(a) Health plan companies offering individual and small group health plans must include the essential health benefits package required under section 1302(a) of the Affordable Care Act and as described in this subdivision.
(b) The essential health benefits package means coverage that:
(1) provides essential health benefits as outlined in the Affordable Care Act;
(2) limits cost-sharing for such coverage in accordance with the Affordable Care Act, as described in subdivision 2; and
(3) subject to subdivision 3, provides bronze, silver, gold, or platinum level of coverage in accordance with the Affordable Care Act.
If a health plan company offers health plans in any level of coverage specified under section 1302(d) of the Affordable Care Act, as described in subdivision 1, paragraph (b), clause (3), the health plan company shall also offer coverage in that level to individuals who have not attained 21 years of age as of the beginning of a policy year.
A health plan company that does not provide an individual or small group health plan in the bronze, silver, gold, or platinum level of coverage, as described in subdivision 1, paragraph (b), clause (3), shall be treated as meeting the requirements of section 1302(d) of the Affordable Care Act with respect to any policy year if the health plan company provides a catastrophic plan that meets the requirements of section 1302(e) of the Affordable Care Act.
For purposes of this section, "essential health benefits" has the meaning given under section 1302(b) of the Affordable Care Act and includes:
(1) ambulatory patient services;
(2) emergency services;
(4) laboratory services;
(5) maternity and newborn care;
(6) mental health and substance use disorder services, including behavioral health treatment;
(7) pediatric services, including oral and vision care;
(8) prescription drugs;
(9) preventive and wellness services and chronic disease management;
(10) rehabilitative and habilitative services and devices; and
(11) additional essential health benefits included in the EHB-benchmark plan, as defined under the Affordable Care Act.
This section does not apply to a dental plan described in section 1311(d)(2)(B)(ii) of the Affordable Care Act.
Copyright © 2015 by the Revisor of Statutes, State of Minnesota. All rights reserved.