Page:United States Statutes at Large Volume 111 Part 1.djvu/579

 PUBLIC LAW 105-33—AUG. 5, 1997 111 STAT. 555 to at least 75 percent of the actuarial value of the coverage of that category of services in such package. "(3) EXISTING COMPREHENSIVE STATE-BASED COVERAGE. — Health benefits coverage under an existing comprehensive State-based program, described in subsection (d)(1). "(4) SECRETARY-APPROVED covERAGE.Any other health benefits coverage that the Secretary determines, upon application by a State, provides appropriate coverage for the population of targeted low-income children proposed to be provided such coverage. "(b) BENCHMARK BENEFIT PACKAGES.— The benchmark benefit packages are as follows: " (1) FEHBP-EQUIVALENT CHILDREN'S 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. "(2) STATE EMPLOYEE COVERAGE. — A health benefits coverage plan that is offered and generally available to State employees in the State involved. "(3) COVERAGE OFFERED THROUGH HMO.—The health insurance coverage plan that— "(A) is offered by a health maintenance organization (as defined in section 2791(b)(3) of the Public Health Service Act), and "(B) 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. " (c) CATEGORIES OF SERVICES; DETERMINATION OF ACTUARL\L VALUE OF COVERAGE.— "(1) CATEGORIES OF BASIC SERVICES.—For purposes of this section, the categories of basic services described in this paragraph are as follows: "(A) Inpatient and outpatient hospital services. "(B) Physicians' surgical and medical services. "(C) Laboratory and x-ray services. "(D) Well-baby and well-child care, including ageappropriate immunizations. "(2) CATEGORIES OF ADDITIONAL SERVICES.— For purposes of this section, the categories of additional services described in this paragraph are as follows: "(A) Coverage of prescription drugs. "(B) Mental health services. "(C) Vision services. "(D) Hearing services. "(3) TREATMENT OF OTHER CATEGORIES.— Nothing in this subsection shall be construed as preventing a State child health plan from providing coverage of benefits that are not within a category of services described in paragraph (1) or (2). "(4) DETERMINATION OF ACTUARIAL VALUE. —The actuarial value of coverage of benchmark benefit packages, coverage offered under the State child health plan, and coverage of any categories of additional services under benchmark benefit packages and under coverage offered by such a plan, shall be set forth in an actuarial opinion in an actuarial report that has been prepared—

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