27

ensure the provision of quality health care and financial 1

security, that 2
(1) provides payment for the items and services 3
described in subsection (b) in accordance with gen- 4
erally accepted standards of medical or other appro- 5
priate clinical or professional practice; 6
(2) limits cost-sharing for such covered health 7
care items and services in accordance with such ben- 8
efit standards, consistent with subsection (c); 9
(3) does not impose any annual or lifetime limit 10
on the coverage of covered health care items and 11
services; 12
(4) complies with section 115(a) (relating to 13
network adequacy); and 14
(5) is equivalent, as certified by Office of the 15
Actuary of the Centers for Medicare & Medicaid 16
Services, to the average prevailing employer-spon- 17
sored coverage. 18
(b) MINIMUM SERVICES TO BE COVERED.The 19
items and services described in this subsection are the fol- 20
lowing: 21
(1) Hospitalization. 22
(2) Outpatient hospital and outpatient clinic 23
services, including emergency department services. 24
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July 14, 2009 (12:51 p.m.)
F:\P11\NHI\TRICOMM\AAHCA09_001.XML
f:\VHLC\071409\071409.140.xml (444390|2)