republic-os/legal/us/code/title-42/chapter-157/section-18062.md

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LegalText	42 U.S.C. § 18062	Establishment of risk corridors for plans in individual and small group markets	us	united_states_code	code_section	42	THE PUBLIC HEALTH AND WELFARE	157	QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS	18062	42 U.S.C. § 18062	current	119-100	2026-06-26	official	https://uscode.house.gov/download/releasepoints/us/pl/119/100/xml_usc42@119-100.zip	/us/usc/t42/s18062	data/legal/raw/us/code/title-42/usc42.xml	76daba0455b1711cf4598944166e4fd1a66cd310290ab0cd11aa5a0f49d786ff	644321055a08eb1f260a6a3e31ac157fa024756abf612a9fd6857e7e400cf24e	fbb9f53b876fb5c8e28f19339000af87d94b8efaea114533ba564350d403f46d	2026-07-04	official	legal us-code

42 U.S.C. § 18062 - Establishment of risk corridors for plans in individual and small group markets

Text

(a) In general The Secretary shall establish and administer a program of risk corridors for calendar years 2014, 2015, and 2016 under which a qualified health plan offered in the individual or small group market shall participate in a payment adjustment system based on the ratio of the allowable costs of the plan to the plan’s aggregate premiums. Such program shall be based on the program for regional participating provider organizations under part D of title XVIII of the Social Security Act [42 U.S.C. 1395w–101 et seq.].

(b) Payment methodology (1) Payments out The Secretary shall provide under the program established under subsection (a) that if—

(A) a participating plan’s allowable costs for any plan year are more than 103 percent but not more than 108 percent of the target amount, the Secretary shall pay to the plan an amount equal to 50 percent of the target amount in excess of 103 percent of the target amount; and

(B) a participating plan’s allowable costs for any plan year are more than 108 percent of the target amount, the Secretary shall pay to the plan an amount equal to the sum of 2.5 percent of the target amount plus 80 percent of allowable costs in excess of 108 percent of the target amount.

(2) Payments in The Secretary shall provide under the program established under subsection (a) that if—

(A) a participating plan’s allowable costs for any plan year are less than 97 percent but not less than 92 percent of the target amount, the plan shall pay to the Secretary an amount equal to 50 percent of the excess of 97 percent of the target amount over the allowable costs; and

(B) a participating plan’s allowable costs for any plan year are less than 92 percent of the target amount, the plan shall pay to the Secretary an amount equal to the sum of 2.5 percent of the target amount plus 80 percent of the excess of 92 percent of the target amount over the allowable costs.

(c) Definitions In this section:

(1) Allowable costs (A) In general The amount of allowable costs of a plan for any year is an amount equal to the total costs (other than administrative costs) of the plan in providing benefits covered by the plan.

(B) Reduction for risk adjustment and reinsurance payments Allowable costs shall 11 So in original. Probably should be followed by “be”. reduced by any risk adjustment and reinsurance payments received under section 22 So in original. Probably should be “sections”. 18061 and 18063 of this title.

(2) Target amount The target amount of a plan for any year is an amount equal to the total premiums (including any premium subsidies under any governmental program), reduced by the administrative costs of the plan.

(Pub. L. 111–148, title I, § 1342, Mar. 23, 2010, 124 Stat. 211.)

Notes

Editorial Notes

References in TextThe Social Security Act, referred to in subsec. (a), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Part D of title XVIII of the Act is classified generally to part D (§ 1395w–101 et seq.) of subchapter XVIII of chapter 7 of this title. For complete classification of this Act to the Code, see section 1305 of this title and Tables.