,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #fbee  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,novemb] #ba1         
#bjbe,ms4 ,craig 7= h]self1 ,mrs4       
,mc,bath1 ,mr4 ,hors=d1 ,mr4 ,l&sman1 & 
,ms4 ,s*ri]7 introduc$ ! foll[+ bill2   
:i* 0 ref]r$ to ! ,committee on ,en]gy &
 ,comm]ce1 & 9 addition to ! ,committees
 on ,ways & ,means1 & ,education &      
,work=ce1 = a p]iod to be subsequ5tly   
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d title ,,xxvii ( !     
,public ,heal? ,s]vice ,act1 ! ,int]nal 
,rev5ue ,code ( #aihf1 & ! ,employee    
,retirem5t ,income ,security ,act (     
#aigd to e/abli% requirem5ts ) respect  
to co/-%>+ = c]ta9 insul9 products1 & = 
o!r purposes4  #a4 ,%ort title ,?is ,act
 may be cit$ z ! ,af=dable ,insul9 ,n[  
,act4  #b4 ,requirem5ts ) respect to    
co/-%>+ = insul9 products  7a7 ,,phsa   
,"p ,d ( title ,,xxvii ( ! ,public      
,heal? ,s]vice ,act 7#db ,u4,s4,c4      

#cjj;gg-#aaa et seq47 is am5d$ by add+  
at ! end ! foll[+ new section3          
#bgii;,a-#aa4 ,requirem5ts ) respect to 
co/-%>+ = c]ta9 insul9 products  7a7 ,9 
g5]al ,= plan ye>s beg9n+ on or aft]    
,janu>y #a1 #bjbf1 a gr\p heal? plan or 
heal? insurance issu] (f]+ gr\p or      
individual heal? insurance cov]age %all 
provide cov]age ( select$ insul9        
products1 & ) respect to su* products1  
%all n-- 7#a7 apply any d$uctible2 or   
7#b7 impose any co/-%>+ 9 excess ( !    
less] (1 p] #cj-;day supply-- 7,a7 #ce2 
or  7,b7 ! am\nt equal to #be p]c5t ( ! 
negotiat$ price ( ! select$ insul9      
product net ( all price concessions     
receiv$ by or on behalf ( ! plan or     
cov]age1 includ+ price concessions      
receiv$ by or on behalf ( ?ird-p>ty     
entities provid+ s]vices to ! plan or   
cov]age1 su* z ph>macy b5efit managem5t 
s]vices4  7b7 ,def9itions ,9 ?is        
section3 7#a7 ,select$ insul9 products  
,! t]m select$ insul9 products means at 
lea/ "o ( ea* dosage =m 7su* z vial1    

pump1 or inhal] dosage =ms7 ( ea*       
diff]5t type 7su* z rapid-act+1         
%ort-act+1 int]m$iate-act+1 long-act+1  
ultra long-act+1 & premix$7 ( insul9 7z 
def9$ bel[71 :5 available1 z select$ by 
! gr\p heal? plan or heal? insurance    
issu]4  7#b7 ,insul9 def9$ ,! t]m insul9
 means insul9 t is lic5s$ "u subsection 
7a7 or 7k7 ( section #cea & cont9ues to 
be m>ket$ "u su* section1 includ+ any   
insul9 product t has be5 deem$ to be    
lic5s$ "u section #cea7;a7 pursuant to  
section #gjjb7;e77#d7 ( ! ,biologics    
,price ,competition & ,innovation ,act (
 #bjji & cont9ues to be m>ket$ pursuant 
to su* lic5sure4  7c7 ,out-(-,network   
provid]s ,no?+ 9 ?is section requires a 
plan or issu] t has a network ( provid]s
 to provide b5efits = select$ insul9    
products describ$ 9 ?is section t are   
deliv]$ by an out-(-network provid]1 or 
precludes a plan or issu] t has a       
network ( provid]s f impos+ high]       
co/-%>+ ?an ! levels specifi$ 9         
subsection 7a7 = select$ insul9 products

 describ$ 9 ?is section t are deliv]$ by
 an out-(-network provid]4  7d7 ,rule ( 
con/ruction ,subsection 7a7 %all n be   
con/ru$ to require cov]age (1 or prev5t 
a gr\p heal? plan or heal? insurance    
cov]age f impos+ co/-%>+ o!r ?an !      
levels specifi$ 9 subsection 7a7 on1    
insul9 products t are n select$ insul9  
products1 to ! ext5t t su* cov]age is n 
o!rwise requir$ & su* co/-%>+ is o!rwise
 p]mitt$ "u ,f$]al & applicable ,/ate   
law4  7e7 ,application ( co/-,%>+ t[>ds 
d$uctibles & out-(-,pocket maximums ,any
 co/-%>+ paym5ts made pursuant to       
subsection 7a77#b7 %all be c\nt$ t[>d   
any d$uctible or out-(-pocket maximum t 
applies "u ! plan or cov]age4  4  7b7   
,,irc  7#a7 ,9 g5]al ,sub*apt] ,b (     
*apt] #ajj ( ! ,int]nal ,rev5ue ,code ( 
#aihf is am5d$ by add+ at ! end ! foll[+
 new section3  #ihbf4 ,requirem5ts )    
respect to co/-%>+ = c]ta9 insul9       
products  7a7 ,9 g5]al ,= plan ye>s     
beg9n+ on or aft] ,janu>y #a1 #bjbf1 a  
gr\p heal? plan %all provide cov]age (  

select$ insul9 products1 & ) respect to 
su* products1 %all n-- 7#a7 apply any   
d$uctible2 or  7#b7 impose any co/-%>+ 9
 excess ( ! less] (1 p] #cj-;day        
supply-- 7,a7 #ce2 or  7,b7 ! am\nt     
equal to #be p]c5t ( ! negotiat$ price (
 ! select$ insul9 product net ( all     
price concessions receiv$ by or on      
behalf ( ! plan1 includ+ price          
concessions receiv$ by or on behalf (   
?ird-p>ty entities provid+ s]vices to ! 
plan1 su* z ph>macy b5efit managem5t    
s]vices4  7b7 ,def9itions ,9 ?is        
section3 7#a7 ,select$ insul9 products  
,! t]m select$ insul9 products means at 
lea/ "o ( ea* dosage =m 7su* z vial1    
pump1 or inhal] dosage =ms7 ( ea*       
diff]5t type 7su* z rapid-act+1         
%ort-act+1 int]m$iate-act+1 long-act+1  
ultra long-act+1 & premix$7 ( insul9 7z 
def9$ bel[71 :5 available1 z select$ by 
! gr\p heal? plan4  7#b7 ,insul9 def9$  
,! t]m insul9 means insul9 t is lic5s$  
"u subsection 7a7 or 7k7 ( section #cea 
( ! ,public ,heal? ,s]vice ,act 7#db    

,u4,s4,c4 #bfb7 & cont9ues to be m>ket$ 
"u su* section1 includ+ any insul9      
product t has be5 deem$ to be lic5s$ "u 
section #cea7;a7 ( su* ,act pursuant to 
section #gjjb7;e77#d7 ( ! ,biologics    
,price ,competition & ,innovation ,act (
 #bjji 7,public ,law #aaa-adh7 &        
cont9ues to be m>ket$ pursuant to su*   
lic5sure4  7c7 ,out-(-,network provid]s 
,no?+ 9 ?is section requires a plan t   
has a network ( provid]s to provide     
b5efits = select$ insul9 products       
describ$ 9 ?is section t are deliv]$ by 
an out-(-network provid]1 or precludes a
 plan t has a network ( provid]s f      
impos+ high] co/-%>+ ?an ! levels       
specifi$ 9 subsection 7a7 = select$     
insul9 products describ$ 9 ?is section t
 are deliv]$ by an out-(-network        
provid]4  7d7 ,rule ( con/ruction       
,subsection 7a7 %all n be con/ru$ to    
require cov]age (1 or prev5t a gr\p     
heal? plan f impos+ co/-%>+ o!r ?an !   
levels specifi$ 9 subsection 7a7 on1    
insul9 products t are n select$ insul9  

products1 to ! ext5t t su* cov]age is n 
o!rwise requir$ & su* co/-%>+ is o!rwise
 p]mitt$ "u ,f$]al & applicable ,/ate   
law4  7e7 ,application ( co/-,%>+ t[>ds 
d$uctibles & out-(-,pocket maximums ,any
 co/-%>+ paym5ts made pursuant to       
subsection 7a77#b7 %all be c\nt$ t[>d   
any d$uctible or out-(-pocket maximum t 
applies "u ! plan4  4  7#b7 ,cl]ical    
am5dm5t ,! table ( sections = sub*apt]  
,b ( *apt] #ajj ( ! ,int]nal ,rev5ue    
,code ( #aihf is am5d$ by add+ at ! end 
! foll[+ new item3  ,sec4 #ihbf4        
,requirem5ts ) respect to co/-%>+ =     
c]ta9 insul9 products4  4  7c7 ,,erisa  
7#a7 ,9 g5]al ,subp>t ,b ( "p #g (      
subtitle ,b ( title ,i ( ! ,employee    
,retirem5t ,income ,security ,act (     
#aigd 7#bi ,u4,s4,c4 #aahe et seq47 is  
am5d$ by add+ at ! end ! foll[+3  #gbf4 
,requirem5ts ) respect to co/-%>+ =     
c]ta9 insul9 products  7a7 ,9 g5]al ,=  
plan ye>s beg9n+ on or aft] ,janu>y #a1 
#bjbf1 a gr\p heal? plan or heal?       
insurance issu] (f]+ gr\p heal?         

insurance cov]age %all provide cov]age (
 select$ insul9 products1 & ) respect to
 su* products1 %all n-- 7#a7 apply any  
d$uctible2 or  7#b7 impose any co/-%>+ 9
 excess ( ! less] (1 p] #cj-;day        
supply-- 7,a7 #ce2 or  7,b7 ! am\nt     
equal to #be p]c5t ( ! negotiat$ price (
 ! select$ insul9 product net ( all     
price concessions receiv$ by or on      
behalf ( ! plan or cov]age1 includ+     
price concessions receiv$ by or on      
behalf ( ?ird-p>ty entities provid+     
s]vices to ! plan or cov]age1 su* z     
ph>macy b5efit managem5t s]vices4  7b7  
,def9itions ,9 ?is section3 7#a7        
,select$ insul9 products ,! t]m select$ 
insul9 products means at lea/ "o ( ea*  
dosage =m 7su* z vial1 pump1 or inhal]  
dosage =ms7 ( ea* diff]5t type 7su* z   
rapid-act+1 %ort-act+1 int]m$iate-act+1 
long-act+1 ultra long-act+1 & premix$7 (
 insul9 7z def9$ bel[71 :5 available1 z 
select$ by ! gr\p heal? plan or heal?   
insurance issu]4  7#b7 ,insul9 def9$ ,! 
t]m insul9 means insul9 t is lic5s$ "u  

subsection 7a7 or 7k7 ( section #cea ( !
 ,public ,heal? ,s]vice ,act 7#db       
,u4,s4,c4 #bfb7 & cont9ues to be m>ket$ 
"u su* section1 includ+ any insul9      
product t has be5 deem$ to be lic5s$ "u 
section #cea7;a7 ( su* ,act pursuant to 
section #gjjb7;e77#d7 ( ! ,biologics    
,price ,competition & ,innovation ,act (
 #bjji 7,public ,law #aaa-adh7 &        
cont9ues to be m>ket$ pursuant to su*   
lic5sure4  7c7 ,out-(-,network provid]s 
,no?+ 9 ?is section requires a plan or  
issu] t has a network ( provid]s to     
provide b5efits = select$ insul9        
products describ$ 9 ?is section t are   
deliv]$ by an out-(-network provid]1 or 
precludes a plan or issu] t has a       
network ( provid]s f impos+ high]       
co/-%>+ ?an ! levels specifi$ 9         
subsection 7a7 = select$ insul9 products
 describ$ 9 ?is section t are deliv]$ by
 an out-(-network provid]4  7d7 ,rule ( 
con/ruction ,subsection 7a7 %all n be   
con/ru$ to require cov]age (1 or prev5t 
a gr\p heal? plan or heal? insurance    

cov]age f impos+ co/-%>+ o!r ?an !      
levels specifi$ 9 subsection 7a7 on1    
insul9 products t are n select$ insul9  
products1 to ! ext5t t su* cov]age is n 
o!rwise requir$ & su* co/-%>+ is o!rwise
 p]mitt$ "u ,f$]al & applicable ,/ate   
law4  7e7 ,application ( co/-,%>+ t[>ds 
d$uctibles & out-(-,pocket maximums ,any
 co/-%>+ paym5ts made pursuant to       
subsection 7a77#b7 %all be c\nt$ t[>d   
any d$uctible or out-(-pocket maximum t 
applies "u ! plan or cov]age4  4  7#b7  
,cl]ical am5dm5t ,! table ( cont5ts 9   
section #a ( ! ,employee ,retirem5t     
,income ,security ,act ( #aigd 7#bi     
,u4,s4,c4 #ajja et seq47 is am5d$ by    
ins]t+ aft] ! item relat+ to section    
#gbe ! foll[+3  ,sec4 #gbf4 ,requirem5ts
 ) respect to co/-%>+ = c]ta9 insul9    
products4  4  7d7 ,no effect on o!r     
co/-,%>+ ,section #acjb7;d77#b7 ( !     
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahjbb7;d77#b77 is  
am5d$ by add+ at ! end ! foll[+ new     
subp>agraph3  7,d7 ,special rule relat+ 

to insul9 cov]age ,! exemption ( cov]age
 ( select$ insul9 products 7z def9$ 9   
section #bgii;,a-#aa7;b7 ( ! ,public    
,heal? ,s]vice ,act7 f ! application (  
any d$uctible pursuant to section       
#bgii;,a-#aa7;a77#a7 ( su* ,act1 section
 #gbf7;a77#a7 ( ! ,employee ,retirem5t  
,income ,security ,act ( #aigd1 or      
section #ihbf7;a77#a7 ( ! ,int]nal      
,rev5ue ,code ( #aihf %all n be consid]$
 :5 det]m9+ ! actu>ial value ( a        
qualifi$ heal? plan "u ?is subsection4  
4  7e7 ,cov]age ( c]ta9 insul9 products 
"u cata/rophic plans ,section #acjb7;e7 
( ! ,pati5t ,protection & ,af=dable ,c>e
 ,act 7#db ,u4,s4,c4 #ahjbb7;e77 is     
am5d$ by add+ at ! end ! foll[+3  7#d7  
,cov]age ( c]ta9 insul9 products  7,a7  
,9 g5]al ,not)/&+ p>agraph 7#a77;,b77i71
 a heal? plan describ$ 9 p>agraph 7#a7  
%all provide cov]age ( select$ insul9   
products1 9 accordance ) section        
#bgii;,a-#aa ( ! ,public ,heal? ,s]vice 
,act1 = a plan ye> be=e an enroll$      
individual has incurr$ co/-%>+ exp5ses 9

 an am\nt equal to ! annual limitation 9
 effect "u subsection 7c77#a7 = ! plan  
ye>4  7,b7 ,t]m9ology ,= purposes (     
subp>agraph 7,a7-- 7i7 ! t]m select$    
insul9 products has ! mean+ giv5 su* t]m
 9 section #bgii;,a-#aa7;b7 ( ! ,public 
,heal? ,s]vice ,act2 &  7ii7 !          
requirem5ts ( section #bgii;,a-#aa ( su*
 ,act %all be appli$ by deem+ ea*       
ref]5ce 9 su* section to individual     
heal? insurance cov]age to be a ref]5ce 
to a plan describ$ 9 p>agraph 7#a74  4