Standardized health benefit plan - established - components - rules - independent analysis - repeal

(b) Include, at a minimum, pediatric and other essential health benefits;

(c) Be offered through the exchange and in the individual market through the public benefit corporation;

(d) Be a standardized benefit design that:

(I) Is created through a stakeholder engagement process that includes physicians, health-care industry and consumer representatives, individuals who represent health-care workers or who work in health care, and individuals working in or representing communities that are diverse with regard to race, ethnicity, immigration status, age, ability, sexual orientation, gender identity, or geographic regions of the state and that are affected by higher rates of health disparities and inequities;

(II) Has a defined benefit design and cost-sharing that improves access and affordability; and

(III) Is designed to improve racial health equity and decrease racial health disparities through a variety of means, which are identified collaboratively with consumer stakeholders, including:

(A) Improving perinatal health-care coverage; and

(B) Providing first-dollar, predeductible coverage for certain high-value services, such as primary and behavioral health care;

(e) Be actuarially sound and allow a carrier to continue to meet the financial requirements in article 3 of this title 10;

(f) Comply with the federal act, including the risk adjustment requirements under 45 CFR 153, and this article 16; and

(g) Have a network that is:

(I) Culturally responsive and, to the greatest extent possible, reflects the diversity of its enrollees in terms of race, ethnicity, gender identity, and sexual orientation in the area that the network exists; and

(II) No more narrow than the most restrictive network the carrier is offering for nonstandardized plans in the individual market for the metal tier for that rating area.

(2) (a) In developing the network for the standardized plan pursuant to subsection (1)(g) of this section, each carrier shall:

(I) Include as part of its network access plan a description of the carrier's efforts to construct diverse, culturally responsive networks that are well-positioned to address health equity and reduce health disparities; and

(II) Include a majority of the essential community providers in the service area in its network.

(b) If a carrier is unable to achieve the network adequacy requirements in subsection (1)(g) of this section, the carrier shall file an action plan with the division that describes the carrier's efforts to achieve the requirements in subsection (1)(g) of this section.

(c) The commissioner shall promulgate rules regarding the network adequacy requirements in subsection (1)(g) of this section and the action plan in subsection (2)(b) of this section.

(3) (a) The standardized plan must be offered in a manner that allows consumers to easily compare the standardized plans offered by each carrier.

(b) The exchange, in collaboration with the commissioner and after a stakeholder engagement process with consumers, producers, and carriers, shall develop a format for displaying the standardized plans on the exchange in a manner that allows for standardized plans to be easily identified and compared.

(4) The commissioner may update the standardized plan annually by rule through the stakeholder process described in subsection (1)(d)(I) of this section.

(5) The commissioner shall contract with an independent third party to conduct an analysis of the impact of this section on health plan enrollment, health insurance affordability, and health equity. To the extent available, the analysis must include disaggregated data by race, ethnicity, immigration status, sexual orientation, gender identity, age, and ability. If the data is not available, the analysis must note such unavailability. The analysis must include information concerning total out-of-pocket health-care spending. The analysis must be completed on or before January 1, 2026.

(6) (a) The commissioner shall collaborate with the exchange concerning the survey required in section 10-22-114, which survey addresses consumers' experience.

(b) This subsection (6) is repealed, effective July 1, 2026.

(7) The commissioner is not required to comply with the Procurement Code, articles 101 to 112 of title 24, for the purposes of this section.