4

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

5

son shall not be treated as failing to meet the re

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

A B H 5

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

21

to individual coverage at not more than 150
percent of the usually applicable community

22

23

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 subsection are met if the person offering applicable

5

6

accident and health insurance contracts issues such

10

11

Paragraph (1) shall not apply to a failure to issue
a contract to an eligible employer if such employer
is unable to pay the premium for such contract.
“(d) BENEFITS.—For purposes of this section-

12

13

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

20

shall not be treated as providing the core benefits 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 individual with respect to such benefits.

2

3

“(B) LIMIT

ON

OUT-OF-POCKET

EX

4

PENSES.—The plan does not require out-of

5

pocket expenses for any plan year in excess of $2,500 per individual for such benefits.

6

7

“(C) CHILDREN.

8

“(i) No DEDUCTIBLES OR COINSUR

9

ANCE.-In the case of children, there shall

14

FITS.—Subject to the periodicity schedule established with respect to the services

6

schedule of periodicity which reflects the general, appropriate frequency with which

7

8

services listed in the preceding sentence

18

made for the following, without the application of deductibles, coinsurance,

19

or

9

of Obstetrics and Gynecology, shall establish a schedule of periodicity which reflects

10

11

the general, appropriate frequency with

12

which services listed in clause (i) should be

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

22

date of termination of the pregnancy)

23

ends.

24

"(3) PREEMPTION.—No provision of State law shall apply that requires the offering, as part of an

25