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.

SEC. 103. GUARANTEEING YOU CAN KEEP THE COVERAGE YOU HAVE.

(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.

SEC. 104. COORDINATION OF SUPPLEMENTAL COVERAGE UNDER THE MEDICAID PROGRAM TO HAPI PLAN COVERAGE FOR NONDISABLED, NONELDERLY ADULT INDIVIDUALS.

(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.

Subtitle B--Standards for Healthy Americans Private Insurance Coverage

SEC. 111. HEALTHY AMERICANS PRIVATE INSURANCE PLANS.

(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.

SEC. 112. SPECIFIC COVERAGE REQUIREMENTS.

(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.

SEC. 113. UPDATING HEALTHY AMERICANS PRIVATE INSURANCE PLAN REQUIREMENTS.

(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.

Subtitle C--Eligibility for Premium and Personal Responsibility Contribution Subsidies

SEC. 121. ELIGIBILITY FOR PREMIUM SUBSIDIES.

(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.

SEC. 122. ELIGIBILITY FOR PERSONAL RESPONSIBILITY CONTRIBUTION SUBSIDIES.

(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.

SEC. 123. DEFINITIONS AND SPECIAL RULES.

(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.

Subtitle D--Wellness Programs

SEC. 131. REQUIREMENTS FOR WELLNESS PROGRAMS.

(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.