United States. Congress

“ ACCESS LIMITED TO LAWFUL RESIDENTS- If an individual is not, or is not reasonably expected to be for the entire period for which enrollment is sought, a citizen or national of the United States or an alien lawfully present in the United States, the individual shall not be treated as a qualified individual and may not be covered under a qualified health plan in the individual market that is offered through an Exchange. ”

“ STATE LAW- A State law requiring grandfathered health plans to be included in a pool described in paragraph (1) or (2) shall not apply. (d) Empowering Consumer Choice- (1) CONTINUED OPERATION OF MARKET OUTSIDE EXCHANGES- Nothing in this title shall be construed to prohibit-- (A) a health insurance issuer from offering outside of an Exchange a health plan to a qualified individual or qualified employer; and (B) a qualified individual from enrolling in, or a qualified employer from selecting for its employees, a health plan offered outside of an Exchange. ”

“ FAIR AND IMPARTIAL INFORMATION AND SERVICES- The Secretary, in collaboration with States, shall develop standards to ensure that information made available by navigators is fair, accurate, and impartial. ”

“ CONSULTATION- An Exchange shall consult with stakeholders relevant to carrying out the activities under this section, including-- (A) health care consumers who are enrollees in qualified health plans; (B) individuals and entities with experience in facilitating enrollment in qualified health plans; (C) representatives of small businesses and self-employed individuals; (D) State Medicaid offices; and (E) advocates for enrolling hard to reach populations. ”

“ Such criteria shall require that, to be certified, a plan shall, at a minimum-- (A) meet marketing requirements, and not employ marketing practices or benefit designs that have the effect of discouraging the enrollment in such plan by individuals with significant health needs; (B) ensure a sufficient choice of providers (in a manner consistent with applicable network adequacy provisions under section 2702 (c) of the Public Health Service Act) , and provide information to enrollees and prospective enrollees on the availability of in-network and out-of-network providers ”