such coverage in that level as a plan in which the only 
enrollees are individuals who, as of the beginning of a plan 
year, have not attained the age of 21. 
‘‘(d) DENTAL ONLY.—This section shall not apply to 
a plan described in section 1311(d)(2)(B)(ii) of the Pa-
tient Protection and Affordable Care Act.’’. 
(2) CLERICAL AMENDMENT.—The table of con-
tents in section 1 of such Act is amended by insert-
ing after the item relating to section 726 (as in-
serted by section 101) the following new item: 
‘‘Sec. 727. Comprehensive coverage.’’. 
(c) IRC.— 
(1) IN
GENERAL.—Subchapter B of chapter 
100 of the Internal Revenue Code of 1986, as 
amended by section 101, is further amended by add-
ing at the end the following new section: 
‘‘SEC. 9827. COMPREHENSIVE COVERAGE. 
‘‘(a) COST-SHARING LIMITATION.— 
‘‘(1) IN GENERAL.—A group health plan shall 
ensure that— 
‘‘(A) any annual cost-sharing imposed 
under the plan (including any such cost-sharing 
so imposed with respect to prescription drugs) 
does not exceed the dollar amounts specified in 
paragraph (2); and 
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‘‘(B) any annual cost-sharing imposed 
under the plan with respect to prescription 
drugs does not exceed the dollar amounts speci-
fied in paragraph (3). 
‘‘(2) LIMITATION ON OVERALL OUT-OF-POCKET 
COST-SHARING.—For purposes of paragraph (1)(A), 
the dollar amounts specified in this paragraph are 
the following: 
‘‘(A) With respect to self-only coverage— 
‘‘(i) for plan years beginning in 2027, 
the dollar amount in effect under section 
1302(c)(1) of the Patient Protection and 
Affordable Care Act for such coverage for 
plan years beginning in 2014, increased by 
an amount equal to the product of that 
amount and the premium adjustment per-
centage specified in paragraph (4) of such 
section for the calendar year; and 
‘‘(ii) for plan years beginning in 2028 
or a subsequent year, the dollar amount in 
effect under this subparagraph for plan 
years beginning in 2027, increased by an 
amount equal to the product of that 
amount the premium adjustment percent-
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age specified in paragraph (4) for the cal-
endar year. 
‘‘(B) With respect to coverage other than 
self-only coverage, for plan years beginning in 
2027 or a subsequent year, twice the amount in 
effect under subparagraph (A) for such plan 
year. 
If the amount of any increase under subparagraph 
(A) is not a multiple of $50, such increase shall be 
rounded to the next lowest multiple of $50. 
‘‘(3) LIMITATION ON PRESCRIPTION DRUG OUT- 
OF-POCKET COST-SHARING.—For purposes of para-
graph (1)(B), the dollar amounts specified in this 
paragraph are the following: 
‘‘(A) With respect to self-only coverage— 
‘‘(i) for plan years beginning in 2027, 
$2,000; and 
‘‘(ii) for plan years beginning in 2028 
or a subsequent year, the dollar amount in 
effect under this subparagraph for plan 
years beginning in 2027, increased by an 
amount equal to the product of that 
amount and the premium adjustment per-
centage under paragraph (4) for the cal-
endar year. 
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‘‘(B) With respect to coverage other than 
self-only coverage, for plan years beginning in 
2027 or a subsequent year, twice the amount in 
effect under subparagraph (A) for such plan 
year. 
If the amount of any increase under subparagraph 
(A) is not a multiple of $50, such increase shall be 
rounded to the next lowest multiple of $50. 
‘‘(4) PREMIUM
ADJUSTMENT
PERCENTAGE.— 
For purposes of paragraphs (2)(A)(ii) and (3)(A)(ii), 
the premium adjustment percentage for any cal-
endar year is the percentage (if any) by which the 
average per capita premium for health insurance 
coverage in the United States for the preceding cal-
endar year (as estimated by the Secretary no later 
than October 1 of such preceding calendar year) ex-
ceeds such average per capita premium for 2026 (as 
determined by the Secretary). 
‘‘(5) COST-SHARING.—In this section: 
‘‘(A) IN GENERAL.—The term ‘cost-shar-
ing’ includes— 
‘‘(i) deductibles, coinsurance, copay-
ments, or similar charges; and 
‘‘(ii) any other expenditure required of 
an insured individual which is a qualified 
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medical expense (within the meaning of 
section 223(d)(2) of the Internal Revenue 
Code of 1986) with respect to essential 
health benefits covered under the plan. 
‘‘(B) EXCEPTIONS.—Such term does not 
include premiums, balance billing amounts for 
non-network providers, or spending for non-cov-
ered services. 
‘‘(6) IMPLEMENTATION.—The Secretary may 
implement the provisions of this subsection by sub-
regulatory guidance, interim final rule, or otherwise. 
‘‘(b) DENTAL ONLY.—This section shall not apply to 
a plan described in section 1311(d)(2)(B)(ii) of the Pa-
tient Protection and Affordable Care Act.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions for subchapter B of chapter 100 of the Inter-
nal Revenue Code of 1986, as amended by section 
101, is further amended by adding at the end the 
following new item: 
‘‘Sec. 9827. Comprehensive coverage.’’. 
(d) CONFORMING AMENDMENTS.—The Patient Pro-
tection and Affordable Care Act (Public Law 111–148) 
is amended— 
(1) in section 1302— 
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(A) in subsection (a)(2), by inserting ‘‘with 
respect to plan years beginning before January 
1, 2027,’’ before ‘‘limits cost-sharing’’; and 
(B) in subsection (e)(1)(B)(i)— 
(i) by inserting ‘‘(or, with respect to 
plan years beginning on or after January 
1, 2027, in effect under section 2799A– 
12(b)(1)(A)) of the Public Health Service 
Act)’’ after ‘‘subsection (c)(1)’’; and 
(ii) by inserting ‘‘and except, with re-
spect to plan years beginning on or after 
January 1, 2027, in the case of an indi-
vidual who has incurred cost-sharing ex-
penses with respect to prescription drugs 
in an amount equal to the annual limita-
tion in effect under section 2799A– 
12(b)(1)(B) of such Act, for benefits con-
sisting of prescription drugs’’ after ‘‘sec-
tion 2713’’; and 
(2) in section 1402(c)(1)(A), by inserting ‘‘(or, 
with respect to plan years beginning on or after Jan-
uary 1, 2027, the applicable out-of-pocket limit 
under section 2799A–12(b)(1)(A) of the Public 
Health Service Act)’’ after ‘‘section 1302(c)(1)’’. 
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