of a family whose applicable modified gross 
income (expressed as a percentage of the 
poverty 
level, 
as 
defined 
in 
section 
2261(b)(2)) is equal to or exceeds 200 per-
cent, but does not exceed 300 percent, of 
the poverty level applicable to a family of 
the size involved, whenever in a calendar 
year an individual’s expenses in the family 
for premiums under this title and for the 
deductible and coinsurance with respect to 
services covered under this title (including 
expenses for benefits described in sub-
section (c)) and furnished during the year 
equals 5 percent of the amount of such ap-
plicable modified gross income for the fam-
ily— 
‘‘(I) no additional premiums shall 
be imposed for remaining months in 
the year; and 
‘‘(II) payment of benefits under 
this title for members of such family 
for services furnished during the re-
mainder of the year shall be paid 
without the application of any deduct-
ible or coinsurance. 
VerDate Aug 31 2005 
22:10 Apr 10, 2007
Jkt 059200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H1841.IH
H1841
jlentini on PROD1PC65 with BILLS
‘‘(ii) INCOME BETWEEN 300 AND 500 
PERCENT OF POVERTY LINE.—In the case 
of a family whose applicable modified gross 
income (expressed as a percentage of the 
poverty 
level, 
as 
defined 
in 
section 
2261(b)(2)) exceeds 300 percent, but does 
not exceed 500 percent, of such poverty 
level applicable to a family of the size in-
volved, whenever in a calendar year an in-
dividual’s expenses in the family for pre-
miums under this title and for the deduct-
ible and coinsurance with respect to serv-
ices covered under this title (including ex-
penses for benefits described in subsection 
(c)) and furnished during the year equals 
7.5 percent of the amount of such applica-
ble modified gross income for the family— 
‘‘(I) no additional premiums shall 
be imposed for remaining months in 
the year; and 
‘‘(II) payment of benefits under 
this title for members of such family 
for services furnished during the re-
mainder of the year shall be paid 
VerDate Aug 31 2005 
22:10 Apr 10, 2007
Jkt 059200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H1841.IH
H1841
jlentini on PROD1PC65 with BILLS
without the application of any deduct-
ible or coinsurance. 
‘‘(C) COUNTING ALL EXPENSES FOR PRE-
MIUMS, 
DEDUCTIBLES
AND
COINSURANCE 
WITHOUT
REGARD
TO
TRUE
OUT-OF-POCKET 
COSTS.—In applying subparagraphs (A) and 
(B), expenses for an individual’s premiums, de-
ductible, and coinsurance shall be counted with-
out regard to whether such expenses are paid, 
payable, reimbursed, or reimbursable by an-
other person, including through a group health 
plan, insurance or otherwise, or other third 
party payment arrangement. 
‘‘(4) INDEXING
DOLLAR
AMOUNTS
BY
CPI.— 
Each dollar amount specified in paragraphs (1) and 
(3)(A) shall be increased to the year involved by the 
compounded sum of the increase in the consumer 
price index for all urban consumers (U.S. City aver-
age, as published by the Bureau of Labor Statistics 
of the Department of Labor) for each year after 
2007 and up to the year involved. Any increase 
under this paragraph for a year shall be rounded, 
with respect to paragraph (1), to the nearest mul-
tiple of $5 and, with respect to paragraph (2), to the 
nearest multiple of $100. 
VerDate Aug 31 2005 
22:10 Apr 10, 2007
Jkt 059200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H1841.IH
H1841
jlentini on PROD1PC65 with BILLS
‘‘(c) PRESCRIPTION DRUGS.—Benefits shall also be 
made available under this title (as specified by the Sec-
retary) for prescription drugs and biologicals which are 
not less than the benefits for such drugs and biologicals 
under the standard option for the service benefit plan de-
scribed in section 8903(1) of title 5, United States Code, 
offered during 2006. 
‘‘(d) CHILDREN.— 
‘‘(1) NO DEDUCTIBLES OR COINSURANCE.—In 
the case of children (as defined in section 
2261(a)(1)), there shall be no deductible or coinsur-
ance applicable to covered benefits (including bene-
fits described in paragraphs (2) and (3)). 
‘‘(2) ADDITIONAL PREVENTIVE BENEFITS.— 
‘‘(A) IN GENERAL.—Subject to the perio-
dicity schedule established with respect to the 
services under subparagraph (B), for children 
benefits shall be available under this title for 
the following items and services: 
‘‘(i) Newborn and well-baby care, in-
cluding normal newborn care and pediatri-
cian services for high-risk deliveries. 
‘‘(ii) Well-child care, including routine 
office visits, routine immunizations (includ-
VerDate Aug 31 2005 
22:10 Apr 10, 2007
Jkt 059200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H1841.IH
H1841
jlentini on PROD1PC65 with BILLS
ing the vaccine itself), routine laboratory 
tests, and preventive dental care. 
‘‘(B) PERIODICITY SCHEDULE.—The Sec-
retary, in consultation with the American Acad-
emy of Pediatrics and the American Dental As-
sociation, shall establish a schedule of perio-
dicity which reflects the general, appropriate 
frequency with which services listed in subpara-
graph (A) should be provided to healthy chil-
dren. 
‘‘(3) COVERAGE OF EPSDT.—For children, ben-
efits also shall be available under this title for early 
and periodic screening, diagnostic, and treatment 
services (as defined in section 1905(r)) not otherwise 
covered under paragraph (2). 
‘‘(4) OTHER ADDITIONAL SERVICES FOR CHIL-
DREN.—For children, benefits also shall be available 
under this title for the following: 
‘‘(A) Inpatient hospital services (without 
regard to the restrictions described in sub-
sections (a)(1) and (b)(1) of section 1812 and 
the 
coinsurance 
described 
in 
section 
1813(a)(1)). 
‘‘(B) Eyeglasses and hearing aids, and ex-
aminations therefor. 
VerDate Aug 31 2005 
22:10 Apr 10, 2007
Jkt 059200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H1841.IH
H1841
jlentini on PROD1PC65 with BILLS
‘‘(e) PREGNANCY-RELATED SERVICES.—In the case 
of a pregnant woman (as defined in section 2261(a)(3)), 
benefits under this title shall include entitlement to have 
payment made for the following, without the application 
of a deductible or coinsurance: 
‘‘(1) Prenatal care, including care for all com-
plications of pregnancy. 
‘‘(2) Inpatient labor and delivery services. 
‘‘(3) Postnatal care. 
‘‘(f) LOWER-INCOME INDIVIDUALS.— 
‘‘(1) LIMITATIONS ON DEDUCTIBLES AND COIN-
SURANCE.— 
‘‘(A) NONE
FOR
LOW-INCOME
INDIVID-
UALS.—In the case of a low-income individual, 
there shall be no deductible or coinsurance 
under this title. 
‘‘(B) PHASE-IN
FOR
OTHER
LOWER-IN-
COME INDIVIDUALS.—In the case of an indi-
vidual whose applicable modified gross income 
(as defined in section 2261(b)(1)) exceeds twice 
the poverty level (as defined in section 
2261(b)(2)) but does not exceed three times the 
poverty level, the deductible and coinsurance 
applicable under this title shall bear the same 
VerDate Aug 31 2005 
22:10 Apr 10, 2007
Jkt 059200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H1841.IH
H1841
jlentini on PROD1PC65 with BILLS