section 8903(1) of title 5, United 
States Code. 
‘‘(II) STATE
EMPLOYEE
COV-
ERAGE.—A health benefits coverage 
plan that is offered and generally 
available to State employees in the 
State involved. 
‘‘(III) 
COVERAGE
OFFERED 
THROUGH
HMO.—The health insur-
ance coverage plan that is offered by 
a health maintenance organization (as 
defined in section 2791(b)(3) of the 
Public Health Service Act), and has 
the largest insured commercial, non-
medicaid enrollment of covered lives of 
such coverage plans offered by such a 
health maintenance organization in 
the State involved. 
‘‘(iii) CATEGORIES
OF
BASIC
SERV-
ICES.—For purposes of this subparagraph, 
the categories of basic services described in 
this clause are as follows: 
‘‘(I) Inpatient and outpatient 
hospital services.
‘‘(II) Physicians’ surgical and 
medical services. 
‘‘(III) Laboratory and x-ray serv-
ices. 
‘‘(IV) Well-baby and well-child 
care, including age-appropriate immu-
nizations. 
‘‘(iv) CATEGORIES
OF
ADDITIONAL 
SERVICES.—For purposes of this subpara-
graph, the categories of additional services 
described in this clause are as follows: 
‘‘(I) Coverage of prescription 
drugs. 
‘‘(II) Mental health services. 
‘‘(III) Vision services. 
‘‘(IV) Hearing services. 
‘‘(v) TREATMENT
OF
OTHER
CAT-
EGORIES.—Nothing in this subparagraph 
shall be construed as preventing substan-
tial health insurance coverage from includ-
ing coverage of benefits that are not within 
a category of services described in clause 
(iii) or (iv). 
‘‘(vi) DETERMINATION OF ACTUARIAL 
VALUE.—The actuarial value of coverage
of benchmark benefit packages and cov-
erage of any categories of additional serv-
ices under benchmark benefit packages and 
under coverage offered by such a plan shall 
be set forth in an actuarial opinion in an 
actuarial report that has been prepared—
‘‘(I) by an individual who is a 
member of the American Academy of 
Actuaries; 
‘‘(II) using generally accepted ac-
tuarial principles and methodologies; 
‘‘(III) using a standardized set of 
utilization and price factors; 
‘‘(IV) using a standardized popu-
lation that is representative of pri-
vately insured individuals similarly sit-
uated when compared to individuals 
expected to be covered under the sub-
stantial health insurance coverage; 
‘‘(V) applying the same principles 
and factors in comparing the value of 
different coverage (or categories of 
services); and 
‘‘(VI) without taking into ac-
count any differences in coverage
based on the method of delivery or 
means of cost control or utilization 
used. 
The actuary preparing the opinion shall se-
lect and specify in the memorandum the 
standardized set and population to be used 
under subclauses (III) and (IV).’’. 
(b) REMEDY AGAINST QUALIFIED INDIVIDUALS FOR 
NOT MAINTAINING SUBSTANTIAL HEALTH INSURANCE 
COVERAGE WHILE OBTAINING EMERGENCY ROOM SERV-
ICES.—
(1) IN GENERAL.—Section 502 of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 
1102) is amended—
(A) in subsection (a)(8), by striking ‘‘or’’ 
at the end; 
(B) in subsection (a)(9), by striking the 
period and inserting ‘‘; or’’; 
(C) by adding at the end of subsection (a) 
the following new paragraph: 
‘‘(10) by the Secretary or a State, in accord-
ance with subsection (c)(7), to provide appropriate 
equitable remedies for failures to meet the require-
ments of section 206(g)(2).’’;
(D) by redesignating subsection (c)(8) as 
subsection (c)(9); and 
(E) by inserting after subsection (c)(7) the 
following new paragraph: 
‘‘(8) In any action under subsection (a)(10), the 
court may provide appropriate equitable relief in connec-
tion with failures to meet the requirements of section 
206(g)(2). Such relief may include an order that the de-
fendant maintain, for at least the 2-year period com-
mencing with the date of the failure described in section 
206(g)(2), substantial health insurance coverage (as de-
fined in section 206(g)(3)(B)) covering the patient in-
volved.’’. 
(2) 
CONCURRENT
JURISDICTION.—Section 
502(e)(1) of such Act (29 U.S.C. 1132(e)(1)) is 
amended—
(A) in the first sentence, by striking ‘‘sub-
section (a)(1)(B)’’ and inserting ‘‘paragraph 
(1)(B), (7), or (10) of subsection (a) of this 
section’’; and 
(B) in the last sentence, by striking ‘‘para-
graphs (1)(B) and (7)’’ and inserting ‘‘para-
graphs (1)(B), (7), and (10)’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to failures (to meet
the requirements of section 206(g)(2) of the Employee Re-
tirement Income Security Act of 1974) occurring on or 
after the date of the enactment of this Act.
Æ