Title I, SEC. 1423. STANDARDS FOR COST SHARING POLICIES. 
      (a) Rules for Offering of Policies. Subject to subsection (f), a cost 
    sharing policy may be offered to an individual only if 

        (1) the policy is offered by the regional alliance health plan in which 
      the individual is enrolled; 

        (2) the regional alliance health plan offers the policy to all 
      individuals enrolled in the plan; 

        (3) the plan offers each such individual a choice of a policy that 
      provides standard coverage and a policy that provides maximum coverage 
      (in accordance with standards established by the Board); and 

        (4) the policy is offered only during the annual open enrollment period 
      for regional alliance health plans (described in section 1323(d)(1)). 

      (b) Prohibition of Coverage of Copayments. Each cost sharing policy may 
    not provide any benefits relating to any copayments established under the 
    schedule of copayments and coinsurance under section 1135. 

      (c) Equivalent Coverage for All Services. Each cost sharing policy must 
    provide coverage for items and services in the comprehensive benefit 
    package to the same extent as the policy provides coverage for all items 
    and services in the package. 

      (d) Requirements for Pricing. 

        (1) In general. The price of any cost sharing policy shall 

          (A) be the same for each individual to whom the policy is offered; 

          (B) take into account any expected increase in utilization resulting 
        from the purchase of the policy by individuals enrolled in the regional 
        alliance health plan; and 

          (C) not result in a loss-ratio of less than 90 percent. 

        (2) Loss-ratio defined. In paragraph (1)(C), a ``loss-ratio'' is the 
      ratio of the premium returned to the consumer in payout relative to the 
      total premium collected. 

      (e) Loss of State Certification for Regional Alliance Health Plans 
    Failing to Meet Standards. A State may not certify a regional alliance 
    health plan that offers a cost sharing policy unless the plan and the 
    policy meet the standards described in this section. 

      (f) Special Rules for FEHBP Supplemental Plans. Subsection (a) shall not 
    apply to an FEHBP supplemental plan described in section 8203(f)(1), but 
    only if the plan meets the following requirements: 

        (1) The plan must be offered to all individuals to whom such a plan is 
      required to be offered under section 8204. 

        (2) The plan must offers each such individual a choice of a policy that 
      provides standard coverage and a policy that provides maximum coverage 
      (in accordance with standards established by the Board under subsection 
      (a)(3)). 

        (3) The plan is offered only during the annual open enrollment period 
      for regional alliance health plans (described in section 1323(d)(1)). 

        (4)(A) The price of the plan shall include an amount, established in 
      accordance with rules established by the Board in consultation with the 
      Office of Personnel Management, that takes into account any expected 
      increase in utilization of the items and services in the comprehensive 
      benefit package resulting from the purchase of the plan by individuals 
      enrolled in a regional alliance health plan. 

          (B) The plan provides for payment, in a manner specified by the Board 
        in the case of an individual enrolled in the plan and in a regional 
        alliance health plan, to the regional alliance health plan of an amount 
        equivalent to the additional amount described in subparagraph (A).