---
kind: "section"
citation: "42 U.S.C. § 18021"
title: "42"
title_heading: "The Public Health and Welfare"
number: "18021"
heading: "Qualified health plan defined"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/18021"
units:
  - "Chapter 157 — Quality, Affordable Health Care for All Americans"
  - "Subchapter III — Available Coverage Choices for All Americans"
  - "Part A — Establishment of Qualified Health Plans"
---

# §18021. Qualified health plan defined

- (a) **Qualified health plan—** In this title:[^1]
  - (1) **In general—** The term “qualified health plan” means a [health plan](#b-1-A) that—
    - (A) has in effect a certification (which may include a seal or other indication of approval) that such plan meets the criteria for certification described in [section 18031(c) of this title](/usc/42/18031.md?p=c) issued or recognized by each Exchange through which such plan is offered;
    - (B) provides the essential health benefits package described in [section 18022(a) of this title](/usc/42/18022.md?p=a); and
    - (C) is offered by a [health insurance issuer](#b-2) that—
      - (i) is licensed and in good standing to offer [health insurance coverage](#b-2) in each [State](/usc/42/18024.md?p=d) in which such issuer offers [health insurance coverage](#b-2) under this title;[^1]
      - (ii) agrees to offer at least one [qualified health plan](#a-1) in the silver level and at least one plan in the gold level in each such Exchange;
      - (iii) agrees to charge the same premium rate for each [qualified health plan](#a-1) of the issuer without regard to whether the plan is offered through an Exchange or whether the plan is offered directly from the issuer or through an agent; and
      - (iv) complies with the regulations developed by the [Secretary](/usc/42/18024.md?p=c) under [section 18031(d) of this title](/usc/42/18031.md?p=d) and such other requirements as an applicable Exchange may establish.
  - (2) **Inclusion of CO–OP plans and multi-State qualified health plans—** Any reference in this title[^1] to a [qualified health plan](#a-1) shall be deemed to include a [qualified health plan](#a-1) offered through the CO–OP program under [section 18042 of this title](/usc/42/18042.md), and a multi-[State](/usc/42/18024.md?p=d) plan under [section 18054 of this title](/usc/42/18054.md), unless specifically provided for otherwise.
  - (3) **Treatment of qualified direct primary care medical home plans—** The [Secretary](/usc/42/18024.md?p=c) of Health and Human Services shall permit a [qualified health plan](#a-1) to provide coverage through a qualified direct primary care medical home plan that meets criteria established by the [Secretary](/usc/42/18024.md?p=c), so long as the [qualified health plan](#a-1) meets all requirements that are otherwise applicable and the services covered by the medical home plan are coordinated with the entity offering the [qualified health plan](#a-1).
  - (4) **Variation based on rating area—** A [qualified health plan](#a-1), including a multi-[State](/usc/42/18024.md?p=d) [qualified health plan](#a-1), may as appropriate vary premiums by rating area (as defined in [section 300gg(a)(2) of this title](/usc/42/300gg.md?p=a-2)).
- (b) **Terms relating to health plans—** In this title:[^1]
  - (1) **Health plan—**
    - (A) **In general—** The term “health plan” means [health insurance coverage](#b-2) and a [group health plan](#b-3).
    - (B) **Exception for self-insured plans and MEWAs—** Except to the extent specifically provided by this title,[^1] the term “[health plan](#b-1-A)” shall not include a [group health plan](#b-3) or multiple employer welfare arrangement to the extent the plan or arrangement is not subject to [State](/usc/42/18024.md?p=d) insurance regulation under [section 1144 of title 29](/usc/29/1144.md).
  - (2) **Health insurance coverage and issuer—** The terms “health insurance coverage” and “health insurance issuer” have the meanings given such terms by [section 300gg–91(b) of this title](/usc/42/300gg–91.md?p=b).
  - (3) **Group health plan—** The term “group health plan” has the meaning given such term by [section 300gg–91(a) of this title](/usc/42/300gg–91.md?p=a).

## Footnotes

[^1]: See References in Text note below.

## Source credit

(Pub. L. 111–148, title I, § 1301, title X, § 10104(a), Mar. 23, 2010, 124 Stat. 162, 896.)

## Notes

### Editorial Notes

### References in Text

This title, where footnoted in text, is title I of Pub. L. 111–148, Mar. 23, 2010, 124 Stat. 130, which enacted this chapter and enacted, amended, and transferred numerous other sections and notes in the Code. For complete classification of title I to the Code, see Tables.

### Amendments

2010—Subsec. (a)(2) to (4). Pub. L. 111–148, § 10104(a), added pars. (2) to (4) and struck out former par. (2). Prior to amendment, text of par. (2) read as follows: “Any reference in this title to a qualified health plan shall be deemed to include a qualified health plan offered through the CO-OP program under section 18042 of this title or a community health insurance option under section 18043 of this title, unless specifically provided for otherwise.”