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42 U.S.C. § 300gg–6 — Comprehensive health insurance coverage
Federal law — U.S. Code and appendices · legal_authorities
**(a) Coverage for essential health benefits package** A health insurance issuer that offers health insurance coverage in the individual or small group market shall ensure that such coverage includes the essential health benefits package required under [section 18022(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18022/a&num=0&edition=prelim).
**(b) Cost-sharing under group health plans** A group health plan shall ensure that any annual cost-sharing imposed under the plan does not exceed the limitations provided for under paragraph (1) of section 18022(c) 11 See References in Text note below. of this title.
**(c) Child-only plans** If a health insurance issuer offers health insurance coverage in any level of coverage specified under [section 18022(d) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18022/d&num=0&edition=prelim), the issuer shall also offer such coverage in that level as a plan in which the only enrollees are individuals who, as of the beginning of a plan year, have not attained the age of 21.
**(d) Dental only** This section shall not apply to a plan described in section 18031(d)(2)(B)(ii) 1 of this title.
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 300gg–6
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Stable record: federal_law:legal_authorities:record_usc_936a72671b6356048b49fd6f
Source file: Laws/federal/codes/united-states-code/title-42/section-300gg6-comprehensive-health-insurance-coverage--542df0a747.md
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Source location: Title 42, Chapter 6A, § 300gg–6; chapter-6a-public-health-service.md
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**(a) Coverage for essential health benefits package** A health insurance issuer that offers health insurance coverage in the individual or small group market shall ensure that such coverage includes the essential health benefits package required under [section 18022(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18022/a&num=0&edition=prelim).
**(b) Cost-sharing under group health plans** A group health plan shall ensure that any annual cost-sharing imposed under the plan does not exceed the limitations provided for under paragraph (1) of section 18022(c) 11 See References in Text note below. of this title.
**(c) Child-only plans** If a health insurance issuer offers health insurance coverage in any level of coverage specified under [section 18022(d) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section18022/d&num=0&edition=prelim), the issuer shall also offer such coverage in that level as a plan in which the only enrollees are individuals who, as of the beginning of a plan year, have not attained the age of 21.
**(d) Dental only** This section shall not apply to a plan described in section 18031(d)(2)(B)(ii) 1 of this title.
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Federal law — U.S. Code and appendices · legal_authorities
For the purpose of any reorganization under [section 203 of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section203&num=0&edition=prelim), the Secretary, with the approval of the Director of the Office of Management and Budget, is authorized to make such transfers of funds between appropriations as may be necessary for the continuance of transferred functions.
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 238f
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Federal law — U.S. Code and appendices · legal_authorities
**(a) 11 So in original. No subsec. (b) has been enacted. Prohibiting discriminatory premium rates**
(1) **In general** — With respect to the premium rate charged by a health insurance issuer for health insurance coverage offered in the individual or small group market—
(A) such rate shall vary with respect to the particular plan or coverage involved only by—
(i) whether such plan or coverage covers an individual or family;
(ii) rating area, as established in accordance with paragraph (2);
(iii) age, except that such rate shall not vary by more than 3 to 1 for adults (consistent with [section 300gg–6(c) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg–6/c&num=0&edition=prelim)); and
(iv) tobacco use, except that such rate shall not vary by more than 1.5 to 1; and
(B) such rate shall not vary with respect to the particular plan or coverage involved by any other factor not described in subparagraph (A).
(2) **Rating area**
(A) *In general* — Each State shall establish 1 or more rating areas within that State for purposes of applying the requirements of this subchapter.
(B) *Secretarial review* — The Secretary shall review the rating areas established by each State under subparagraph (A) to ensure the adequacy of such areas for purposes of carrying out the requirements of this subchapter. If the Secretary determines a State’s rating areas are not adequate, or that a State does not establish such areas, the Secretary may establish rating areas for that State.
(3) **Permissible age bands** — The Secretary, in consultation with the National Association of Insurance Commissioners, shall define the permissible age bands for rating purposes under paragraph (1)(A)(iii).
(4) **Application of variat
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 300gg
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Essential health benefits package** In this title,11 See References in Text note below. the term “essential health benefits package” means, with respect to any health plan, coverage that—
(1) provides for the essential health benefits defined by the Secretary under subsection (b);
(2) limits cost-sharing for such coverage in accordance with subsection (c); and
(3) subject to subsection (e), provides either the bronze, silver, gold, or platinum level of coverage described in subsection (d).
**(b) Essential health benefits**
(1) **In general** — Subject to paragraph (2), the Secretary shall define the essential health benefits, except that such benefits shall include at least the following general categories and the items and services covered within the categories:
(A) Ambulatory patient services.
(B) Emergency services.
(C) Hospitalization.
(D) Maternity and newborn care.
(E) Mental health and substance use disorder services, including behavioral health treatment.
(F) Prescription drugs.
(G) Rehabilitative and habilitative services and devices.
(H) Laboratory services.
(I) Preventive and wellness services and chronic disease management.
(J) Pediatric services, including oral and vision care.
(2) **Limitation**
(A) *In general* — The Secretary shall ensure that the scope of the essential health benefits under paragraph (1) is equal to the scope of benefits provided under a typical employer plan, as determined by the Secretary. To inform this determination, the Secretary of Labor shall conduct a survey of employer-sponsored coverage to determine the benefits typically covered by employers, including multiemployer plans, and provide a report on such survey to the Secretary.
(B) *Certification* — In defining the essential healt
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 18022
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