Page:United States Statutes at Large Volume 124.djvu/219

 124 STAT. 193 PUBLIC LAW 111–148—MAR. 23, 2010 in States that elect to opt out as provided for in subsection (a)(3)), health care coverage that provides value, choice, com- petition, and stability of affordable, high quality coverage throughout the United States. (2) COMMUNITY HEALTH INSURANCE OPTION.—In this sec- tion, the term ‘‘community health insurance option’’ means health insurance coverage that— (A) except as specifically provided for in this section, complies with the requirements for being a qualified health plan; (B) provides high value for the premium charged; (C) reduces administrative costs and promotes adminis- trative simplification for beneficiaries; (D) promotes high quality clinical care; (E) provides high quality customer service to bene- ficiaries; (F) offers a sufficient choice of providers; and (G) complies with State laws (if any), except as other- wise provided for in this title, relating to the laws described in section 1324(b). (3) ESSENTIAL HEALTH BENEFITS.— (A) GENERAL RULE.—Except as provided in subpara- graph (B), a community health insurance option offered under this section shall provide coverage only for the essen- tial health benefits described in section 1302(b). (B) STATES MAY OFFER ADDITIONAL BENEFITS.—Nothing in this section shall preclude a State from requiring that benefits in addition to the essential health benefits required under subparagraph (A) be provided to enrollees of a community health insurance option offered in such State. (C) CREDITS.— (i) IN GENERAL.—An individual enrolled in a community health insurance option under this section shall be eligible for credits under section 36B of the Internal Revenue Code of 1986 in the same manner as an individual who is enrolled in a qualified health plan. (ii) NO ADDITIONAL FEDERAL COST.—A requirement by a State under subparagraph (B) that benefits in addition to the essential health benefits required under subparagraph (A) be provided to enrollees of a commu- nity health insurance option shall not affect the amount of a premium tax credit provided under section 36B of the Internal Revenue Code of 1986 with respect to such plan. (D) STATE MUST ASSUME COST.—A State shall make payments to or on behalf of an eligible individual to defray the cost of any additional benefits described in subpara- graph (B). (E) ENSURING ACCESS TO ALL SERVICES.—Nothing in this Act shall prohibit an individual enrolled in a commu- nity health insurance option from paying out-of-pocket the full cost of any item or service not included as an essential health benefit or otherwise covered as a benefit by a health plan. Nothing in subparagraph (B) shall prohibit any type of medical provider from accepting an out-of-pocket pay- ment from an individual enrolled in a community health Payments. Definition.