Sec. 203. Ensure plans provide comprehensive benefits
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Section 1302(b)(4) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18022(b)(4) ) is amended— in subparagraph (A), by inserting and so that benefits are included within each of such categories ; in subparagraph (G), by striking at the end and ; in subparagraph (H), by striking the period at the end and inserting ; and ; and by adding at the end the following new subparagraph: ensure that, beginning January 1, 2019— in the case of health benefits that are established as essential health benefits, there shall not be substitution of such benefits across benefit categories; a qualified health plan shall not be treated as providing coverage for the essential health benefits unless under such plan— coverage of prescription drugs provides for access to a wide variety of classes of drugs within the prescription drug formulary of such plan; and in the case that a drug that is medically necessary for an enrollee under such plan is not included within such formulary, such individual has access to such drug through an exceptions process established by the plan; and habilitative services are covered at parity with rehabilitative services. .
Section 1302(d) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18022(d) ) is amended by adding at the end the following new paragraph: For purposes of providing individuals with the opportunity to make simpler comparisons of health plans offered by different health insurance issuers and simplify the selection process, the Secretary shall, for each plan year beginning with plan year 2020, through rulemaking, specify a structure described in subparagraph (B)(i) for a standard benefit plan for such plan year for each of the bronze, silver, and gold levels of coverage and for each actuarial value variation of a silver plan resulting from the application of section 1402(c).
A standard benefit plan for a plan year for a level of coverage or actuarial value variation of a silver plan shall be modeled on the most commonly purchased plans (determined by enrollments in such plans) during the previous 2 plan years offered in the federally facilitated Exchange operated pursuant to section 1321(c) in such level or variation and shall include coverage of deductible-exempt services consistent with actual purchasing patterns of consumers in the previous two plan years.
For purposes of this paragraph, the term standard benefit plan means a qualified health plan to be offered through an Exchange on the individual market that has either— a standardized cost-sharing structure specified by the Secretary pursuant to rulemaking; or a standardized cost-sharing structure specified by the Secretary pursuant to rulemaking that is modified by the health insurance issuer of such plan only to the extent necessary to align with high deductible health plan requirements under section 223 of the Internal Revenue Code of 1986 or the applicable annual limitation on cost sharing under subsection
(c)and actuarial value requirements specified by the Secretary. .
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Sec. 203
Ensure plans provide comprehensive benefits
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