5 1 and health contracts to any employer makes avail able to such employer an accident and health con tract which provides benefits which are identical to the core benefits described in subsection (d). A per son shall not be treated as failing to meet the re quirements of this paragraph if the deductible and copayment requirements are less than those in the core benefits. "(2) OTHER REQUIREMENTS.-The requirements of paragraph (1) are not met unless "(A) the contract provides continuous fullyear open enrollment (including conversions), "(B) the premiums for coverage under the contract are determined on the basis of the av erage per capita cost of providing coverage to all individuals covered under applicable accident and health insurance contracts issued by the person issuing such contract, and "(C) individuals leaving the group covered by the contract are offered the option to convert to individual coverage at not more than 150 percent of the usually applicable community rate for the State in which the contract was is sued, without any waiting period, without re 6 gard to health, and without regard to the size of the group. "(c) GUARANTEED ISSUE. “(1) IN GENERAL.-The requirements of this subsection are met if the person offering applicable accident and health insurance contracts issues such contracts to any employer seeking to enter into such a contract. "(2) EXCEPTIONS FOR CERTAIN EMPLOYERS.— 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 "(1) CORE BENEFITS.-The term 'core benefits' means benefits which are the same benefits as are provided under title XVIII of the Social Security Act to individuals entitled to benefits under part A, and enrolled under part B, of such title. “(2) DEDUCTIBLES AND COPAYMENTS.-A plan shall not be treated as providing the core benefits described in paragraph (1) unless the following requirements are met: "(A) $500 DEDUCTIBLE PER INDIVID UAL.-The plan does not require a deductible 1 2 3 4 5 6 7 8 7 amount for any plan year in excess of $500 per individual with respect to such benefits. "(B) LIMIT ON OUT-OF-POCKET EX PENSES. The plan does not require out-of pocket expenses for any plan year in excess of $2,500 per individual for such benefits. "(C) CHILDREN. "(i) NO DEDUCTIBLES OR COINSUR ANCE. In the case of children, there shall coinsurance, deductibles, or copayments applicable to covered benefits 10 90 described in clause (ii). "(ii) ADDITIONAL PREVENTIVE BENEFITS. Subject to the periodicity schedule established with respect to the services under this clause, for children benefits shall be available under the plan for the following items and services: "(I) Newborn and well-baby care, including normal newborn care and pediatrician services for high-risk deliveries. "(II) Well-child care, including routine office visits, routine immuni zations (including the vaccine itself), 8 routine laboratory tests, and preven tive dental care. The Secretary of Health and Human Services, in consultation with the American Academy of Pediatrics, shall establish a schedule of periodicity which reflects the general, appropriate frequency with which services listed in the preceding sentence should be provided to healthy children. "(iii) CHILD DEFINED.-For purposes of this subparagraph, the term 'child' means an individual who has not attained age 23. "(D) PREGNANCY-RELATED SERVICES.— "(i) IN GENERAL.-In the case of a pregnant woman, benefits under the plan shall include entitlement to have payment made for the following, without the application of deductibles, coinsurance, or copayments, subject to the periodicity schedule established with respect to the services under clause (ii): "(I) Prenatal care, including care for all complications of pregnancy. 9 "(II) Inpatient labor and delivery services. "(III) Postnatal care. "(IV) Postnatal family planning services. "(ii) PERIODICITY SCHEDULE.—The Secretary of Health and Human Services, in consultation with the American College of Obstetrics and Gynecology, shall establish a schedule of periodicity which reflects the general, appropriate frequency with which services listed in clause (i) should be provided to pregnant women without complications of pregnancy. "(iii) PREGNANT WOMAN.-For pur poses of this subparagraph, the term 'preg nant woman' means a woman who has been certified by a physician (in a manner specified by the Secretary) as being pregnant, until the last day of the month in which the 60-day period (beginning on the date of termination of the pregnancy) ends. "(3) PREEMPTION.-No provision of State law shall apply that requires the offering, as part of an |