(3) A t the employee's option, an employee of an employer
member of the association with coverage under an association
health plan who terminates employment with that employer
member, and within 63 days is employed by another employer
member of the association, may remain covered under the
association health plan.
§ 4103. Association health plan coverage requirements.
Association health plan coverage shall:
(1) Be guarantee issued and guaranteed renewable.
(2) B e subject to the group market coverage requirements
under the Affordable Care Act, including, but not limited to,
the prohibition against denying coverage based on a
preexisting condition.
(3) Comply with all coverage requirements applicable to
a health insurance policy offered, issued or renewed to a
group of 51 or more employees in this Commonwealth.
(4) Provide essential health benefits, as specified in
section 1302 of the Affordable Care Act (42 U.S.C. § 18022),
as contained in the benchmark plan then currently in use in
the Pennsylvania small group market.
(5) Provide a level of coverage that is designed to
provide benefits that are actuarially equivalent to or
greater than 60% of the full actuarial value of the benefits
provided under the policy, as calculated in accordance with
the requirements of the Affordable Care Act.
§ 4104. Association health plan rate and premium requirements.
(a) Calculation.--A health insurer shall calculate rates for
an association health plan based on all of the employees who are
enrolled in coverage under the policy as a single risk pool.
(b) Same industry, trade or profession.-- In the case of an
20210HB0555PN0919 - 8 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30