Required scope of health insurance coverage
The child health assistance provided to a targeted low-income child under the plan in the form described in paragraph (1) of section 1397aa(a) of this title shall consist, consistent with paragraphs (5), (6), (7), and (8) of subsection (c), of any of the following:
(1) Benchmark coverage
(1)Benchmark coverage#
Health benefits coverage that is at least equivalent to the benefits coverage in a benchmark benefit package described in subsection (b).
(2)Benchmark-equivalent coverage#
Health benefits coverage that meets the following requirements:
(A) Inclusion of basic services The coverage includes benefits for items and services within each of the categories of basic services described in subsection (c)(1).
(B) Aggregate actuarial value equivalent to benchmark package The coverage has an aggregate actuarial value that is at least actuarially equivalent to one of the benchmark benefit packages.
(C) Substantial actuarial value for additional services included in benchmark package With respect to each of the categories of additional services described in subsection (c)(2) for which coverage is provided under the benchmark benefit package used under subparagraph (B), the coverage has an actuarial value that is equal to at least 75 percent of the actuarial value of the coverage of that category of services in such package.
(3)Existing comprehensive State-based coverage#
Health benefits coverage under an existing comprehensive State-based program, described in subsection (d)(1).
(4)Secretary-approved coverage#
Any other health benefits coverage that the Secretary determines, upon application by a State, provides appropriate coverage for the population of targeted low-income children proposed to be provided such coverage.