‘‘(3) REQUIREMENTS.—The requirements of 
this paragraph, with respect to an application sub-
mitted under paragraph (1), are the following: 
‘‘(A) The application is submitted at such 
time, and in such manner, as the Secretary may 
require. 
‘‘(B) The application specifies how the ap-
proval of such application will provide for one 
or more of the following: 
‘‘(i) Reducing average premiums for 
health insurance coverage in the State. 
‘‘(ii) Increasing enrollment in health 
insurance coverage in the State. 
‘‘(iii) Stabilizing the market for health 
insurance coverage in the State. 
‘‘(iv) Stabilizing premiums for individ-
uals with pre-existing conditions. 
‘‘(v) Increasing the choice of health 
plans in the State. 
‘‘(C) The application specifies the period 
for which the waiver is to be effective, con-
sistent with paragraph (4). 
‘‘(D) In the case of an application for pur-
poses of paragraph (1)(A), the application
specifies the higher ratio to be applied pursuant 
to such paragraph. 
‘‘(E) In the case of an application for pur-
poses of paragraph (1)(B), the application 
specifies the essential health benefits to be ap-
plied pursuant to such paragraph. 
‘‘(F) In the case of an application for pur-
poses of paragraph (1)(C), the application dem-
onstrates that the State has in place a program 
that carries out the purpose described in para-
graph (1) or (2) of section 2202(a) of the So-
cial Security Act or participates in the program 
established under section 2205 of such Act. 
‘‘(4) TERM OF WAIVER.— 
‘‘(A) IN GENERAL.—No waiver for a State 
under this subsection may extend over a period 
of longer than 10 years unless the State re-
quests continuation of such waiver, and such re-
quest shall be deemed granted unless the Sec-
retary, within 90 days after the date of its sub-
mission to the Secretary, either denies such re-
quest in writing or informs the State in writing 
with respect to any additional information 
which is needed in order to make a final deter-
mination with respect to the request.
‘‘(B) SPECIAL RULE.—A waiver applied for 
by a State under paragraph (1)(C) may only be 
effective for a period during which the State— 
‘‘(i) has in place a program that car-
ries out the purpose described in para-
graph (1) or (2) of section 2202(a) of the 
Social Security Act; or 
‘‘(ii) participates in the program es-
tablished under section 2205 of such Act. 
‘‘(5) NON-APPLICATION RULES.— 
‘‘(A) SPECIFIED NON-APPLICATION PROVI-
SIONS.—In no case may a waiver for purposes 
of paragraph (1) apply with respect to any of 
the following provisions: 
‘‘(i) Section 1301 of the Patient Pro-
tection and Affordable Care Act, to the ex-
tent that such section applies to qualified 
health plans offered through the CO-OP 
program under section 1322 of such Act or 
multi-State plans under section 1334 of 
such Act. 
‘‘(ii) Sections 1312(d)(3)(D), 1331, 
1332, 1333, and 1334 of such Act. 
‘‘(B) HOLD HARMLESS.—Any standard or 
requirement adopted by a State pursuant to the
terms of a waiver approved under this sub-
section shall be deemed to comply with section 
1252 of the Patient Protection and Affordable 
Care Act and subsection (a) of section 1324 of 
such Act, insofar as such standard or require-
ment relates to a Federal or State law de-
scribed in subsection (b)(2) of such section (re-
lating to rating).’’. 
(b) APPLICATION
TO ESSENTIAL HEALTH BENE-
FITS.—Section 1302(a)(1) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18022(a)(1)) is amended 
by inserting ‘‘(or, in the case of health insurance coverage 
offered in the individual or small group market in a State 
for which there is an applicable waiver in effect under sec-
tion 2701(b) of the Public Health Service Act for a plan 
year, the essential health benefits applicable under such 
waiver)’’ after ‘‘subsection (b)’’. 
SEC. 137. CONSTRUCTIONS. 
(a) NO GENDER RATING.—Nothing in this Act shall 
be construed as permitting health insurance issuers to dis-
criminate in rates for health insurance coverage by gender. 
(b) NO LIMITING ACCESS TO COVERAGE FOR INDI-
VIDUALS WITH PREEXISTING CONDITIONS.—Nothing in 
this Act shall be construed as permitting health insurance
issuers to limit access to health coverage for individuals 
with preexisting conditions. 
Subtitle E—Implementation 
Funding 
SEC. 141. AMERICAN HEALTH CARE IMPLEMENTATION 
FUND. 
(a) IN GENERAL.—There is hereby established an 
American Health Care Implementation Fund (referred to 
in this section as the ‘‘Fund’’) within the Department of 
Health and Human Services to carry out sections 121, 
132, 202, and 214 (including the amendments made by 
such sections). 
(b) FUNDING.—There is appropriated to the Fund, 
out of any funds in the Treasury not otherwise appro-
priated, $1,000,000,000 for Federal administrative ex-
penses to carry out the sections described in subsection 
(a) (including the amendments made by such sections).