For purposes of this part the following definitions apply:
Creditable coverage means coverage of an individual as defined in section 2701(c)(1) of the Public Health Service Act as of March 23, 2010 and 45 CFR 146.113(a)(1).
Enrollee means an individual receiving coverage from a PCIP established under this section.
Lawfully present has the meaning given the term at 45 CFR 155.20.
Out-of-pocket costs means the sum of the annual deductible and the other annual out-of-pocket expenses, other than for premiums, required to be paid under the program.
Pre-Existing condition exclusion has the meaning given such term in 45 CFR 144.103.
Pre-Existing Condition Insurance Plan (PCIP) means the temporary high risk health insurance pool plan (sometimes referred to as a “qualified high risk pool”) that provides coverage in a State, or combination of States, in accordance with the requirements of section 1101 of the Affordable Care Act and this part. The term “PCIP program” is generally used to describe the national program the Secretary is charged with carrying out, under which States or non-profit entities operate individual PCIPs.
Resident means an individual who has been legally domiciled in a State.
Service Area refers to the geographic area encompassing an entire State or States in which PCIP furnishes benefits.
State refers each of the 50 States and the District of Columbia.
[75 FR 45029, July 30, 2010, as amended at 77 FR 52616, Aug. 30, 2012; 89 FR 39436, May 8, 2024]
Notes of Decisions
Dep't of Homeland Sec. v. Regents of Univ. of Cal., 140 S. Ct. 1891 (2020).
· cites it 2× “Despite these changes, the memorandum contradictorily claimed that it "confer[red] no substantive right [or] immigration status," because "[o]nly the Congress, acting through its legislative authority, can confer these rights.”
United States v. Ruberman Ardon Chinchilla, 987 F.3d 1303 (11th Cir. 2021).
· cites it 2× “Both regulations cross-reference 45 C.F.R. § 152.2 for the definition of “lawfully present,” which provides that an alien is considered “lawfully present” when the alien has an order of supervision granting employment authorization.”
State v. Maricopa Cnty. Cmty. Coll. Dist. Bd., 416 P.3d 803 (Ariz. 2018).
“3 (a)(4)(vi) (stating that an alien "currently in deferred action status" is "lawfully present" for purposes of Social Security benefits "only"); 45 C.F.R. § 152.2 (stating that an alien "currently in deferred action status" is "[l]awfully present" for purposes of Affordable…”
Texas v. United States, 86 F. Supp. 3d 591 (S.D. Tex. 2015).
“See 45 C.F.R. § 152.2 (8). The States argue that the Obama Administration is expected to promulgate similar regulations that will also bar beneficiaries of the DAPA Directive from participating in the ACA’s employer insurance mandate.”
Arizona Dream Act Coalition v. Brewer, 945 F. Supp. 2d 1049 (D. Ariz. 2013).
“” Defendants also note that the Department of Health and Human Services (“DHHS”) has determined that DACA recipients are not “lawfully present” for purposes of health care benefits conferred on other deferred action recipients, 45 C.F.R. § 152.2 (8), and argue that this…”
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