‘‘PART II—AFFORDABLE PLANS 
‘‘SEC. 3021. DEFINITIONS. 
‘‘In this part: 
‘‘(1) ADOPTING
STATE.—The term ‘adopting 
State’ means a State that has enacted a law pro-
viding that small group, individual, and large group 
health insurers in such State may offer and sell 
products in accordance with the List of Required 
Benefits and the Terms of Application as provided 
for in section 3022(b). 
‘‘(2) ELIGIBLE
INSURER.—The term ‘eligible 
insurer’ means a health insurance issuer that is li-
censed in a nonadopting State and that— 
‘‘(A) notifies the Secretary, not later than 
30 days prior to the offering of coverage de-
scribed in this subparagraph, that the issuer in-
tends to offer health insurance coverage con-
sistent with the List of Required Benefits and 
Terms of Application in a nonadopting State; 
‘‘(B) notifies the insurance department of 
a nonadopting State (or other applicable State 
agency), not later than 30 days prior to the of-
fering of coverage described in this subpara-
graph, that the issuer intends to offer health in-
surance coverage in that State consistent with 
the List of Required Benefits and Terms of Ap-
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plication, and provides with such notice a copy 
of any insurance policy that it intends to offer 
in the State, its most recent annual and quar-
terly financial reports, and any other informa-
tion required to be filed with the insurance de-
partment of the State (or other State agency) 
by the Secretary in regulations; and 
‘‘(C) includes in the terms of the health in-
surance coverage offered in nonadopting States 
(including in the terms of any individual certifi-
cates that may be offered to individuals in con-
nection with such group health coverage) and 
filed with the State pursuant to subparagraph 
(B), a description in the insurer’s contract of 
the List of Required Benefits and a description 
of the Terms of Application, including a de-
scription of the benefits to be provided, and 
that adherence to such standards is included as 
a term of such contract. 
‘‘(3) HEALTH
INSURANCE
COVERAGE.—The 
term ‘health insurance coverage’ means any coverage 
issued in the small group, individual, or large group 
health insurance markets, including with respect to 
small business health plans, except that such term 
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shall not include excepted benefits (as defined in sec-
tion 2791(c)). 
‘‘(4) LIST OF REQUIRED BENEFITS.—The term 
‘List of Required Benefits’ means the List issued 
under section 3022(a). 
‘‘(5) NONADOPTING
STATE.—The term ‘non-
adopting State’ means a State that is not an adopt-
ing State. 
‘‘(6) STATE LAW.—The term ‘State law’ means 
all laws, decisions, rules, regulations, or other State 
actions (including actions by a State agency) having 
the effect of law, of any State. 
‘‘(7) STATE
PROVIDER
FREEDOM
OF
CHOICE 
LAW.—The term ‘State Provider Freedom of Choice 
Law’ means a State law requiring that a health in-
surance issuer, with respect to health insurance cov-
erage, not discriminate with respect to participation, 
reimbursement, or indemnification as to any pro-
vider who is acting within the scope of the provider’s 
license or certification under applicable State law. 
‘‘(8) TERMS
OF
APPLICATION.—The term 
‘Terms of Application’ means terms provided under 
section 3022(a). 
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‘‘SEC. 3022. OFFERING AFFORDABLE PLANS. 
‘‘(a) LIST OF REQUIRED BENEFITS.—Not later than 
3 months after the date of enactment of this title, the Sec-
retary, in consultation with the National Association of In-
surance Commissioners, shall issue by interim final rule 
a list (to be known as the ‘List of Required Benefits’) of 
covered benefits, services, or categories of providers that 
are required to be provided by health insurance issuers, 
in each of the small group, individual, and large group 
markets, in at least 26 States as a result of the application 
of State covered benefit, service, and category of provider 
mandate laws. With respect to plans sold to or through 
small business health plans, the List of Required Benefits 
applicable to the small group market shall apply. 
‘‘(b) TERMS OF APPLICATION.— 
‘‘(1) STATE WITH MANDATES.—With respect to 
a State that has a covered benefit, service, or cat-
egory of provider mandate in effect that is covered 
under the List of Required Benefits under sub-
section (a), such State mandate shall, subject to 
paragraph (3) (concerning uniform application), 
apply to a coverage plan or plan in, as applicable, 
the small group, individual, or large group market or 
through a small business health plan in such State. 
‘‘(2) STATES WITHOUT MANDATES.—With re-
spect to a State that does not have a covered ben-
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efit, service, or category of provider mandate in ef-
fect that is covered under the List of Required Ben-
efits under subsection (a), such mandate shall not 
apply, as applicable, to a coverage plan or plan in 
the small group, individual, or large group market or 
through a small business health plan in such State. 
‘‘(3) UNIFORM APPLICATION OF LAWS.— 
‘‘(A) IN
GENERAL.—With respect to a 
State described in paragraph (1), in applying a 
covered benefit, service, or category of provider 
mandate that is on the List of Required Bene-
fits under subsection (a) the State shall permit 
a coverage plan or plan offered in the small 
group, individual, or large group market or 
through a small business health plan in such 
State to apply such benefit, service, or category 
of provider coverage in a manner consistent 
with the manner in which such coverage is ap-
plied under one of the three most heavily sub-
scribed national health plans offered under the 
Federal Employee Health Benefits Program 
under chapter 89 of title 5, United States Code 
(as determined by the Secretary in consultation 
with the Director of the Office of Personnel 
Management), and consistent with the Publica-
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tion of Benefit Applications under subsection 
(c). In the event a covered benefit, service, or 
category of provider appearing in the List of 
Required Benefits is not offered in one of the 
three most heavily subscribed national health 
plans offered under the Federal Employees 
Health Benefits Program, such covered benefit, 
service, or category of provider requirement 
shall be applied in a manner consistent with the 
manner in which such coverage is offered in the 
remaining most heavily subscribed plan of the 
remaining Federal Employees Health Benefits 
Program plans, as determined by the Secretary, 
in consultation with the Director of the Office 
of Personnel Management. 
‘‘(B) EXCEPTION REGARDING STATE PRO-
VIDER FREEDOM OF CHOICE LAWS.—Notwith-
standing subparagraph (A), in the event a cat-
egory of provider mandate is included in the 
List of Covered Benefits, any State Provider 
Freedom of Choice Law (as defined in section 
3021(7)) that is in effect in any State in which 
such category of provider mandate is in effect 
shall not be preempted, with respect to that cat-
egory of provider, by this part. 
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‘‘(c) PUBLICATION
OF BENEFIT APPLICATIONS.— 
Not later than 3 months after the date of enactment of 
this title, and on the first day of every calendar year there-
after, the Secretary, in consultation with the Director of 
the Office of Personnel Management, shall publish in the 
Federal Register a description of such covered benefits, 
services, and categories of providers covered in that cal-
endar year by each of the three most heavily subscribed 
nationally available Federal Employee Health Benefits 
Plan options which are also included on the List of Re-
quired Benefits. 
‘‘(d) EFFECTIVE DATES.— 
‘‘(1) SMALL BUSINESS HEALTH PLANS.—With 
respect to health insurance provided to participating 
employers of small business health plans, the re-
quirements of this part (concerning lower cost plans) 
shall apply beginning on the date that is 12 months 
after the date of enactment of this title. 
‘‘(2) NON-ASSOCIATION
COVERAGE.—With re-
spect to health insurance provided to groups or indi-
viduals other than participating employers of small 
business health plans, the requirements of this part 
shall apply beginning on the date that is 15 months 
after the date of enactment of this title. 
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‘‘(e) UPDATING OF LIST OF REQUIRED BENEFITS.— 
Not later than 2 years after the date on which the list 
of required benefits is issued under subsection (a), and 
every 2 years thereafter, the Secretary, in consultation 
with the National Association of Insurance Commis-
sioners, shall update the list based on changes in the laws 
and regulations of the States. The Secretary shall issue 
the updated list by regulation, and such updated list shall 
be effective upon the first plan year following the issuance 
of such regulation. 
‘‘SEC. 3023. APPLICATION AND PREEMPTION. 
‘‘(a) SUPERCEDING OF STATE LAW.— 
‘‘(1) IN GENERAL.—This part shall supersede 
any and all State laws insofar as such laws relate to 
mandates relating to covered benefits, services, or 
categories of provider in the health insurance market 
as applied to an eligible insurer, or health insurance 
coverage issued by an eligible insurer, including with 
respect to coverage issued to a small business health 
plan, in a nonadopting State. 
‘‘(2) NONADOPTING STATES.—This part shall 
supersede any and all State laws of a nonadopting 
State (whether enacted prior to or after the date of 
enactment of this title) insofar as such laws— 
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‘‘(A) prohibit an eligible insurer from of-
fering, marketing, or implementing health in-
surance coverage consistent with the Benefit 
Choice Standards, as provided for in section 
3022(a); or 
‘‘(B) have the effect of retaliating against 
or otherwise punishing in any respect an eligible 
insurer for offering, marketing, or imple-
menting health insurance coverage consistent 
with the Benefit Choice Standards. 
‘‘(b) SAVINGS CLAUSE AND CONSTRUCTION.— 
‘‘(1) NONAPPLICATION TO ADOPTING STATES.— 
Subsection (a) shall not apply with respect to adopt-
ing States. 
‘‘(2) NONAPPLICATION
TO
CERTAIN
INSUR-
ERS.—Subsection (a) shall not apply with respect to 
insurers that do not qualify as eligible insurers who 
offer health insurance coverage in a nonadopting 
State. 
‘‘(3) NONAPPLICATION WHERE OBTAINING RE-
LIEF UNDER STATE LAW.—Subsection (a)(1) shall 
not supercede any State law of a nonadopting State 
to the extent necessary to permit individuals or the 
insurance department of the State (or other State 
agency) to obtain relief under State law to require 
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an eligible insurer to comply with the Benefit Choice 
Standards. 
‘‘(4) NO EFFECT ON PREEMPTION.—In no case 
shall this part be construed to limit or affect in any 
manner the preemptive scope of sections 502 and 
514 of the Employee Retirement Income Security 
Act of 1974. In no case shall this part be construed 
to create any cause of action under Federal or State 
law or enlarge or affect any remedy available under 
the Employee Retirement Income Security Act of 
1974. 
‘‘(5) PREEMPTION
LIMITED
TO
BENEFITS.— 
Subsection (a) shall not preempt any State law that 
does not have a reference to or a connection with 
State mandates regarding covered benefits, services, 
or categories of providers that would otherwise apply 
to eligible insurers. 
‘‘SEC. 3024. CIVIL ACTIONS AND JURISDICTION. 
‘‘(a) IN GENERAL.—The courts of the United States 
shall have exclusive jurisdiction over civil actions involving 
the interpretation of this part. 
‘‘(b) ACTIONS.—An eligible insurer may bring an ac-
tion in the district courts of the United States for injunc-
tive or other equitable relief against any officials or agents 
of a nonadopting State in connection with any conduct or 
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action, or proposed conduct or action, by such officials or 
agents which violates, or which would if undertaken vio-
late, section 3023. 
‘‘(c) DIRECT FILING IN COURT OF APPEALS.—At the 
election of the eligible insurer, an action may be brought 
under subsection (b) directly in the United States Court 
of Appeals for the circuit in which the nonadopting State 
is located by the filing of a petition for review in such 
Court. 
‘‘(d) EXPEDITED REVIEW.— 
‘‘(1) DISTRICT COURT.—In the case of an ac-
tion brought in a district court of the United States 
under subsection (b), such court shall complete such 
action, including the issuance of a judgment, prior 
to the end of the 120-day period beginning on the 
date on which such action is filed, unless all parties 
to such proceeding agree to an extension of such pe-
riod. 
‘‘(2) COURT OF APPEALS.—In the case of an 
action brought directly in a United States Court of 
Appeal under subsection (c), or in the case of an ap-
peal of an action brought in a district court under 
subsection (b), such Court shall complete all action 
on the petition, including the issuance of a judg-
ment, prior to the end of the 60-day period begin-
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ning on the date on which such petition is filed with 
the Court, unless all parties to such proceeding 
agree to an extension of such period. 
‘‘(e) STANDARD OF REVIEW.—A court in an action 
filed under this section, shall render a judgment based on 
a review of the merits of all questions presented in such 
action and shall not defer to any conduct or action, or 
proposed conduct or action, of a nonadopting State. 
‘‘SEC. 3025. RULES OF CONSTRUCTION. 
‘‘(a) IN GENERAL.—Notwithstanding any other pro-
vision of Federal or State law, a health insurance issuer 
in an adopting State or an eligible insurer in a non-adopt-
ing State may amend its existing policies to be consistent 
with the terms of this subtitle (concerning rating and ben-
efits). 
‘‘(b) HEALTH SAVINGS ACCOUNTS.—Nothing in this 
subtitle shall be construed to create any mandates for cov-
erage of benefits for HSA-qualified health plans that 
would require reimbursements in violation of section 
223(c)(2) of the Internal Revenue Code of 1986.’’. 
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Subtitle C—Harmonization of 
Health Insurance Standards 
SEC. 221. HEALTH INSURANCE STANDARDS HARMONI-
ZATION. 
Title XXX of the Public Health Service Act (as added 
by section 211) is amended by adding at the end the fol-
lowing: 
‘‘Subtitle B—Standards 
Harmonization 
‘‘SEC. 3031. DEFINITIONS. 
‘‘In this subtitle: 
‘‘(1) ADOPTING
STATE.—The term ‘adopting 
State’ means a State that has enacted the har-
monized standards adopted under this subtitle in 
their entirety and as the exclusive laws of the State 
that relate to the harmonized standards. 
‘‘(2) ELIGIBLE
INSURER.—The term ‘eligible 
insurer’ means a health insurance issuer that is li-
censed in a nonadopting State and that— 
‘‘(A) notifies the Secretary, not later than 
30 days prior to the offering of coverage de-
scribed in this subparagraph, that the issuer in-
tends to offer health insurance coverage con-
sistent with the harmonized standards in a non-
adopting State; 
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‘‘(3) HARMONIZED
STANDARDS.—The term 
‘harmonized standards’ means the standards cer-
tified by the Secretary under section 3033(d). 
‘‘(4) HEALTH
INSURANCE
COVERAGE.—The 
term ‘health insurance coverage’ means any coverage 
issued in the health insurance market, except that 
such term shall not include excepted benefits (as de-
fined in section 2791(c). 
‘‘(5) NONADOPTING
STATE.—The term ‘non-
adopting State’ means a State that fails to enact, 
within 18 months of the date on which the Secretary 
certifies the harmonized standards under this sub-
title, the harmonized standards in their entirety and 
as the exclusive laws of the State that relate to the 
harmonized standards. 
‘‘(6) STATE LAW.—The term ‘State law’ means 
all laws, decisions, rules, regulations, or other State 
actions (including actions by a State agency) having 
the effect of law, of any State. 
‘‘SEC. 3032. HARMONIZED STANDARDS. 
‘‘(a) BOARD.— 
‘‘(1) ESTABLISHMENT.—Not later than 3 
months after the date of enactment of this title, the 
Secretary, in consultation with the NAIC, shall es-
tablish the Health Insurance Consensus Standards 
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Board (referred to in this subtitle as the ‘Board’) to 
develop recommendations that harmonize incon-
sistent State health insurance laws in accordance 
with the procedures described in subsection (b). 
‘‘(2) COMPOSITION.— 
‘‘(A) IN GENERAL.—The Board shall be 
composed of the following voting members to be 
appointed by the Secretary after considering the 
recommendations of professional organizations 
representing the entities and constituencies de-
scribed in this paragraph: 
‘‘(i) Four State insurance commis-
sioners as recommended by the National 
Association of Insurance Commissioners, of 
which 2 shall be Democrats and 2 shall be 
Republicans, and of which one shall be des-
ignated as the chairperson and one shall be 
designated as the vice chairperson. 
‘‘(ii) Four representatives of State 
government, two of which shall be gov-
ernors of States and two of which shall be 
State legislators, and two of which shall be 
Democrats and two of which shall be Re-
publicans. 
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‘‘(iii) Four representatives of health 
insurers, of which one shall represent in-
surers that offer coverage in the small 
group market, one shall represent insurers 
that offer coverage in the large group mar-
ket, one shall represent insurers that offer 
coverage in the individual market, and one 
shall represent carriers operating in a re-
gional market. 
‘‘(iv) Two representatives of insurance 
agents and brokers. 
‘‘(v) Two independent representatives 
of the American Academy of Actuaries who 
have familiarity with the actuarial methods 
applicable to health insurance. 
‘‘(B) EX OFFICIO MEMBER.—A representa-
tive of the Secretary shall serve as an ex officio 
member of the Board. 
‘‘(3) ADVISORY
PANEL.—The Secretary shall 
establish an advisory panel to provide advice to the 
Board, and shall appoint its members after consid-
ering the recommendations of professional organiza-
tions representing the entities and constituencies 
identified in this paragraph: 
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‘‘(A) Two representatives of small business 
health plans. 
‘‘(B) Two representatives of employers, of 
which one shall represent small employers and 
one shall represent large employers. 
‘‘(C) Two representatives of consumer or-
ganizations. 
‘‘(D) Two representatives of health care 
providers. 
‘‘(4) QUALIFICATIONS.—The membership of the 
Board shall include individuals with national rec-
ognition for their expertise in health finance and ec-
onomics, actuarial science, health plans, providers of 
health services, and other related fields, who provide 
a mix of different professionals, broad geographic 
representation, and a balance between urban and 
rural representatives. 
‘‘(5) ETHICAL
DISCLOSURE.—The Secretary 
shall establish a system for public disclosure by 
members of the Board of financial and other poten-
tial conflicts of interest relating to such members. 
Members of the Board shall be treated as employees 
of Congress for purposes of applying title I of the 
Ethics in Government Act of 1978 (Public Law 95– 
521). 
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‘‘(6) DIRECTOR AND STAFF.—Subject to such 
review as the Secretary deems necessary to assure 
the efficient administration of the Board, the chair 
and vice-chair of the Board may— 
‘‘(A) employ and fix the compensation of 
an Executive Director (subject to the approval 
of the Comptroller General) and such other per-
sonnel as may be necessary to carry out its du-
ties (without regard to the provisions of title 5, 
United States Code, governing appointments in 
the competitive service); 
‘‘(B) seek such assistance and support as 
may be required in the performance of its du-
ties from appropriate Federal departments and 
agencies; 
‘‘(C) enter into contracts or make other ar-
rangements, as may be necessary for the con-
duct of the work of the Board (without regard 
to section 3709 of the Revised Statutes (41 
U.S.C. 5)); 
‘‘(D) make advance, progress, and other 
payments which relate to the work of the 
Board; 
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‘‘(E) provide transportation and subsist-
ence for persons serving without compensation; 
and 
‘‘(F) prescribe such rules as it deems nec-
essary with respect to the internal organization 
and operation of the Board. 
‘‘(7) TERMS.—The members of the Board shall 
serve for the duration of the Board. Vacancies in the 
Board shall be filled as needed in a manner con-
sistent with the composition described in paragraph 
(2). 
‘‘(b) DEVELOPMENT
OF
HARMONIZED
STAND-
ARDS.— 
‘‘(1) IN
GENERAL.—In accordance with the 
process described in subsection (c), the Board shall 
identify and recommend nationally harmonized 
standards for each of the following process cat-
egories: 
‘‘(A) FORM FILING AND RATE FILING.— 
Form and rate filing standards shall be estab-
lished which promote speed to market and in-
clude the following defined areas for States that 
require such filings: 
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‘‘(i) Procedures for form and rate fil-
ing pursuant to a streamlined administra-
tive filing process. 
‘‘(ii) Timeframes for filings to be re-
viewed by a State if review is required be-
fore they are deemed approved. 
‘‘(iii) Timeframes for an eligible in-
surer to respond to State requests fol-
lowing its review. 
‘‘(iv) A process for an eligible insurer 
to self-certify. 
‘‘(v) State development of form and 
rate filing templates that include only non- 
preempted State law and Federal law re-
quirements for eligible insurers with timely 
updates. 
‘‘(vi) Procedures for the resubmission 
of forms and rates. 
‘‘(vii) Disapproval rationale of a form 
or rate filing based on material omissions 
or violations of non-preempted State law or 
Federal law with violations cited and ex-
plained. 
‘‘(viii) For States that may require a 
hearing, a rationale for hearings based on 
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violations of non-preempted State law or 
insurer requests. 
‘‘(B) MARKET CONDUCT REVIEW.—Market 
conduct review standards shall be developed 
which provide for the following: 
‘‘(i) Mandatory participation in na-
tional databases. 
‘‘(ii) The confidentiality of examina-
tion materials. 
‘‘(iii) The identification of the State 
agency with primary responsibility for ex-
aminations. 
‘‘(iv) Consultation and verification of 
complaint data with the eligible insurer 
prior to State actions. 
‘‘(v) Consistency of reporting require-
ments with the recordkeeping and adminis-
trative practices of the eligible insurer. 
‘‘(vi) Examinations that seek to cor-
rect material errors and harmful business 
practices rather than infrequent errors. 
‘‘(vii) Transparency and publishing of 
the State’s examination standards. 
‘‘(viii) Coordination of market conduct 
analysis. 
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‘‘(ix) Coordination and nonduplication 
between State examinations of the same el-
igible insurer. 
‘‘(x) Rationale and protocols to be 
met before a full examination is conducted. 
‘‘(xi) 
Requirements 
on 
examiners 
prior to beginning examinations such as 
budget planning and work plans. 
‘‘(xii) Consideration of methods to 
limit examiners’ fees such as caps, com-
petitive bidding, or other alternatives. 
‘‘(xiii) Reasonable fines and penalties 
for material errors and harmful business 
practices. 
‘‘(C) PROMPT PAYMENT OF CLAIMS.—The 
Board shall establish prompt payment stand-
ards for eligible insurers based on standards 
similar to those applicable to the Social Secu-
rity Act as set forth in section 1842(c)(2) of 
such Act (42 U.S.C. 1395u(c)(2)). Such prompt 
payment standards shall be consistent with the 
timing and notice requirements of the claims 
procedure rules to be specified under subpara-
graph (D), and shall include appropriate excep-
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tions such as for fraud, nonpayment of pre-
miums, or late submission of claims. 
‘‘(D) INTERNAL
REVIEW.—The Board 
shall establish standards for claims procedures 
for eligible insurers that are consistent with the 
requirements relating to initial claims for bene-
fits and appeals of claims for benefits under the 
Employee Retirement Income Security Act of 
1974 as set forth in section 503 of such Act 
(29 U.S.C. 1133) and the regulations there-
under. 
‘‘(2) RECOMMENDATIONS.—The Board shall 
recommend harmonized standards for each element 
of the categories described in subparagraph (A) 
through (D) of paragraph (1) within each such mar-
ket. Notwithstanding the previous sentence, the 
Board shall not recommend any harmonized stand-
ards that disrupt, expand, or duplicate the benefit, 
service, or provider mandate standards provided in 
the Benefit Choice Standards pursuant to section 
3022(a). 
‘‘(c) PROCESS
FOR
IDENTIFYING
HARMONIZED 
STANDARDS.— 
‘‘(1) IN
GENERAL.—The Board shall develop 
recommendations to harmonize inconsistent State in-
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surance laws with respect to each of the process cat-
egories described in subparagraphs (A) through (D) 
of subsection (b)(1). 
‘‘(2) REQUIREMENTS.—In adopting standards 
under this section, the Board shall consider the fol-
lowing: 
‘‘(A) Any model acts or regulations of the 
National Association of Insurance Commis-
sioners in each of the process categories de-
scribed in subparagraphs (A) through (D) of 
subsection (b)(1). 
‘‘(B) Substantially similar standards fol-
lowed by a plurality of States, as reflected in 
existing State laws, relating to the specific proc-
ess categories described in subparagraphs (A) 
through (D) of subsection (b)(1). 
‘‘(C) Any Federal law requirement related 
to specific process categories described in sub-
paragraphs (A) through (D) of subsection 
(b)(1). 
‘‘(D) In the case of the adoption of any 
standard that differs substantially from those 
referred to in subparagraphs (A), (B), or (C), 
the Board shall provide evidence to the Sec-
retary that such standard is necessary to pro-
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tect health insurance consumers or promote 
speed to market or administrative efficiency. 
‘‘(E) The criteria specified in clauses (i) 
through (iii) of subsection (d)(2)(B). 
‘‘(d) RECOMMENDATIONS
AND CERTIFICATION
BY 
SECRETARY.— 
‘‘(1) RECOMMENDATIONS.—Not later than 18 
months after the date on which all members of the 
Board are selected under subsection (a), the Board 
shall recommend to the Secretary the certification of 
the harmonized standards identified pursuant to 
subsection (c). 
‘‘(2) CERTIFICATION.— 
‘‘(A) IN
GENERAL.—Not later than 120 
days after receipt of the Board’s recommenda-
tions under paragraph (1), the Secretary shall 
certify the recommended harmonized standards 
as provided for in subparagraph (B), and issue 
such standards in the form of an interim final 
regulation. 
‘‘(B) CERTIFICATION PROCESS.—The Sec-
retary shall establish a process for certifying 
the recommended harmonized standard, by cat-
egory, as recommended by the Board under this 
section. Such process shall— 
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‘‘(i) ensure that the certified stand-
ards for a particular process area achieve 
regulatory harmonization with respect to 
health plans on a national basis; 
‘‘(ii) ensure that the approved stand-
ards are the minimum necessary, with re-
gard to substance and quantity of require-
ments, to protect health insurance con-
sumers and maintain a competitive regu-
latory environment; and 
‘‘(iii) ensure that the approved stand-
ards will not limit the range of group 
health plan designs and insurance prod-
ucts, such as catastrophic coverage only 
plans, health savings accounts, and health 
maintenance organizations, that might oth-
erwise be available to consumers. 
‘‘(3) APPLICATION
AND
EFFECTIVE
DATE.— 
The standards certified by the Secretary under para-
graph (2) shall apply and become effective on the 
date that is 18 months after the date on which the 
Secretary certifies the harmonized standards. 
‘‘(e) TERMINATION.—The Board shall terminate and 
be dissolved after making the recommendations to the Sec-
retary pursuant to subsection (d)(1). 
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‘‘(f) ONGOING REVIEW.—Not earlier than 3 years 
after the termination of the Board under subsection (e), 
and not earlier than every 3 years thereafter, the Sec-
retary, in consultation with the National Association of In-
surance Commissioners and the entities and constituencies 
represented on the Board and the Advisory Panel, shall 
prepare and submit to the appropriate committees of Con-
gress a report that assesses the effect of the harmonized 
standards applied under this section on access, cost, and 
health insurance market functioning. The Secretary may, 
based on such report and applying the process established 
for certification under subsection (d)(2)(B), in consulta-
tion with the National Association of Insurance Commis-
sioners and the entities and constituencies represented on 
the Board and the Advisory Panel, update the harmonized 
standards through notice and comment rulemaking. 
‘‘(g) PUBLICATION.— 
‘‘(1) LISTING.—The Secretary shall maintain 
an up to date listing of all harmonized standards 
certified under this section on the Internet website 
of the Department of Health and Human Services. 
‘‘(2) SAMPLE CONTRACT LANGUAGE.—The Sec-
retary shall publish on the Internet website of the 
Department of Health and Human Services sample 
contract language that incorporates the harmonized 
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standards certified under this section, which may be 
used by insurers seeking to qualify as an eligible in-
surer. The types of harmonized standards that shall 
be included in sample contract language are the 
standards that are relevant to the contractual bar-
gain between the insurer and insured. 
‘‘(h) STATE ADOPTION AND ENFORCEMENT.—Not 
later than 18 months after the certification by the Sec-
retary of harmonized standards under this section, the 
States may adopt such harmonized standards (and become 
an adopting State) and, in which case, shall enforce the 
harmonized standards pursuant to State law. 
‘‘SEC. 3033. APPLICATION AND PREEMPTION. 
‘‘(a) SUPERCEDING OF STATE LAW.— 
‘‘(1) IN GENERAL.—The harmonized standards 
certified under this subtitle and applied as provided 
for in section 3033(d)(3), shall supersede any and 
all State laws of a non-adopting State insofar as 
such State laws relate to the areas of harmonized 
standards as applied to an eligible insurer, or health 
insurance coverage issued by a eligible insurer, in-
cluding with respect to coverage issued to a small 
business health plan, in a nonadopting State. 
‘‘(2) NONADOPTING
STATES.—This subtitle 
shall supersede any and all State laws of a non-
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adopting State (whether enacted prior to or after the 
date of enactment of this title) insofar as they 
may— 
‘‘(A) prohibit an eligible insurer from of-
fering, marketing, or implementing health in-
surance coverage consistent with the har-
monized standards; or 
‘‘(B) have the effect of retaliating against 
or otherwise punishing in any respect an eligible 
insurer for offering, marketing, or imple-
menting health insurance coverage consistent 
with the harmonized standards under this sub-
title. 
‘‘(b) SAVINGS CLAUSE AND CONSTRUCTION.— 
‘‘(1) NONAPPLICATION TO ADOPTING STATES.— 
Subsection (a) shall not apply with respect to adopt-
ing States. 
‘‘(2) NONAPPLICATION
TO
CERTAIN
INSUR-
ERS.—Subsection (a) shall not apply with respect to 
insurers that do not qualify as eligible insurers who 
offer health insurance coverage in a nonadopting 
State. 
‘‘(3) NONAPPLICATION WHERE OBTAINING RE-
LIEF UNDER STATE LAW.—Subsection (a)(1) shall 
not supercede any State law of a nonadopting State 
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to the extent necessary to permit individuals or the 
insurance department of the State (or other State 
agency) to obtain relief under State law to require 
an eligible insurer to comply with the harmonized 
standards under this subtitle. 
‘‘(4) NO EFFECT ON PREEMPTION.—In no case 
shall this subtitle be construed to limit or affect in 
any manner the preemptive scope of sections 502 
and 514 of the Employee Retirement Income Secu-
rity Act of 1974. In no case shall this subtitle be 
construed to create any cause of action under Fed-
eral or State law or enlarge or affect any remedy 
available under the Employee Retirement Income 
Security Act of 1974. 
‘‘(c) EFFECTIVE DATE.—This section shall apply be-
ginning on the date that is 18 months after the date on 
harmonized standards are certified by the Secretary under 
this subtitle. 
‘‘SEC. 3034. CIVIL ACTIONS AND JURISDICTION. 
‘‘(a) IN GENERAL.—The district courts of the United 
States shall have exclusive jurisdiction over civil actions 
involving the interpretation of this subtitle. 
‘‘(b) ACTIONS.—An eligible insurer may bring an ac-
tion in the district courts of the United States for injunc-
tive or other equitable relief against any officials or agents 
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of a nonadopting State in connection with any conduct or 
action, or proposed conduct or action, by such officials or 
agents which violates, or which would if undertaken vio-
late, section 3033. 
‘‘(c) DIRECT FILING IN COURT OF APPEALS.—At the 
election of the eligible insurer, an action may be brought 
under subsection (b) directly in the United States Court 
of Appeals for the circuit in which the nonadopting State 
is located by the filing of a petition for review in such 
Court. 
‘‘(d) EXPEDITED REVIEW.— 
‘‘(1) DISTRICT COURT.—In the case of an ac-
tion brought in a district court of the United States 
under subsection (b), such court shall complete such 
action, including the issuance of a judgment, prior 
to the end of the 120-day period beginning on the 
date on which such action is filed, unless all parties 
to such proceeding agree to an extension of such pe-
riod. 
‘‘(2) COURT OF APPEALS.—In the case of an 
action brought directly in a United States Court of 
Appeal under subsection (c), or in the case of an ap-
peal of an action brought in a district court under 
subsection (b), such Court shall complete all action 
on the petition, including the issuance of a judg-
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ment, prior to the end of the 60-day period begin-
ning on the date on which such petition is filed with 
the Court, unless all parties to such proceeding 
agree to an extension of such period. 
‘‘(e) STANDARD OF REVIEW.—A court in an action 
filed under this section, shall render a judgment based on 
a review of the merits of all questions presented in such 
action and shall not defer to any conduct or action, or 
proposed conduct or action, of a nonadopting State. 
‘‘SEC. 3035. AUTHORIZATION OF APPROPRIATIONS; RULE 
OF CONSTRUCTION. 
‘‘(a) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary to carry out this subtitle. 
‘‘(b) HEALTH SAVINGS ACCOUNTS.—Nothing in this 
subtitle shall be construed to create any mandates for cov-
erage of any benefits below the deductible levels set for 
any health savings account-qualified health plan pursuant 
to section 223 of the Internal Revenue Code of 1986.’’. 
TITLE III—TAX–RELATED 
HEALTH INCENTIVES 
SEC. 301. SECA TAX DEDUCTION FOR HEALTH INSURANCE 
COSTS. 
(a) IN GENERAL.—Subsection (l) of section 162 of 
the Internal Revenue Code of 1986 (relating to special 
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