Page:United States Statutes at Large Volume 110 Part 3.djvu/250

 110 STAT. 1980 PUBLIC LAW 104-191—AUG. 21, 1996 "(A) are designed for, made generally available to, and actively marketed to, and enroll both eligible and other individuals by the issuer; and "(B) meet the requirement of paragraph (2) or (3), as elected by the issuer. For purposes of this subsection, policy forms which have dif- ferent cost-sharing arrangements or different riders shall be considered to be different policy forms. "(2) CHOICE OF MOST POPULAR POLICY FORMS.— The requirement of this paragraph is met, for health insurance coverage policy forms offered by an issuer in the individual market, if the issuer offers the policy forms for individual health insurance coverage with the largest, and next to largest, premium volume of all such policy forms offered by the issuer in the State or applicable marketing or service area (as may be prescribed in regulation) by the issuer in the individual market in the period involved. " (3) CHOICE OF 2 POLICY FORMS WITH REPRESENTATIVE COVERAGE.— "(A) IN GENERAL. —The requirement of this paragraph is met, for health insurance coverage policy forms offered by an issuer in the individual market, if the issuer offers a lower-level coverage policy form (as defined in subparagraph (B)) and a higher-level coverage policy form (as defined in subparagraph (O) each of which includes benefits substantially similar to other individual health insurance coverage offered by the issuer in that State and each of which is covered under a method described in section 2744(c)(3)(A) (relating to risk adjustment, risk spreading, or financial subsidization). "(B) LOWER-LEVEL OF COVERAGE DESCRIBED.—A poHcy form is described in this subparagraph if the actuarial value of the benefits under the coverage is at least 85 percent but not greater than 100 percent of a weighted average (described in subparagraph (D)). "(C) HIGHER-LEVEL OF COVERAGE DESCRIBED.— A policy form is described in this subparagraph if— "(i) the actuarial value of the benefits under the coverage is at least 15 percent greater than the actuarial value of the coverage described in subparagraph (B) offered by the issuer in the area involved; and "(ii) the actuarial value of the benefits under the coverage is at least 100 percent but not greater than 120 percent of a weighted average (described in subparagraph (D)). "(D) WEIGHTED AVERAGE.— For purposes of this paragraph, the weighted average described in this subparagraph is the average actuarial value of the benefits provided by all the health insurance coverage issued (as elected by the issuer) either by that issuer or by all issuers in the State in the individual market during the previous year (not including coverage issued under this section), weighted by enrollment for the different coverage. "(4) ELECTION.— The issuer elections under this subsection shall apply uniformly to all eligible individuals in the State for that issuer. Such an election shall be effective for policies offered during a period of not shorter than 2 years.

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