124 STAT. 207 PUBLIC LAW 111–148—MAR. 23, 2010 only if the Secretary determines that such health care choice compact— (A) will provide coverage that is at least as comprehen- sive as the coverage defined in section 1302(b) and offered through Exchanges established under this title; (B) will provide coverage and cost sharing protections against excessive out-of-pocket spending that are at least as affordable as the provisions of this title would provide; (C) will provide coverage to at least a comparable number of its residents as the provisions of this title would provide; (D) will not increase the Federal deficit; and (E) will not weaken enforcement of laws and regula- tions described in paragraph (1)(B)(i) in any State that is included in such compact. (4) EFFECTIVE DATE.—A health care choice compact described in paragraph (1) shall not take effect before January 1, 2016. (b) AUTHORITY FOR NATIONWIDE PLANS.— (1) IN GENERAL.—Except as provided in paragraph (2), if an issuer (including a group of health insurance issuers affili- ated either by common ownership and control or by the common use of a nationally licensed service mark) of a qualified health plan in the individual or small group market meets the require- ments of this subsection (in this subsection a ‘‘nationwide quali- fied health plan’’)— (A) the issuer of the plan may offer the nationwide qualified health plan in the individual or small group market in more than 1 State; and (B) with respect to State laws mandating benefit cov- erage by a health plan, only the State laws of the State in which such plan is written or issued shall apply to the nationwide qualified health plan. (2) STATE OPT-OUT.—A State may, by specific reference in a law enacted after the date of enactment of this title, provide that this subsection shall not apply to that State. Such opt-out shall be effective until such time as the State by law revokes it. (3) PLAN REQUIREMENTS.—An issuer meets the require- ments of this subsection with respect to a nationwide qualified health plan if, in the determination of the Secretary— (A) the plan offers a benefits package that is uniform in each State in which the plan is offered and meets the requirements set forth in paragraphs (4) through (6); (B) the issuer is licensed in each State in which it offers the plan and is subject to all requirements of State law not inconsistent with this section, including but not limited to, the standards and requirements that a State imposes that do not prevent the application of a require- ment of part A of title XXVII of the Public Health Service Act or a requirement of this title; (C) the issuer meets all requirements of this title with respect to a qualified health plan, including the require- ment to offer the silver and gold levels of the plan in each Exchange in the State for the market in which the plan is offered; Applicability.
