Page:United States Statutes at Large Volume 124.djvu/1045

124 STAT. 1019 PUBLIC LAW 111–148—MAR. 23, 2010 ‘‘(II) with respect to all markets described in subparagraph (D)(ii)(I), a medical loss ratio of not less than 90 percent, and ‘‘(iii) with respect to annual payment dates in cal- endar years after 2011, for which the medical loss ratio (determined in a manner consistent with the determination of such ratio under section 2718(b)(1)(A) of the Public Health Service Act) with respect to all such markets for such entity for the preceding calendar year is not less than 89 percent (except that with respect to such annual payment date for 2012, the calculation under 2718(b)(1)(B)(ii) of such Act is deter- mined by reference to the previous year, and with respect to such annual payment date for 2013, such calculation is determined by reference to the average for the previous 2 years).’’. (d) CERTAIN INSURANCE EXEMPTED FROM FEE.—Paragraph (3) of section 9010(h) of this Act is amended to read as follows: ‘‘(3) HEALTH INSURANCE.—The term ‘health insurance’ shall not include— ‘‘(A) any insurance coverage described in paragraph (1)(A) or (3) of section 9832(c) of the Internal Revenue Code of 1986, ‘‘(B) any insurance for long-term care, or ‘‘(C) any medicare supplemental health insurance (as defined in section 1882(g)(1) of the Social Security Act).’’. (e) ANTI-AVOIDANCE GUIDANCE.—Subsection (i) of section 9010 of this Act is amended by inserting ‘‘and shall prescribe such regula- tions as are necessary or appropriate to prevent avoidance of the purposes of this section, including inappropriate actions taken to qualify as an exempt entity under subsection (c)(2)’’ after ‘‘section’’. (f) CONFORMING AMENDMENTS.— (1) Section 9010(a)(1) of this Act is amended by striking ‘‘2009’’ and inserting ‘‘2010’’. (2) Section 9010(c)(2)(B) of this Act is amended by striking ‘‘(except’’ and all that follows through ‘‘1323)’’. (3) Section 9010(c)(3) of this Act is amended by adding at the end the following new sentence: ‘‘If any entity described in subparagraph (C)(i)(I), (D)(i)(I), or (E)(i) of paragraph (2) is treated as a covered entity by reason of the application of the preceding sentence, the net premiums written with respect to health insurance for any United States health risk of such entity shall not be taken into account for purposes of this section.’’. (4) Section 9010(g)(1) of this Act is amended by striking ‘‘and third party administration agreement fees’’. (5) Section 9010(j) of this Act is amended— (A) by striking ‘‘2008’’ and inserting ‘‘2009’’, and (B) by striking ‘‘, and any third party administration agreement fees received after such date’’. (g) EFFECTIVE DATE.—The amendments made by this section shall take effect as if included in the enactment of section 9010.