Page:United States Statutes at Large Volume 124.djvu/247

124 STAT. 221 PUBLIC LAW 111–148—MAR. 23, 2010 (b) ELIGIBLE INSURED.—In this section, the term ‘‘eligible insured’’ means an individual— (1) who enrolls in a qualified health plan in the silver level of coverage in the individual market offered through an Exchange; and (2) whose household income exceeds 100 percent but does not exceed 400 percent of the poverty line for a family of the size involved. In the case of an individual described in section 36B(c)(1)(B) of the Internal Revenue Code of 1986, the individual shall be treated as having household income equal to 100 percent for purposes of applying this section. (c) DETERMINATION OF REDUCTION IN COST-SHARING.— (1) REDUCTION IN OUT-OF-POCKET LIMIT.— (A) IN GENERAL.—The reduction in cost-sharing under this subsection shall first be achieved by reducing the applicable out-of pocket limit under section 1302(c)(1) in the case of— (i) an eligible insured whose household income is more than 100 percent but not more than 200 percent of the poverty line for a family of the size involved, by two-thirds; (ii) an eligible insured whose household income is more than 200 percent but not more than 300 per- cent of the poverty line for a family of the size involved, by one-half; and (iii) an eligible insured whose household income is more than 300 percent but not more than 400 per- cent of the poverty line for a family of the size involved, by one-third. (B) COORDINATION WITH ACTUARIAL VALUE LIMITS.— (i) IN GENERAL.—The Secretary shall ensure the reduction under this paragraph shall not result in an increase in the plan’s share of the total allowed costs of benefits provided under the plan above— (I) 90 percent in the case of an eligible insured described in paragraph (2)(A); (II) 80 percent in the case of an eligible insured described in paragraph (2)(B); and (III) 70 percent in the case of an eligible insured described in clause (ii) or (iii) of subpara- graph (A). (ii) ADJUSTMENT.—The Secretary shall adjust the out-of pocket limits under paragraph (1) if necessary to ensure that such limits do not cause the respective actuarial values to exceed the levels specified in clause (i). (2) ADDITIONAL REDUCTION FOR LOWER INCOME INSUREDS.— The Secretary shall establish procedures under which the issuer of a qualified health plan to which this section applies shall further reduce cost-sharing under the plan in a manner suffi- cient to— (A) in the case of an eligible insured whose household income is not less than 100 percent but not more than 150 percent of the poverty line for a family of the size involved, increase the plan’s share of the total allowed Procedures.