4

the core benefits described in subsection (d). A per

5

son shall not be treated as failing to meet the re

6

quirements of this paragraph if the deductible and
copayment requirements are less than those in the

7

8

core benefits.

9

“(2) OTHER REQUIREMENTS.—The require

10

ments of paragraph (1) are not met unless

11

"(A) the contract provides continuous full

12

year open enrollment (including conversions),

13

"(B) the premiums for coverage under the

14

contract are determined on the basis of the av

15

erage per capita cost of providing coverage to
all individuals covered under applicable accident

16

17

and health insurance contracts issued by the

rate for the State in which the contract was is

24

sued, without any waiting period, without re

6

1

gard to health, and without regard to the size

4

"(1) IN GENERAL.—The requirements of this

9

“(2) EXCEPTIONS FOR CERTAIN EMPLOYERS. —

10

Paragraph (1) shall not apply to a failure to issue

11

a contract to an eligible employer if such employer

12

is unable to pay the premium for such contract.

13

“(d) BENEFITS.—For purposes of this section

14

“(1) CORE BENEFITS.—The term 'core benefits'

15

means benefits which are the same benefits as are

16

provided under title XVIII of the Social Security Act

17

to individuals entitled to benefits under part A, and

18

enrolled under part B, of such title.

19

“(2) DEDUCTIBLES AND COPAYMENTS.—A plan shall not be treated as providing the core benefits

20

21

described in paragraph (1) unless the following re

UAL.—The plan does not require a deductible

7

1

amount for any plan year in excess of $500 per

4

PENSES.—The plan does not require out-of

9

ANCE.-In the case of children, there shall

5

6

Academy of Pediatrics, shall establish a schedule of periodicity which reflects the general, appropriate frequency with which

7

8

services listed in the preceding sentence

21

22

schedule established with respect to the services under clause (ii):

“(I) Prenatal care, including care

23

24

for all complications of pregnancy.

9

10

of Obstetrics and Gynecology, shall establish a schedule of periodicity which reflects the general, appropriate frequency with

11

12

which services listed in clause (i) should be

13

provided to pregnant women without com

14

plications of pregnancy.

"(iii) PREGNANT WOMAN.–For pur

15

16

poses of this subparagraph, the term 'preg

20

nant, until the last day of the month in

21

which the 60-day period (beginning on the date of termination of the pregnancy)

22

23

ends.

24

“(3) PREEMPTION.—No provision of State law

25

shall apply that requires the offering, as part of an