determined under this paragraph is the amount that bears the same ratio
to the basic premium subsidy amount as--

(A) the excess of--

(i) such individual's modified adjusted gross income, over

(ii) an amount equal to 100 percent of the poverty line as applicable to a family of the size involved, bears to

(B) the excess of--

(i) an amount equal to the applicable percentage of the poverty line as applicable to a family of the size involved, over

(ii) an amount equal to 100 percent of the poverty line as applicable to a family of the size involved.

(3) APPLICABLE PERCENTAGE- For purposes of this subsection, the applicable percentage is 400 percent.

(c) Basic Premium Subsidy Amount- For purposes of this
section, the term `basic premium subsidy amount' means, with respect to
any individual, the lesser of--

(1) the annual premium for the HAPI plan under which the individual is a covered individual; or

(2) the weighted average of the premium for HAPI plans
of the same class of coverage (as described in section 111(d)(1)) as
the individual's in the applicable coverage area.

(d) Change in Status Notification-

(1) IN GENERAL- If an individual's modified adjusted
income changes such that the individual becomes eligible or ineligible
for a subsidy under this section, the individual shall report that
change to the HHA of the individual's State of residence not more than
60 days after the change takes effect. If an individual reports the
change within 60 days under the preceding sentence, the individual's
HAPI plan coverage shall be deemed credible coverage for the purposes
of maintaining coverage for preexisting conditions.

(2) ADJUSTMENT- The HHA shall adjust the premium
subsidy of such individual to take effect on the first month after the
date of the notification under paragraph (1) for which the next premium
payment would be due from the individual.

(e) Catastrophic Event- A State may develop mechanisms to
ensure that covered individuals do not have a break in coverage due to
a catastrophic financial event.

(a) Full Subsidy- To meet the eligibility requirements
under subtitle B for an HHA, for any taxable year, in the case of a
covered individual who is determined to have a modified adjusted gross
income that is below 100 percent of the poverty line as applicable to a
family of the size involved, an HHA shall provide to such an individual
a subsidy equal to the full amount of any personal responsibility
contributions applicable to such individual.

(b) Partial Subsidy- To meet the eligibility requirements
under subtitle B for an HHA, for any taxable year, in the case of a
covered individual who is determined to have a modified adjusted gross
income that is at or above 100 percent of the poverty line as
applicable to a family of the size involved, an HHA may provide to such
an individual a subsidy equal to the part of the amount of any personal
responsibility contributions applicable to such individual.

(a) Determination of Modified Adjusted Gross Income-

(1) IN GENERAL- In this subtitle, the term `modified
adjusted gross income' means adjusted gross income (as defined in
section 62 of the Internal Revenue Code of 1986)--

(A) determined without regard to sections 86, 135, 137, 199, 221, 222, 911, 931, and 933 of such Code; and

(B) increased by--

(i) the amount of interest received or accrued during the taxable year which is exempt from tax under such Code; and

(ii) the amount of any social security benefits
(as defined in section 86(d) of such Code) received or accrued during
the taxable year.

(2) TAXABLE YEAR TO BE USED TO DETERMINE MODIFIED
ADJUSTED GROSS INCOME- In applying this subtitle to determine an
individual's annual premiums, the covered individual's modified
adjusted gross income shall be such income determined using the
individual's most recent income tax return or other information
furnished to the Secretary by such individual, as the Secretary may
require.

(b) Poverty Line- In this subtitle, the term `poverty line'
has the meaning given such term in section 673(2) of the Community
Health Services Block Grant Act (42 U.S.C. 9902(2)), including any
revision required by such section.

(c) Other Procedures To Determine Subsidies- The Secretary
shall promulgate regulations to be used by HHAs to calculate the
premium subsidies under section 121 and personal responsibility
subsidies under section 122 for individuals whose modified adjusted
gross income described in subsection (a)(2) is significantly lower than
the modified adjusted gross income of the year involved.

(d) Special Rule for Unlawfully Present Aliens- A health
insurance issuer shall remit to the Federal Government any funding,
including any subsidy payments, received by such issuer from the
Federal Government on behalf of any adult alien who is unlawfully
present in the United States.

(e) Special Rule for Aliens- The Secretary of Homeland
Security may not extend or renew an alien's eligibility for status in
the United States or adjust the status of an alien in the United States
if the alien owes--

(1) a premium payment for a HAPI plan that is past due; or

(2) a penalty incurred for failing to pay such a premium.

(f) No Discharge in Bankruptcy- In the case of any
bankruptcy filed by or on behalf of any person after the date that is 2
years after the date of enactment of this Act, under title 11, United
States Code, any penalty imposed with respect to such person for
failure to pay a HAPI plan premium shall not be subject to discharge
under such title.

(a) Definition- In this Act, the term `wellness program'
means a program that consists of a combination of activities that are
designed to increase awareness, assess risks, educate, and promote
voluntary behavior change to improve the health of an individual,
modify his or her consumer health behavior, enhance his or her personal
well-being and productivity, and prevent illness and injury.

(b) Discounts-

(1) ELIGIBILITY- With respect to a HAPI plan that is
offered in a State that permits premium discounts for enrollees who
participate in a wellness program, to be eligible to receive such a
discount, the administrator of the wellness program, on behalf of the
enrollee, shall certify in writing to the plan that--

(A)(i) the enrollee is participating in an approved wellness program; or

(ii) the dependent child of the enrollee is participating in an approved wellness program; and

(B) the wellness program meets the requirements of this subsection.

(2) REQUIREMENTS- A wellness program meets the requirements of this paragraph if such program--

(A) is reasonably designed (as determined by the
HAPI plan) to promote good health and prevent disease for program
participants;

(B) has been approved by the HAPI plan for purposes of applying participation discounts;

(C) is offered to all enrollees in a HAPI plan regardless of health status;

(D) permits any enrollee for whom it is
unreasonably difficult to meet the initial program standard for
participation due to a medical condition (or for whom it is medically
inadvisable to attempt) an opportunity to meet a reasonable alternative
participation standard--

(i)(I) that is developed prior to enrollment of the enrollee; or

(II) that is developed in consultation with the
enrollee after enrollment of the enrollee, after a determination has
been made that the enrollee cannot safely meet the program
participation standard; and

(ii) the availability of which is disclosed in the original documents relating to participation in the program;

(E) applies procedures for determining whether an
enrollee is participating in a meaningful manner in the program,
including procedures to determine if such participation is resulting in
lifestyle changes that are indicative of an improved health outcome or
outcomes; and

(F) meets any other requirements imposed by the HAPI plan.

(3) RELATION TO HEALTH STATUS- Participation in a
wellness program may not be used by a HAPI plan to make rate or
discount determinations with respect to the health status of an
enrollee.

(4) AVAILABILITY OF DISCOUNTS-

(A) OFFERING OF ENROLLMENT- A HAPI plan shall
provide enrollees with the opportunity to participate in a wellness
program (for purposes of qualifying for premium discounts) at least
once each year.

(B) DETERMINATIONS- Determinations with respect to
the successful participation by an enrollee in a wellness program for
purposes of qualifying for discounts shall be made by the HAPI plan
based on a retrospective review of the scope of activities of the
enrollee under the program. The HAPI plan may require a minimum level
of successful participation in such a program prior to applying any
premium discount.

(C) PARTICIPATION IN MULTIPLE PROGRAMS- An enrollee
may participate in multiple wellness programs to reach the maximum
premium discount permitted by the HAPI plan under applicable State law.

(5) PERSONAL RESPONSIBILITY CONTRIBUTION DISCOUNT- A
HAPI plan may elect to provide discounts in the amount of the personal
responsibility contribution that is required of an enrollee if the
enrollee participates in an approved wellness program.

(c) Employer Incentive for Wellness Programs- For
provisions relating to employers deducting the costs of offering
wellness programs or worksite health centers see section 162(l) of the
Internal Revenue Code of 1986.

=========

HAPI Act?

HAPI for who?

~OGD~
.

The answer is cap and trade is off the table now.