124 STAT. 904 PUBLIC LAW 111–148—MAR. 23, 2010 ‘‘(3) otherwise complies with the minimum standards pre- scribed for carriers offering health benefits plans under section 8902(e) of title 5, United States Code, to the extent that such standards do not conflict with a provision of this title; and ‘‘(4) meets such other requirements as determined appro- priate by the Director, in consultation with the Secretary. ‘‘(c) REQUIREMENTS FOR MULTI-STATE QUALIFIED HEALTH PLAN.— ‘‘(1) IN GENERAL.—A multi-State qualified health plan meets the requirements of this subsection if, in the determina- tion of the Director— ‘‘(A) the plan offers a benefits package that is uniform in each State and consists of the essential benefits described in section 1302; ‘‘(B) the plan meets all requirements of this title with respect to a qualified health plan, including requirements relating to the offering of the bronze, silver, and gold levels of coverage and catastrophic coverage in each State Exchange; ‘‘(C) except as provided in paragraph (5), the issuer provides for determinations of premiums for coverage under the plan on the basis of the rating requirements of part A of title XXVII of the Public Health Service Act; and ‘‘(D) the issuer offers the plan in all geographic regions, and in all States that have adopted adjusted community rating before the date of enactment of this Act. ‘‘(2) STATES MAY OFFER ADDITIONAL BENEFITS.—Nothing in paragraph (1)(A) shall preclude a State from requiring that benefits in addition to the essential health benefits required under such paragraph be provided to enrollees of a multi- State qualified health plan offered in such State. ‘‘(3) CREDITS.— ‘‘(A) IN GENERAL.—An individual enrolled in a multi- State qualified health plan under this section shall be eligible for credits under section 36B of the Internal Rev- enue Code of 1986 and cost sharing assistance under sec- tion 1402 in the same manner as an individual who is enrolled in a qualified health plan. ‘‘(B) NO ADDITIONAL FEDERAL COST.—A requirement by a State under paragraph (2) that benefits in addition to the essential health benefits required under paragraph (1)(A) be provided to enrollees of a multi-State qualified health plan shall not affect the amount of a premium tax credit provided under section 36B of the Internal Rev- enue Code of 1986 with respect to such plan. ‘‘(4) STATE MUST ASSUME COST.—A State shall make pay- ments— ‘‘(A) to an individual enrolled in a multi-State qualified health plan offered in such State; or ‘‘(B) on behalf of an individual described in subpara- graph (A) directly to the multi-State qualified health plan in which such individual is enrolled; to defray the cost of any additional benefits described in para- graph (2). ‘‘(5) APPLICATION OF CERTAIN STATE RATING REQUIRE- MENTS.—With respect to a multi-State qualified health plan that is offered in a State with age rating requirements that
