PUBLIC LAW 109–171—FEB. 8, 2006
120 STAT. 91
‘‘(1) IN GENERAL.—For purposes of subsection (a)(1), each of the following coverages shall be considered to be benchmark coverage: ‘‘(A) FEHBP-EQUIVALENT HEALTH INSURANCE COVERAGE.—The standard Blue Cross/Blue Shield preferred provider option service benefit plan, described in and offered under section 8903(1) of title 5, United States Code. ‘‘(B) STATE EMPLOYEE COVERAGE.—A health benefits coverage plan that is offered and generally available to State employees in the State involved. ‘‘(C) COVERAGE OFFERED THROUGH HMO.—The health insurance coverage plan that— ‘‘(i) is offered by a health maintenance organization (as defined in section 2791(b)(3) of the Public Health Service Act), and ‘‘(ii) has the largest insured commercial, non-medicaid enrollment of covered lives of such coverage plans offered by such a health maintenance organization in the State involved. ‘‘(D) SECRETARY-APPROVED COVERAGE.—Any other health benefits coverage that the Secretary determines, upon application by a State, provides appropriate coverage for the population proposed to be provided such coverage. ‘‘(2) BENCHMARK-EQUIVALENT COVERAGE.—For purposes of subsection (a)(1), coverage that meets the following requirement shall be considered to be benchmark-equivalent coverage: ‘‘(A) INCLUSION OF BASIC SERVICES.—The coverage includes benefits for items and services within each of the following categories of basic services: ‘‘(i) Inpatient and outpatient hospital services. ‘‘(ii) Physicians’ surgical and medical services. ‘‘(iii) Laboratory and x-ray services. ‘‘(iv) Well-baby and well-child care, including ageappropriate immunizations. ‘‘(v) Other appropriate preventive services, as designated by the Secretary. ‘‘(B) AGGREGATE ACTUARIAL VALUE EQUIVALENT TO BENCHMARK PACKAGE.—The coverage has an aggregate actuarial value that is at least actuarially equivalent to one of the benchmark benefit packages described in paragraph (1). ‘‘(C) SUBSTANTIAL ACTUARIAL VALUE FOR ADDITIONAL SERVICES INCLUDED IN BENCHMARK PACKAGE.—With respect to each of the following categories of additional services for which coverage is provided under the benchmark benefit package used under subparagraph (B), the coverage has an actuarial value that is equal to at least 75 percent of the actuarial value of the coverage of that category of services in such package: ‘‘(i) Coverage of prescription drugs. ‘‘(ii) Mental health services. ‘‘(iii) Vision services. ‘‘(iv) Hearing services. ‘‘(3) DETERMINATION OF ACTUARIAL VALUE.—The actuarial value of coverage of benchmark benefit packages shall be set forth in an actuarial opinion in an actuarial report that has been prepared—
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