S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5782
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 19, 2019
                                ___________
 
 Introduced  by M. of A. ROZIC -- read once and referred to the Committee
   on Insurance
 
 AN ACT to amend the insurance  law,  in  relation  to  providing  health
   insurance  protection  to  New  Yorkers  in the event that the federal
   Affordable Care Act is repealed
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. The insurance law is amended by adding a new section 3217-i
 to read as follows:
   §  3217-I.  ESSENTIAL HEALTH BENEFITS PACKAGE.  (A) COVERAGE REQUIRED.
 NO INSURER SUBJECT TO THIS ARTICLE SHALL DECLINE TO PROVIDE AN ESSENTIAL
 HEALTH BENEFITS PACKAGE AS REQUIRED BY THIS SECTION.
   (B) DEFINITION. THE TERM "ESSENTIAL HEALTH  BENEFITS  PACKAGE"  MEANS,
 WITH  RESPECT  TO ANY HEALTH PLAN, COVERAGE THAT PROVIDES FOR THE ESSEN-
 TIAL HEALTH BENEFITS AS DEFINED BY THE SUPERINTENDENT  UNDER  SUBSECTION
 (C) OF THIS SECTION; LIMITS COST-SHARING FOR SUCH COVERAGE IN ACCORDANCE
 WITH  SUBSECTION  (D)  OF THIS SECTION; AND SUBJECT TO SUBSECTION (D) OF
 THIS SECTION, PROVIDES EITHER BRONZE, SILVER, GOLD OR PLATINUM LEVEL  OF
 COVERAGE AS DESCRIBED IN SUBSECTION (E) OF THIS SECTION.
   (C)  SUPERINTENDENT'S  POWERS  AND  DUTIES  WITH  RESPECT TO ESSENTIAL
 HEALTH BENEFITS. (1) SUBJECT TO PARAGRAPH TWO OF  THIS  SUBSECTION,  THE
 SUPERINTENDENT  SHALL  DEFINE THE ESSENTIAL HEALTH BENEFITS, EXCEPT THAT
 SUCH BENEFITS SHALL INCLUDE AT LEAST THE  FOLLOWING  GENERAL  CATEGORIES
 AND THE ITEMS AND SERVICES COVERED WITHIN SUCH CATEGORIES: (I) AMBULATO-
 RY  PATIENT  SERVICES,  (II)  EMERGENCY SERVICES, (III) HOSPITALIZATION,
 (IV) MATERNITY AND NEWBORN CARE, (V) MENTAL  HEALTH  AND  SUBSTANCE  USE
 DISORDER   SERVICES,   INCLUDING   BEHAVIORAL   HEALTH  TREATMENT,  (VI)
 PRESCRIPTION DRUGS, (VII) REHABILITATIVE AND HABILITATIVE  SERVICES  AND
 DEVICES,  (VIII)  LABORATORY  SERVICES,  (IX)  PREVENTIVE  AND  WELLNESS
 SERVICES AND CHRONIC DISEASE MANAGEMENT,  AND  (X)  PEDIATRIC  SERVICES,
 INCLUDING ORAL AND VISION CARE.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD00844-01-9

 A. 5782                             2
 
   (2)  THE  SUPERINTENDENT  SHALL ENSURE THAT THE SCOPE OF THE ESSENTIAL
 HEALTH BENEFITS UNDER PARAGRAPH ONE OF THIS SUBSECTION IS EQUAL  TO  THE
 SCOPE  OF BENEFITS PROVIDED UNDER A TYPICAL EMPLOYER PLAN, AS DETERMINED
 BY THE SUPERINTENDENT. IN DEFINING THE ESSENTIAL HEALTH  BENEFITS  UNDER
 PARAGRAPH ONE OF THIS SUBSECTION, THE SUPERINTENDENT SHALL:
   (A)  ENSURE THAT SUCH ESSENTIAL HEALTH BENEFITS REFLECT AN APPROPRIATE
 BALANCE  AMONG  THE  CATEGORIES  DESCRIBED  IN  PARAGRAPH  ONE  OF  THIS
 SUBSECTION SO THAT BENEFITS ARE NOT UNDULY WEIGHTED TOWARD ANY CATEGORY;
   (B) NOT MAKE COVERAGE DECISIONS, DETERMINE REIMBURSEMENT RATES, ESTAB-
 LISH  INCENTIVE  PROGRAMS,  OR DESIGN BENEFITS IN WAYS THAT DISCRIMINATE
 AGAINST INDIVIDUALS BECAUSE OF THEIR AGE, DISABILITY, OR EXPECTED LENGTH
 OF LIFE;
   (C) TAKE INTO ACCOUNT THE HEALTH CARE NEEDS OF DIVERSE SEGMENTS OF THE
 POPULATION, INCLUDING WOMEN, CHILDREN, PERSONS  WITH  DISABILITIES,  AND
 OTHER GROUPS;
   (D)  ENSURE  THAT  HEALTH  BENEFITS  ESTABLISHED  AS  ESSENTIAL NOT BE
 SUBJECT TO DENIAL TO INDIVIDUALS AGAINST THEIR WISHES ON  THE  BASIS  OF
 THE  INDIVIDUALS'  AGE OR EXPECTED LENGTH OF LIFE OR OF THE INDIVIDUALS'
 PRESENT OR PREDICTED DISABILITY, DEGREE OF MEDICAL DEPENDENCY, OR QUALI-
 TY OF LIFE;
   (E) PROVIDE THAT A QUALIFIED HEALTH  PLAN  SHALL  NOT  BE  TREATED  AS
 PROVIDING  COVERAGE FOR THE ESSENTIAL HEALTH BENEFITS DESCRIBED IN PARA-
 GRAPH ONE OF THIS SUBSECTION UNLESS THE PLAN PROVIDES THAT:
   (I) COVERAGE FOR EMERGENCY DEPARTMENT SERVICES WILL BE PROVIDED  WITH-
 OUT  IMPOSING  ANY REQUIREMENT UNDER THE PLAN FOR PRIOR AUTHORIZATION OF
 SERVICES OR ANY LIMITATION ON COVERAGE WHERE THE  PROVIDER  OF  SERVICES
 DOES NOT HAVE A CONTRACTUAL RELATIONSHIP WITH THE PLAN FOR THE PROVIDING
 OF  SERVICES  THAT  IS MORE RESTRICTIVE THAN THE REQUIREMENTS OR LIMITA-
 TIONS THAT APPLY TO EMERGENCY DEPARTMENT SERVICES RECEIVED FROM  PROVID-
 ERS WHO DO HAVE SUCH A CONTRACTUAL RELATIONSHIP WITH THE PLAN; AND
   (II)  IF  SUCH  SERVICES ARE PROVIDED OUT-OF-NETWORK, THE COST-SHARING
 REQUIREMENT, EXPRESSED AS A COPAYMENT AMOUNT OR COINSURANCE RATE, IS THE
 SAME REQUIREMENT THAT WOULD APPLY IF SUCH SERVICES WERE PROVIDED IN-NET-
 WORK;
   (F) PROVIDE THAT IF A STAND-ALONE  DENTAL  BENEFITS  PLAN  IS  OFFERED
 THROUGH  AN  EXCHANGE, ANOTHER HEALTH PLAN OFFERED THROUGH SUCH EXCHANGE
 SHALL NOT FAIL TO BE TREATED AS A QUALIFIED HEALTH PLAN  SOLELY  BECAUSE
 THE  PLAN DOES NOT OFFER COVERAGE OF BENEFITS OFFERED THROUGH THE STAND-
 ALONE PLAN THAT ARE OTHERWISE REQUIRED UNDER SUBPARAGRAPH  (G)  OF  THIS
 PARAGRAPH; AND
   (G)  PERIODICALLY UPDATE THE ESSENTIAL HEALTH BENEFITS UNDER PARAGRAPH
 ONE OF THIS SUBSECTION TO ADDRESS ANY GAPS IN ACCESS TO COVERAGE.
   (D) COST-SHARING REQUIREMENTS. (1) THERE SHALL BE AN ANNUAL LIMITATION
 ON COST-SHARING. (A) THE COST-SHARING INCURRED UNDER A HEALTH PLAN  WITH
 RESPECT  TO SELF-ONLY COVERAGE OR COVERAGE OTHER THAN SELF-ONLY COVERAGE
 FOR A PLAN YEAR BEGINNING IN TWO THOUSAND FOURTEEN SHALL NOT EXCEED  THE
 DOLLAR  AMOUNTS IN EFFECT FOR SELF-ONLY AND FAMILY COVERAGE, RESPECTIVE-
 LY, FOR TAXABLE YEARS BEGINNING IN TWO THOUSAND FOURTEEN.
   (B) IN THE CASE OF ANY PLAN YEAR BEGINNING IN A  CALENDAR  YEAR  AFTER
 TWO THOUSAND FOURTEEN, THE LIMITATION UNDER THIS PARAGRAPH SHALL:
   (I)  IN  THE CASE OF SELF-ONLY COVERAGE, BE EQUAL TO THE DOLLAR AMOUNT
 UNDER SUBPARAGRAPH (A) OF THIS PARAGRAPH FOR SELF-ONLY COVERAGE FOR PLAN
 YEARS BEGINNING IN TWO THOUSAND FOURTEEN, INCREASED BY AN  AMOUNT  EQUAL
 TO  THE  PRODUCT  OF  THAT  AMOUNT AND THE PREMIUM ADJUSTMENT PERCENTAGE
 UNDER PARAGRAPH THREE OF THIS SUBSECTION FOR THE CALENDAR YEAR; AND

 A. 5782                             3
 
   (II) IN THE CASE OF OTHER COVERAGE, TWICE THE AMOUNT IN  EFFECT  UNDER
 CLAUSE  (I)  OF  THIS  SUBPARAGRAPH. IF THE AMOUNT OF ANY INCREASE UNDER
 CLAUSE (I) OF THIS SUBPARAGRAPH IS NOT A MULTIPLE OF FIFTY DOLLARS, SUCH
 INCREASE SHALL BE ROUNDED TO THE NEXT LOWEST MULTIPLE OF FIFTY DOLLARS.
   (2) (A) THE TERM "COST-SHARING" SHALL INCLUDE:
   (I) DEDUCTIBLES, COINSURANCE, COPAYMENTS, OR SIMILAR CHARGES; AND
   (II)  ANY OTHER EXPENDITURE REQUIRED OF AN INSURED INDIVIDUAL WHICH IS
 A QUALIFIED MEDICAL EXPENSE WITH RESPECT TO  ESSENTIAL  HEALTH  BENEFITS
 COVERED UNDER THE PLAN.
   (B)  SUCH  TERM DOES NOT INCLUDE PREMIUMS, BALANCE BILLING AMOUNTS FOR
 NON-NETWORK PROVIDERS, OR SPENDING FOR NON-COVERED SERVICES.
   (3) FOR PURPOSES OF CLAUSE (I) OF SUBPARAGRAPH (B) OF PARAGRAPH ONE OF
 THIS SUBSECTION, THE PREMIUM ADJUSTMENT PERCENTAGE FOR ANY CALENDAR YEAR
 IS THE PERCENTAGE, IF ANY, BY WHICH THE AVERAGE PER CAPITA  PREMIUM  FOR
 HEALTH  INSURANCE COVERAGE IN THE UNITED STATES FOR THE PRECEDING CALEN-
 DAR YEAR EXCEEDS SUCH AVERAGE PER CAPITA PREMIUM FOR THE YEAR TWO  THOU-
 SAND THIRTEEN.
   (E)  LEVELS  OF  COVERAGE.  (1)  LEVELS  OF COVERAGE DESCRIBED IN THIS
 SUBSECTION ARE AS FOLLOWS:
   (A) BRONZE LEVEL. A PLAN IN THE BRONZE LEVEL SHALL PROVIDE A LEVEL  OF
 COVERAGE  THAT  IS  DESIGNED  TO  PROVIDE  BENEFITS THAT ARE ACTUARIALLY
 EQUIVALENT TO SIXTY PERCENT OF THE FULL ACTUARIAL VALUE OF THE  BENEFITS
 PROVIDED UNDER THE PLAN.
   (B)  SILVER LEVEL. A PLAN IN THE SILVER LEVEL SHALL PROVIDE A LEVEL OF
 COVERAGE THAT IS DESIGNED  TO  PROVIDE  BENEFITS  THAT  ARE  ACTUARIALLY
 EQUIVALENT  TO  SEVENTY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENE-
 FITS PROVIDED UNDER THE PLAN.
   (C) GOLD LEVEL. A PLAN IN THE GOLD LEVEL  SHALL  PROVIDE  A  LEVEL  OF
 COVERAGE  THAT  IS  DESIGNED  TO  PROVIDE  BENEFITS THAT ARE ACTUARIALLY
 EQUIVALENT TO EIGHTY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENEFITS
 PROVIDED UNDER THE PLAN.
   (D) PLATINUM LEVEL. A PLAN IN THE PLATINUM LEVEL SHALL PROVIDE A LEVEL
 OF COVERAGE THAT IS DESIGNED TO PROVIDE BENEFITS  THAT  ARE  ACTUARIALLY
 EQUIVALENT TO NINETY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENEFITS
 PROVIDED UNDER THE PLAN.
   (2)  (A)  ACTUARIAL VALUE. UNDER REGULATIONS ISSUED BY THE SUPERINTEN-
 DENT, THE LEVEL OF COVERAGE OF A PLAN SHALL BE DETERMINED ON  THE  BASIS
 THAT  THE  ESSENTIAL HEALTH BENEFITS DESCRIBED IN SUBSECTION (C) OF THIS
 SECTION SHALL BE PROVIDED TO A STANDARD POPULATION AND WITHOUT REGARD TO
 THE POPULATION THE PLAN MAY ACTUALLY PROVIDE BENEFITS TO.
   (B) EMPLOYER CONTRIBUTIONS. THE SUPERINTENDENT SHALL ISSUE REGULATIONS
 UNDER WHICH EMPLOYER CONTRIBUTIONS TO A HEALTH SAVINGS  ACCOUNT  MAY  BE
 TAKEN INTO ACCOUNT.
   §  2.  The  insurance law is amended by adding a new section 4306-h to
 read as follows:
   § 4306-H. ESSENTIAL HEALTH BENEFITS PACKAGE. (A) COVERAGE REQUIRED. NO
 CORPORATION SUBJECT TO THIS ARTICLE SHALL DECLINE TO PROVIDE  AN  ESSEN-
 TIAL HEALTH BENEFITS PACKAGE AS REQUIRED BY THIS SECTION.
   (B)  DEFINITION.  THE  TERM "ESSENTIAL HEALTH BENEFITS PACKAGE" MEANS,
 WITH RESPECT TO ANY HEALTH PLAN, COVERAGE THAT PROVIDES FOR  THE  ESSEN-
 TIAL  HEALTH  BENEFITS AS DEFINED BY THE SUPERINTENDENT UNDER SUBSECTION
 (C) OF THIS SECTION; LIMITS COST-SHARING FOR SUCH COVERAGE IN ACCORDANCE
 WITH SUBSECTION (D) OF THIS SECTION; AND SUBJECT TO  SUBSECTION  (D)  OF
 THIS  SECTION, PROVIDES EITHER BRONZE, SILVER, GOLD OR PLATINUM LEVEL OF
 COVERAGE AS DESCRIBED IN SUBSECTION (E) OF THIS SECTION.

 A. 5782                             4
 
   (C) SUPERINTENDENT'S POWERS  AND  DUTIES  WITH  RESPECT  TO  ESSENTIAL
 HEALTH  BENEFITS.  (1)  SUBJECT TO PARAGRAPH TWO OF THIS SUBSECTION, THE
 SUPERINTENDENT SHALL DEFINE THE ESSENTIAL HEALTH BENEFITS,  EXCEPT  THAT
 SUCH  BENEFITS  SHALL  INCLUDE AT LEAST THE FOLLOWING GENERAL CATEGORIES
 AND THE ITEMS AND SERVICES COVERED WITHIN SUCH CATEGORIES: (I) AMBULATO-
 RY  PATIENT  SERVICES,  (II)  EMERGENCY SERVICES, (III) HOSPITALIZATION,
 (IV) MATERNITY AND NEWBORN CARE, (V) MENTAL  HEALTH  AND  SUBSTANCE  USE
 DISORDER   SERVICES,   INCLUDING   BEHAVIORAL   HEALTH  TREATMENT,  (VI)
 PRESCRIPTION DRUGS, (VII) REHABILITATIVE AND HABILITATIVE  SERVICES  AND
 DEVICES,  (VIII)  LABORATORY  SERVICES,  (IX)  PREVENTIVE  AND  WELLNESS
 SERVICES AND CHRONIC DISEASE MANAGEMENT,  AND  (X)  PEDIATRIC  SERVICES,
 INCLUDING ORAL AND VISION CARE.
   (2)  THE  SUPERINTENDENT  SHALL ENSURE THAT THE SCOPE OF THE ESSENTIAL
 HEALTH BENEFITS UNDER PARAGRAPH ONE OF THIS SUBSECTION IS EQUAL  TO  THE
 SCOPE  OF BENEFITS PROVIDED UNDER A TYPICAL EMPLOYER PLAN, AS DETERMINED
 BY THE SUPERINTENDENT. IN DEFINING THE ESSENTIAL HEALTH  BENEFITS  UNDER
 PARAGRAPH ONE OF THIS SUBSECTION, THE SUPERINTENDENT SHALL:
   (A)  ENSURE THAT SUCH ESSENTIAL HEALTH BENEFITS REFLECT AN APPROPRIATE
 BALANCE  AMONG  THE  CATEGORIES  DESCRIBED  IN  PARAGRAPH  ONE  OF  THIS
 SUBSECTION SO THAT BENEFITS ARE NOT UNDULY WEIGHTED TOWARD ANY CATEGORY;
   (B) NOT MAKE COVERAGE DECISIONS, DETERMINE REIMBURSEMENT RATES, ESTAB-
 LISH  INCENTIVE  PROGRAMS,  OR DESIGN BENEFITS IN WAYS THAT DISCRIMINATE
 AGAINST INDIVIDUALS BECAUSE OF THEIR AGE, DISABILITY, OR EXPECTED LENGTH
 OF LIFE;
   (C) TAKE INTO ACCOUNT THE HEALTH CARE NEEDS OF DIVERSE SEGMENTS OF THE
 POPULATION, INCLUDING WOMEN, CHILDREN, PERSONS  WITH  DISABILITIES,  AND
 OTHER GROUPS;
   (D)  ENSURE  THAT  HEALTH  BENEFITS  ESTABLISHED  AS  ESSENTIAL NOT BE
 SUBJECT TO DENIAL TO INDIVIDUALS AGAINST THEIR WISHES ON  THE  BASIS  OF
 THE  INDIVIDUALS'  AGE OR EXPECTED LENGTH OF LIFE OR OF THE INDIVIDUALS'
 PRESENT OR PREDICTED DISABILITY, DEGREE OF MEDICAL DEPENDENCY, OR QUALI-
 TY OF LIFE;
   (E) PROVIDE THAT A QUALIFIED HEALTH  PLAN  SHALL  NOT  BE  TREATED  AS
 PROVIDING  COVERAGE FOR THE ESSENTIAL HEALTH BENEFITS DESCRIBED IN PARA-
 GRAPH ONE OF THIS SUBSECTION UNLESS THE PLAN PROVIDES THAT:
   (I) COVERAGE FOR EMERGENCY DEPARTMENT SERVICES WILL BE PROVIDED  WITH-
 OUT  IMPOSING  ANY REQUIREMENT UNDER THE PLAN FOR PRIOR AUTHORIZATION OF
 SERVICES OR ANY LIMITATION ON COVERAGE WHERE THE  PROVIDER  OF  SERVICES
 DOES NOT HAVE A CONTRACTUAL RELATIONSHIP WITH THE PLAN FOR THE PROVIDING
 OF  SERVICES  THAT  IS MORE RESTRICTIVE THAN THE REQUIREMENTS OR LIMITA-
 TIONS THAT APPLY TO EMERGENCY DEPARTMENT SERVICES RECEIVED FROM  PROVID-
 ERS WHO DO HAVE SUCH A CONTRACTUAL RELATIONSHIP WITH THE PLAN; AND
   (II)  IF  SUCH  SERVICES ARE PROVIDED OUT-OF-NETWORK, THE COST-SHARING
 REQUIREMENT, EXPRESSED AS A COPAYMENT AMOUNT OR COINSURANCE RATE, IS THE
 SAME REQUIREMENT THAT WOULD APPLY IF SUCH SERVICES WERE PROVIDED IN-NET-
 WORK;
   (F) PROVIDE THAT IF A STAND-ALONE  DENTAL  BENEFITS  PLAN  IS  OFFERED
 THROUGH  AN  EXCHANGE, ANOTHER HEALTH PLAN OFFERED THROUGH SUCH EXCHANGE
 SHALL NOT FAIL TO BE TREATED AS A QUALIFIED HEALTH PLAN  SOLELY  BECAUSE
 THE  PLAN DOES NOT OFFER COVERAGE OF BENEFITS OFFERED THROUGH THE STAND-
 ALONE PLAN THAT ARE OTHERWISE REQUIRED UNDER SUBPARAGRAPH  (G)  OF  THIS
 PARAGRAPH; AND
   (G)  PERIODICALLY UPDATE THE ESSENTIAL HEALTH BENEFITS UNDER PARAGRAPH
 ONE OF THIS SUBSECTION TO ADDRESS ANY GAPS IN ACCESS TO COVERAGE.
   (D) COST-SHARING REQUIREMENTS. (1) THERE SHALL BE AN ANNUAL LIMITATION
 ON COST-SHARING. (A) THE COST-SHARING INCURRED UNDER A HEALTH PLAN  WITH

 A. 5782                             5

 RESPECT  TO SELF-ONLY COVERAGE OR COVERAGE OTHER THAN SELF-ONLY COVERAGE
 FOR A PLAN YEAR BEGINNING IN TWO THOUSAND FOURTEEN SHALL NOT EXCEED  THE
 DOLLAR  AMOUNTS IN EFFECT FOR SELF-ONLY AND FAMILY COVERAGE, RESPECTIVE-
 LY, FOR TAXABLE YEARS BEGINNING IN TWO THOUSAND FOURTEEN.
   (B)  IN  THE  CASE OF ANY PLAN YEAR BEGINNING IN A CALENDAR YEAR AFTER
 TWO THOUSAND FOURTEEN, THE LIMITATION UNDER THIS PARAGRAPH SHALL:
   (I) IN THE CASE OF SELF-ONLY COVERAGE, BE EQUAL TO THE  DOLLAR  AMOUNT
 UNDER SUBPARAGRAPH (A) OF THIS PARAGRAPH FOR SELF-ONLY COVERAGE FOR PLAN
 YEARS  BEGINNING  IN TWO THOUSAND FOURTEEN, INCREASED BY AN AMOUNT EQUAL
 TO THE PRODUCT OF THAT AMOUNT  AND  THE  PREMIUM  ADJUSTMENT  PERCENTAGE
 UNDER PARAGRAPH THREE OF THIS SUBSECTION FOR THE CALENDAR YEAR; AND
   (II)  IN  THE CASE OF OTHER COVERAGE, TWICE THE AMOUNT IN EFFECT UNDER
 CLAUSE (I) OF THIS SUBPARAGRAPH. IF THE AMOUNT  OF  ANY  INCREASE  UNDER
 CLAUSE (I) OF THIS SUBPARAGRAPH IS NOT A MULTIPLE OF FIFTY DOLLARS, SUCH
 INCREASE SHALL BE ROUNDED TO THE NEXT LOWEST MULTIPLE OF FIFTY DOLLARS.
   (2) (A) THE TERM "COST-SHARING" SHALL INCLUDE:
   (I) DEDUCTIBLES, COINSURANCE, COPAYMENTS, OR SIMILAR CHARGES; AND
   (II)  ANY OTHER EXPENDITURE REQUIRED OF AN INSURED INDIVIDUAL WHICH IS
 A QUALIFIED MEDICAL EXPENSE WITH RESPECT TO  ESSENTIAL  HEALTH  BENEFITS
 COVERED UNDER THE PLAN.
   (B)  SUCH  TERM DOES NOT INCLUDE PREMIUMS, BALANCE BILLING AMOUNTS FOR
 NON-NETWORK PROVIDERS, OR SPENDING FOR NON-COVERED SERVICES.
   (3) FOR PURPOSES OF CLAUSE (I) OF SUBPARAGRAPH (B) OF PARAGRAPH ONE OF
 THIS SUBSECTION, THE PREMIUM ADJUSTMENT PERCENTAGE FOR ANY CALENDAR YEAR
 IS THE PERCENTAGE, IF ANY, BY WHICH THE AVERAGE PER CAPITA  PREMIUM  FOR
 HEALTH  INSURANCE COVERAGE IN THE UNITED STATES FOR THE PRECEDING CALEN-
 DAR YEAR EXCEEDS SUCH AVERAGE PER CAPITA PREMIUM FOR THE YEAR TWO  THOU-
 SAND THIRTEEN.
   (E)  LEVELS  OF  COVERAGE.  (1)  LEVELS  OF COVERAGE DESCRIBED IN THIS
 SUBSECTION ARE AS FOLLOWS:
   (A) BRONZE LEVEL. A PLAN IN THE BRONZE LEVEL SHALL PROVIDE A LEVEL  OF
 COVERAGE  THAT  IS  DESIGNED  TO  PROVIDE  BENEFITS THAT ARE ACTUARIALLY
 EQUIVALENT TO SIXTY PERCENT OF THE FULL ACTUARIAL VALUE OF THE  BENEFITS
 PROVIDED UNDER THE PLAN.
   (B)  SILVER LEVEL. A PLAN IN THE SILVER LEVEL SHALL PROVIDE A LEVEL OF
 COVERAGE THAT IS DESIGNED  TO  PROVIDE  BENEFITS  THAT  ARE  ACTUARIALLY
 EQUIVALENT  TO  SEVENTY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENE-
 FITS PROVIDED UNDER THE PLAN.
   (C) GOLD LEVEL. A PLAN IN THE GOLD LEVEL  SHALL  PROVIDE  A  LEVEL  OF
 COVERAGE  THAT  IS  DESIGNED  TO  PROVIDE  BENEFITS THAT ARE ACTUARIALLY
 EQUIVALENT TO EIGHTY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENEFITS
 PROVIDED UNDER THE PLAN.
   (D) PLATINUM LEVEL. A PLAN IN THE PLATINUM LEVEL SHALL PROVIDE A LEVEL
 OF COVERAGE THAT IS DESIGNED TO PROVIDE BENEFITS  THAT  ARE  ACTUARIALLY
 EQUIVALENT TO NINETY PERCENT OF THE FULL ACTUARIAL VALUE OF THE BENEFITS
 PROVIDED UNDER THE PLAN.
   (2)  (A)  ACTUARIAL VALUE. UNDER REGULATIONS ISSUED BY THE SUPERINTEN-
 DENT, THE LEVEL OF COVERAGE OF A PLAN SHALL BE DETERMINED ON  THE  BASIS
 THAT  THE  ESSENTIAL HEALTH BENEFITS DESCRIBED IN SUBSECTION (C) OF THIS
 SECTION SHALL BE PROVIDED TO A STANDARD POPULATION AND WITHOUT REGARD TO
 THE POPULATION THE PLAN MAY ACTUALLY PROVIDE BENEFITS TO.
   (B) EMPLOYER CONTRIBUTIONS. THE SUPERINTENDENT SHALL ISSUE REGULATIONS
 UNDER WHICH EMPLOYER CONTRIBUTIONS TO A HEALTH SAVINGS  ACCOUNT  MAY  BE
 TAKEN INTO ACCOUNT.
   §  3.  Subsection (e) of section 3217-f of the insurance law, as added
 by chapter 219 of the laws of 2011, is amended to read as follows:

 A. 5782                             6
 
   (e) For purposes of this section, "essential  health  benefits"  shall
 have  the  SAME  meaning  [ascribed by section 1302(b) of the Affordable
 Care Act, 42 U.S.C. § 18022(b)] AS SUBSECTION (C) OF SECTION THREE THOU-
 SAND TWO HUNDRED SEVENTEEN-I OF THIS ARTICLE.
   § 4. Subsection (h) and paragraph 19 of subsection (k) of section 3221
 of the insurance law, subsection (h) as added by section 54 of part D of
 chapter  56  of  the  laws of 2013 and paragraph 19 of subsection (k) as
 amended by chapter 377 of the laws of  2014,  are  amended  to  read  as
 follows:
   (h)  Every small group policy or association group policy delivered or
 issued for delivery in this state that provides coverage  for  hospital,
 medical  or surgical expense insurance and is not a grandfathered health
 plan shall provide coverage for the essential health benefit package  as
 required in section [2707(a) of the public health service act, 42 U.S.C.
 §  300gg-6(a)]  THREE  THOUSAND TWO HUNDRED SEVENTEEN-I OF THIS ARTICLE.
 For purposes of this subsection:
   (1) "essential health benefits package" shall  have  the  meaning  set
 forth  in  [section  1302(a)  of  the  affordable  care act, 42 U.S.C. §
 18022(a)] SUBSECTION (C) OF SECTION THREE THOUSAND  TWO  HUNDRED  SEVEN-
 TEEN-I OF THIS ARTICLE;
   (2)  "grandfathered health plan" means coverage provided by an insurer
 in which an individual was enrolled on March twenty-third, two  thousand
 ten  for  as  long  as  the  coverage maintains grandfathered status [in
 accordance with section 1251(e) of the affordable care act, 42 U.S.C.  §
 18011(e)];
   (3) "small group" means a group of fifty or fewer employees or members
 exclusive  of  spouses and dependents; provided, however, that beginning
 January first, two thousand sixteen, "small group" means a group of  one
 hundred  or  fewer  employees or members exclusive of spouses and depen-
 dents; and
   (4) "association group" means a group defined  in  subparagraphs  (B),
 (D),  (H), (K), (L) or (M) of paragraph one of subsection (c) of section
 four thousand two hundred thirty-five of this chapter, provided that:
   (A) the group includes one or more individual members; or
   (B) the group includes one or more member employers  or  other  member
 groups that are small groups.
   (19)  Every  group  or  blanket  accident  and health insurance policy
 delivered or issued for delivery in this state  which  provides  medical
 coverage  that includes coverage for physician services in a physician's
 office and every policy which provides major medical or similar  compre-
 hensive-type  coverage shall include coverage for equipment and supplies
 used for the treatment of ostomies, if  prescribed  by  a  physician  or
 other  licensed  health  care  provider  legally authorized to prescribe
 under title eight of the education law. Such coverage shall  be  subject
 to  annual  deductibles  and  coinsurance  as  deemed appropriate by the
 superintendent. The coverage required by this paragraph shall be identi-
 cal to, and shall not enhance or increase the coverage required as  part
 of  essential  health benefits [as required pursuant to section 2707 (a)
 of the public health services act 42 U.S.C. 300 gg-6(a)]  SET  FORTH  IN
 SECTION THREE THOUSAND TWO HUNDRED SEVENTEEN-I OF THIS ARTICLE.
   §  5. Subsection (d) of section 3240 of the insurance law, as added by
 section 41 of part D of chapter 56 of the laws of 2013,  is  amended  to
 read as follows:
   (d)  A  student accident and health insurance policy or contract shall
 provide coverage for essential health benefits as  defined  in  [section

 A. 5782                             7

 1302(b) of the affordable care act, 42 U.S.C. § 18022(b)] SUBSECTION (C)
 OF SECTION THREE THOUSAND TWO HUNDRED SEVENTEEN-I OF THIS ARTICLE.
   § 6. Subsection (u-1) of section 4303 of the insurance law, as amended
 by chapter 377 of the laws of 2014, is amended to read as follows:
   (u-1)  A  medical  expense  indemnity  corporation or a health service
 corporation which provides medical coverage that includes  coverage  for
 physician  services  in  a  physician's  office  and  every policy which
 provides major medical  or  similar  comprehensive-type  coverage  shall
 include  coverage  for  equipment and supplies used for the treatment of
 ostomies, if prescribed by a physician or  other  licensed  health  care
 provider legally authorized to prescribe under title eight of the educa-
 tion law. Such coverage shall be subject to annual deductibles and coin-
 surance  as  deemed  appropriate  by  the  superintendent.  The coverage
 required by this subsection shall be identical to, and shall not enhance
 or increase the coverage required as part of essential  health  benefits
 as  required  pursuant to section [2707(a) of the public health services
 act 42 U.S.C. 300 gg-6(a)] FOUR THOUSAND THREE  HUNDRED  SIX-H  OF  THIS
 ARTICLE.
   §  7.  Subsection (e) of section 4306-e of the insurance law, as added
 by chapter 219 of the laws of 2011, is amended to read as follows:
   (e) For purposes of this section, "essential  health  benefits"  shall
 have  the  meaning  ascribed  by [section 1302(b) of the Affordable Care
 Act, 42 U.S.C. § 18022(b)] SUBSECTION (C) OF SECTION FOUR THOUSAND THREE
 HUNDRED SIX-H OF THIS ARTICLE.
   § 8. Subsections (d) and (e) of section 4326 of the insurance law,  as
 amended  by  section 56 of part D of chapter 56 of the laws of 2013, are
 amended to read as follows:
   (d) A qualifying group health insurance contract shall provide  cover-
 age  for  the  essential  health benefit package as required [in section
 2707(a) of the public health service act, 42  U.S.C.  §  300gg-6(a)]  BY
 SECTION  FOUR THOUSAND THREE HUNDRED SIX-H OF THIS ARTICLE. For purposes
 of this subsection "essential health benefits package"  shall  have  the
 meaning  set  forth  in  [section 1302(a) of the affordable care act, 42
 U.S.C. § 18022(a)] SUBSECTION (C) OF SECTION FOUR THOUSAND THREE HUNDRED
 SIX-H OF THIS ARTICLE.
   (e) A qualifying group health insurance contract issued to a  qualify-
 ing  small  employer  prior to January first, two thousand fourteen that
 does not include all essential  health  benefits  required  pursuant  to
 section  [2707(a)  of  the  public  health  service  act,  42  U.S.C.  §
 300gg-6(a)] FOUR THOUSAND THREE HUNDRED SIX-H OF THIS ARTICLE, shall  be
 discontinued,  including grandfathered health plans. For the purposes of
 this paragraph, "grandfathered health plans" means coverage provided  by
 a  corporation  to  individuals who were enrolled on March twenty-third,
 two thousand ten for as long as  the  coverage  maintains  grandfathered
 status  [in  accordance with section 1251(e) of the affordable care act,
 42 U.S.C. § 18011(e)]. A qualifying small employer shall be transitioned
 to a plan that provides: (1) a level of coverage  that  is  designed  to
 provide  benefits  that  are actuarially equivalent to eighty percent of
 the full actuarial value of the benefits provided under  the  plan;  and
 (2)  coverage  for  the  essential health benefit package as required in
 section  [2707(a)  of  the  public  health  service  act,  42  U.S.C.  §
 300gg-6(a)]  FOUR  THOUSAND  THREE  HUNDRED  SIX-H  OF THIS ARTICLE. The
 superintendent shall standardize the benefit package  and  cost  sharing
 requirements  of  qualified  group health insurance contracts consistent
 with coverage offered through the health benefit  exchange  [established
 pursuant to section 1311 of the affordable care act, 42 U.S.C. § 18031].

 A. 5782                             8
 
   §  9.  Paragraph  1 of subsection (b) of section 4328 of the insurance
 law, as added by section 46 of part D of chapter 56 of the laws of 2013,
 is amended to read as follows:
   (1)  The  individual enrollee direct payment contract offered pursuant
 to this section shall provide coverage for the essential health  benefit
 package  as  required  in  section [2707(a) of the public health service
 act, 42 U.S.C. § 300gg-6(a)] FOUR THOUSAND THREE HUNDRED SIX-H  OF  THIS
 ARTICLE.  For  purposes  of  this  paragraph, "essential health benefits
 package" shall have the meaning set forth in  [section  1302(a)  of  the
 affordable  care  act, 42 U.S.C.   § 18022(a)] SUBSECTION (C) OF SECTION
 FOUR THOUSAND THREE HUNDRED SIX-H OF THIS ARTICLE.
   § 10. Subsections (f) and (g) of section 3232 of the insurance law, as
 added by chapter 219 of  the  laws  of  2011,  are  amended  and  a  new
 subsection (j) is added to read as follows:
   (f)  With  respect to an individual under age nineteen, an insurer may
 not impose any pre-existing condition  exclusion  in  an  individual  or
 group policy of hospital, medical, surgical or prescription drug expense
 insurance  [pursuant  to  the requirements of section 2704 of the Public
 Health Service Act, 42 U.S.C. § 300gg-3, as made  effective  by  section
 1255(2)  of the Affordable Care Act,] except for an individual under age
 nineteen covered under an individual policy of hospital, medical, surgi-
 cal or prescription drug  expense  insurance  that  is  a  grandfathered
 health plan.
   (g)  Beginning  January  first,  two  thousand  fourteen[, pursuant to
 section 2704 of the Public Health Service Act, 42 U.S.C. § 300gg-3,]  an
 insurer  may not impose any pre-existing condition exclusion in an indi-
 vidual or group policy of hospital, medical,  surgical  or  prescription
 drug expense insurance except in an individual policy that is a grandfa-
 thered health plan.
   (J)  FOR PURPOSES OF SUBSECTIONS (F) AND (G) OF THIS SECTION, "PRE-EX-
 ISTING CONDITION" SHALL MEAN  A  LIMITATION  OR  EXCLUSION  OF  BENEFITS
 RELATING TO A CONDITION BASED ON THE FACT THAT THE CONDITION WAS PRESENT
 BEFORE  THE  DATE  OF  ENROLLMENT  FOR SUCH COVERAGE, WHETHER OR NOT ANY
 MEDICAL  ADVICE,  DIAGNOSIS,  CARE,  OR  TREATMENT  WAS  RECOMMENDED  OR
 RECEIVED BEFORE SUCH DATE.
   § 11. Subsections (f) and (g) of section 4318 of the insurance law, as
 added  by  chapter  219  of  the  laws  of  2011,  are amended and a new
 subsection (j) is added to read as follows:
   (f) With respect to an individual under age  nineteen,  a  corporation
 may  not impose any pre-existing condition exclusion in an individual or
 group contract of  hospital,  medical,  surgical  or  prescription  drug
 expense  insurance  pursuant to the requirements of section [2704 of the
 Public Health Service Act, 42 U.S.C. § 300gg-3,  as  made  effective  by
 section  1255(2) of the Affordable Care Act] FOUR THOUSAND THREE HUNDRED
 SIX-H OF THIS ARTICLE, except  for  an  individual  under  age  nineteen
 covered  under  an individual contract of hospital, medical, surgical or
 prescription drug expense insurance that is a grandfathered health plan.
   (g) Beginning  January  first,  two  thousand  fourteen,  pursuant  to
 section  [2704  of  the  Public Health Service Act, 42 U.S.C. § 300gg-3]
 FOUR THOUSAND THREE HUNDRED SIX-H OF THIS ARTICLE, a corporation may not
 impose any pre-existing condition exclusion in an  individual  or  group
 contract  of  hospital,  medical,  surgical or prescription drug expense
 insurance except in an  individual  contract  that  is  a  grandfathered
 health plan.
   (J)  FOR PURPOSES OF SUBSECTIONS (F) AND (G) OF THIS SECTION, "PRE-EX-
 ISTING EXCLUSION" SHALL MEAN  A  LIMITATION  OR  EXCLUSION  OF  BENEFITS

 A. 5782                             9
 
 RELATING TO A CONDITION BASED ON THE FACT THAT THE CONDITION WAS PRESENT
 BEFORE  THE  DATE  OF  ENROLLMENT  FOR SUCH COVERAGE, WHETHER OR NOT ANY
 MEDICAL  ADVICE,  DIAGNOSIS,  CARE,  OR  TREATMENT  WAS  RECOMMENDED  OR
 RECEIVED BEFORE SUCH DATE.
   §  12.  This act shall take effect on such date as the affordable care
 act is fully repealed and at such time as the provisions of such act are
 no longer in force and  effect;  provided  that  the  superintendent  of
 financial services shall notify the legislative bill drafting commission
 upon  the occurrence of the repeal of the federal Affordable Care Act in
 order that the commission may maintain an accurate and timely  effective
 data  base  of the official text of the laws of the state of New York in
 furtherance of effectuating the provisions of section 44 of the legisla-
 tive law and section 70-b of the public officers law.