datamatters24/research-document-archive huggingface dataset:
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HR 3590 EAS/PP 
ered individual from participation in any Fed-
eral health care program (as defined in section 
1128B(f)). 
‘‘(2) INCREASED HARM.—If a covered individual 
violates subsection (b) and the violation exacerbates 
the harm to the victim of the crime or results in harm 
to another individual— 
‘‘(A) the covered individual shall be subject 
to a civil money penalty of not more than 
$300,000; and 
‘‘(B) the Secretary may make a determina-
tion in the same proceeding to exclude the cov-
ered individual from participation in any Fed-
eral health care program (as defined in section 
1128B(f)). 
‘‘(3) EXCLUDED INDIVIDUAL.—During any pe-
riod for which a covered individual is classified as an 
excluded individual under paragraph (1)(B) or 
(2)(B), a long-term care facility that employs such 
individual shall be ineligible to receive Federal funds 
under this Act. 
‘‘(4) EXTENUATING CIRCUMSTANCES.— 
‘‘(A) IN GENERAL.—The Secretary may take 
into account the financial burden on providers
111TH CONGRESS 
1ST SESSION H. R. 3590 
AN ACT 
To amend the Internal Revenue Code of 1986 to modify 
the first-time homebuyers credit in the case of members 
of the Armed Forces and certain other Federal employ-
ees, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
232 
HR 3590 EAS/PP 
(1) IN GENERAL.—The term ‘‘applicable reinsur-
ance entity’’ means a not-for-profit organization— 
(A) the purpose of which is to help stabilize 
premiums for coverage in the individual and 
small group markets in a State during the first 
3 years of operation of an Exchange for such 
markets within the State when the risk of ad-
verse selection related to new rating rules and 
market changes is greatest; and 
(B) the duties of which shall be to carry out 
the reinsurance program under this section by 
coordinating the funding and operation of the 
risk-spreading mechanisms designed to imple-
ment the reinsurance program. 
(2) STATE
DISCRETION.—A State may have 
more than 1 applicable reinsurance entity to carry 
out the reinsurance program under this section with-
in the State and 2 or more States may enter into 
agreements to provide for an applicable reinsurance 
entity to carry out such program in all such States. 
(3) ENTITIES ARE TAX-EXEMPT.—An applicable 
reinsurance entity established under this section shall 
be exempt from taxation under chapter 1 of the Inter-
nal Revenue Code of 1986. The preceding sentence 
shall not apply to the tax imposed by section 511
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Service Members 
Home Ownership Tax Act of 2009’’. 
SEC. 2. WAIVER OF RECAPTURE OF FIRST-TIME HOME-
BUYER CREDIT FOR INDIVIDUALS ON QUALI-
FIED OFFICIAL EXTENDED DUTY. 
(a) IN GENERAL.—Paragraph (4) of section 36(f) of 
the Internal Revenue Code of 1986 is amended by adding 
at the end the following new subparagraph: 
‘‘(E) SPECIAL
RULE
FOR
MEMBERS
OF 
THE ARMED FORCES, ETC.— 
‘‘(i) IN GENERAL.—In the case of the 
disposition of a principal residence by an 
individual (or a cessation referred to in 
paragraph (2)) after December 31, 2008, 
in connection with Government orders re-
ceived by such individual, or such individ-
ual’s spouse, for qualified official extended 
duty service— 
‘‘(I) paragraph (2) and sub-
section (d)(2) shall not apply to such 
disposition (or cessation), and 
‘‘(II) if such residence was ac-
quired before January 1, 2009, para-
graph (1) shall not apply to the tax-
able year in which such disposition (or
239 
HR 3590 EAS/PP 
the Patient Protection and Affordable Care Act, 
or 
‘‘(B) the excess (if any) of— 
‘‘(i) the adjusted monthly premium for 
such month for the applicable second lowest 
cost silver plan with respect to the taxpayer, 
over 
‘‘(ii) an amount equal to 1/12 of the 
product of the applicable percentage and the 
taxpayer’s household income for the taxable 
year. 
‘‘(3) OTHER TERMS AND RULES RELATING TO 
PREMIUM
ASSISTANCE
AMOUNTS.—For purposes of 
paragraph (2)— 
‘‘(A) APPLICABLE PERCENTAGE.— 
‘‘(i) IN GENERAL.—Except as provided 
in clause (ii), the applicable percentage 
with respect to any taxpayer for any tax-
able year is equal to 2.8 percent, increased 
by the number of percentage points (not 
greater than 7) which bears the same ratio 
to 7 percentage points as— 
‘‘(I) the taxpayer’s household in-
come for the taxable year in excess of
cessation) occurs or any subsequent 
taxable year. 
‘‘(ii) QUALIFIED OFFICIAL EXTENDED 
DUTY SERVICE.—For purposes of this sec-
tion, the term ‘qualified official extended 
duty service’ means service on qualified of-
ficial extended duty as— 
‘‘(I) a member of the uniformed 
services, 
‘‘(II) a member of the Foreign 
Service of the United States, or 
‘‘(III) as an employee of the in-
telligence community. 
‘‘(iii) DEFINITIONS.—Any term used 
in this subparagraph which is also used in 
paragraph (9) of section 121(d) shall have 
the same meaning as when used in such 
paragraph.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to dispositions and cessations after 
December 31, 2008. 
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SEC. 3. EXTENSION OF FIRST-TIME HOMEBUYER CREDIT 
FOR INDIVIDUALS ON QUALIFIED OFFICIAL 
EXTENDED 
DUTY 
OUTSIDE 
THE 
UNITED 
STATES. 
(a) IN GENERAL.—Subsection (h) of section 36 of the 
Internal Revenue Code of 1986 is amended— 
(1) by striking ‘‘This section’’ and inserting the 
following: 
‘‘(1) IN GENERAL.—This section’’, and 
(2) by adding at the end the following: 
‘‘(2) SPECIAL
RULES
FOR
INDIVIDUALS
ON 
QUALIFIED
OFFICIAL
EXTENDED
DUTY
OUTSIDE 
THE UNITED STATES.—In the case of any individual 
who serves on qualified official extended duty service 
outside the United States for at least 90 days in cal-
endar year 2009 and, if married, such individual’s 
spouse— 
‘‘(A) paragraph (1) shall be applied by 
substituting ‘December 1, 2010’ for ‘December 
1, 2009’, 
‘‘(B) subsection (f)(4)(D) shall be applied 
by substituting ‘December 1, 2010’ for ‘Decem-
ber 1, 2009’, and 
‘‘(C) in lieu of subsection (g), in the case 
of a purchase of a principal residence after De-
cember 31, 2009, and before July 1, 2010, the 
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taxpayer may elect to treat such purchase as 
made on December 31, 2009, for purposes of 
this section (other than subsections (c) and 
(f)(4)(D)).’’. 
(b) COORDINATION WITH FIRST-TIME HOMEBUYER 
CREDIT FOR DISTRICT OF COLUMBIA.—Paragraph (4) of 
section 1400C(e) of such Code is amended by inserting 
‘‘(December 1, 2010, in the case of a purchase subject 
to section 36(h)(2))’’ after ‘‘December 1, 2009’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to residences purchased after No-
vember 30, 2009. 
SEC. 4. EXCLUSION FROM GROSS INCOME OF QUALIFIED 
MILITARY BASE REALIGNMENT AND CLO-
SURE FRINGE. 
(a) IN GENERAL.—Subsection (n) of section 132 of 
the Internal Revenue Code of 1986 is amended— 
(1) in subparagraph (1) by striking ‘‘this sub-
section) to offset the adverse effects on housing val-
ues as a result of a military base realignment or clo-
sure’’ and inserting ‘‘the American Recovery and 
Reinvestment Tax Act of 2009)’’, and 
(2) in subparagraph (2) by striking ‘‘clause (1) 
of’’. 
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(b) EFFECTIVE DATE.—The amendments made by 
this act shall apply to payments made after February 17, 
2009. 
SEC. 5. INCREASE IN PENALTY FOR FAILURE TO FILE A 
PARTNERSHIP OR S CORPORATION RETURN. 
(a) 
IN
GENERAL.—Sections 
6698(b)(1) 
and 
6699(b)(1) of the Internal Revenue Code of 1986 are each 
amended by striking ‘‘$89’’ and inserting ‘‘$110’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to returns for taxable years begin-
ning after December 31, 2009. 
SEC. 6. TIME FOR PAYMENT OF CORPORATE ESTIMATED 
TAXES. 
The percentage under paragraph (1) of section 
202(b) of the Corporate Estimated Tax Shift Act of 2009 
in effect on the date of the enactment of this Act is in-
creased by 0.5 percentage points. 
Æ 
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Calendar No. 175 
111TH CONGRESS 
1ST SESSION 
H. R. 3590 
AN ACT 
To amend the Internal Revenue Code of 1986 to 
modify the first-time homebuyers credit in the 
case of members of the Armed Forces and cer-
tain other Federal employees, and for other pur-
poses. 
OCTOBER 13, 2009 
Read the second time and placed on the calendar 
VerDate Nov 24 2008 
01:18 Oct 14, 2009
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HR 3590 EAS/PP 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the ‘‘Pa-
tient Protection and Affordable Care Act’’. 
(b) TABLE OF CONTENTS.—The table of contents of this 
Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—QUALITY, AFFORDABLE HEALTH CARE FOR ALL 
AMERICANS 
Subtitle A—Immediate Improvements in Health Care Coverage for All 
Americans 
Sec. 1001. Amendments to the Public Health Service Act. 
‘‘PART A—INDIVIDUAL AND GROUP MARKET REFORMS 
‘‘SUBPART II—IMPROVING COVERAGE 
‘‘Sec. 2711. No lifetime or annual limits. 
‘‘Sec. 2712. Prohibition on rescissions. 
‘‘Sec. 2713. Coverage of preventive health services. 
‘‘Sec. 2714. Extension of dependent coverage. 
‘‘Sec. 2715. Development and utilization of uniform explanation of coverage 
documents and standardized definitions. 
‘‘Sec. 2716. Prohibition of discrimination based on salary. 
‘‘Sec. 2717. Ensuring the quality of care. 
‘‘Sec. 2718. Bringing down the cost of health care coverage. 
‘‘Sec. 2719. Appeals process. 
Sec. 1002. Health insurance consumer information. 
Sec. 1003. Ensuring that consumers get value for their dollars. 
Sec. 1004. Effective dates. 
Subtitle B—Immediate Actions to Preserve and Expand Coverage 
Sec. 1101. Immediate access to insurance for uninsured individuals with a pre-
existing condition. 
Sec. 1102. Reinsurance for early retirees. 
Sec. 1103. Immediate information that allows consumers to identify affordable 
coverage options. 
Sec. 1104. Administrative simplification. 
Sec. 1105. Effective date. 
Subtitle C—Quality Health Insurance Coverage for All Americans 
PART I—HEALTH INSURANCE MARKET REFORMS 
Sec. 1201. Amendment to the Public Health Service Act.
HR 3590 EAS/PP 
‘‘SUBPART I—GENERAL REFORM 
‘‘Sec. 2704. Prohibition of preexisting condition exclusions or other discrimi-
nation based on health status. 
‘‘Sec. 2701. Fair health insurance premiums. 
‘‘Sec. 2702. Guaranteed availability of coverage. 
‘‘Sec. 2703. Guaranteed renewability of coverage. 
‘‘Sec. 2705. Prohibiting discrimination against individual participants and 
beneficiaries based on health status. 
‘‘Sec. 2706. Non-discrimination in health care. 
‘‘Sec. 2707. Comprehensive health insurance coverage. 
‘‘Sec. 2708. Prohibition on excessive waiting periods. 
PART II—OTHER PROVISIONS 
Sec. 1251. Preservation of right to maintain existing coverage. 
Sec. 1252. Rating reforms must apply uniformly to all health insurance issuers 
and group health plans. 
Sec. 1253. Effective dates. 
Subtitle D—Available Coverage Choices for All Americans 
PART I—ESTABLISHMENT OF QUALIFIED HEALTH PLANS 
Sec. 1301. Qualified health plan defined. 
Sec. 1302. Essential health benefits requirements. 
Sec. 1303. Special rules. 
Sec. 1304. Related definitions. 
PART II—CONSUMER CHOICES AND INSURANCE COMPETITION THROUGH 
HEALTH BENEFIT EXCHANGES 
Sec. 1311. Affordable choices of health benefit plans. 
Sec. 1312. Consumer choice. 
Sec. 1313. Financial integrity. 
PART III—STATE FLEXIBILITY RELATING TO EXCHANGES 
Sec. 1321. State flexibility in operation and enforcement of Exchanges and re-
lated requirements. 
Sec. 1322. Federal program to assist establishment and operation of nonprofit, 
member-run health insurance issuers. 
Sec. 1323. Community health insurance option. 
Sec. 1324. Level playing field. 
PART IV—STATE FLEXIBILITY TO ESTABLISH ALTERNATIVE PROGRAMS 
Sec. 1331. State flexibility to establish basic health programs for low-income indi-
viduals not eligible for Medicaid. 
Sec. 1332. Waiver for State innovation. 
Sec. 1333. Provisions relating to offering of plans in more than one State. 
PART V—REINSURANCE AND RISK ADJUSTMENT 
Sec. 1341. Transitional reinsurance program for individual and small group 
markets in each State. 
Sec. 1342. Establishment of risk corridors for plans in individual and small 
group markets.
HR 3590 EAS/PP 
Sec. 1343. Risk adjustment. 
Subtitle E—Affordable Coverage Choices for All Americans 
PART I—PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS 
SUBPART A—PREMIUM TAX CREDITS AND COST-SHARING REDUCTIONS 
Sec. 1401. Refundable tax credit providing premium assistance for coverage 
under a qualified health plan. 
Sec. 1402. Reduced cost-sharing for individuals enrolling in qualified health 
plans. 
SUBPART B—ELIGIBILITY DETERMINATIONS 
Sec. 1411. Procedures for determining eligibility for Exchange participation, pre-
mium tax credits and reduced cost-sharing, and individual re-
sponsibility exemptions. 
Sec. 1412. Advance determination and payment of premium tax credits and cost- 
sharing reductions. 
Sec. 1413. Streamlining of procedures for enrollment through an exchange and 
State Medicaid, CHIP, and health subsidy programs. 
Sec. 1414. Disclosures to carry out eligibility requirements for certain programs. 
Sec. 1415. Premium tax credit and cost-sharing reduction payments disregarded 
for Federal and Federally-assisted programs. 
PART II—SMALL BUSINESS TAX CREDIT 
Sec. 1421. Credit for employee health insurance expenses of small businesses. 
Subtitle F—Shared Responsibility for Health Care 
PART I—INDIVIDUAL RESPONSIBILITY 
Sec. 1501. Requirement to maintain minimum essential coverage. 
Sec. 1502. Reporting of health insurance coverage. 
PART II—EMPLOYER RESPONSIBILITIES 
Sec. 1511. Automatic enrollment for employees of large employers. 
Sec. 1512. Employer requirement to inform employees of coverage options. 
Sec. 1513. Shared responsibility for employers. 
Sec. 1514. Reporting of employer health insurance coverage. 
Sec. 1515. Offering of Exchange-participating qualified health plans through cafe-
teria plans. 
Subtitle G—Miscellaneous Provisions 
Sec. 1551. Definitions. 
Sec. 1552. Transparency in government. 
Sec. 1553. Prohibition against discrimination on assisted suicide. 
Sec. 1554. Access to therapies. 
Sec. 1555. Freedom not to participate in Federal health insurance programs. 
Sec. 1556. Equity for certain eligible survivors. 
Sec. 1557. Nondiscrimination. 
Sec. 1558. Protections for employees. 
Sec. 1559. Oversight. 
Sec. 1560. Rules of construction.
HR 3590 EAS/PP 
Sec. 1561. Health information technology enrollment standards and protocols. 
Sec. 1562. Conforming amendments. 
Sec. 1563. Sense of the Senate promoting fiscal responsibility. 
TITLE II—ROLE OF PUBLIC PROGRAMS 
Subtitle A—Improved Access to Medicaid 
Sec. 2001. Medicaid coverage for the lowest income populations. 
Sec. 2002. Income eligibility for nonelderly determined using modified gross in-
come. 
Sec. 2003. Requirement to offer premium assistance for employer-sponsored insur-
ance. 
Sec. 2004. Medicaid coverage for former foster care children. 
Sec. 2005. Payments to territories. 
Sec. 2006. Special adjustment to FMAP determination for certain States recov-
ering from a major disaster. 
Sec. 2007. Medicaid Improvement Fund rescission. 
Subtitle B—Enhanced Support for the Children’s Health Insurance Program 
Sec. 2101. Additional federal financial participation for CHIP. 
Sec. 2102. Technical corrections. 
Subtitle C—Medicaid and CHIP Enrollment Simplification 
Sec. 2201. Enrollment Simplification and coordination with State Health Insur-
ance Exchanges. 
Sec. 2202. Permitting hospitals to make presumptive eligibility determinations 
for all Medicaid eligible populations. 
Subtitle D—Improvements to Medicaid Services 
Sec. 2301. Coverage for freestanding birth center services. 
Sec. 2302. Concurrent care for children. 
Sec. 2303. State eligibility option for family planning services. 
Sec. 2304. Clarification of definition of medical assistance. 
Subtitle E—New Options for States to Provide Long-Term Services and 
Supports 
Sec. 2401. Community First Choice Option. 
Sec. 2402. Removal of barriers to providing home and community-based services. 
Sec. 2403. Money Follows the Person Rebalancing Demonstration. 
Sec. 2404. Protection for recipients of home and community-based services 
against spousal impoverishment. 
Sec. 2405. Funding to expand State Aging and Disability Resource Centers. 
Sec. 2406. Sense of the Senate regarding long-term care. 
Subtitle F—Medicaid Prescription Drug Coverage 
Sec. 2501. Prescription drug rebates. 
Sec. 2502. Elimination of exclusion of coverage of certain drugs. 
Sec. 2503. Providing adequate pharmacy reimbursement. 
Subtitle G—Medicaid Disproportionate Share Hospital (DSH) Payments 
Sec. 2551. Disproportionate share hospital payments.
HR 3590 EAS/PP 
‘‘(4) with respect to women, such additional pre-
ventive care and screenings not described in para-
graph (1) as provided for in comprehensive guidelines 
supported by the Health Resources and Services Ad-
ministration for purposes of this paragraph. 
‘‘(5) for the purposes of this Act, and for the pur-
poses of any other provision of law, the current rec-
ommendations of the United States Preventive Service 
Task Force regarding breast cancer screening, mam-
mography, and prevention shall be considered the 
most current other than those issued in or around No-
vember 2009. 
Nothing in this subsection shall be construed to prohibit a 
plan or issuer from providing coverage for services in addi-
tion to those recommended by United States Preventive 
Services Task Force or to deny coverage for services that 
are not recommended by such Task Force. 
‘‘(b) INTERVAL.— 
‘‘(1) IN GENERAL.—The Secretary shall establish 
a minimum interval between the date on which a rec-
ommendation described in subsection (a)(1) or (a)(2) 
or a guideline under subsection (a)(3) is issued and 
the plan year with respect to which the requirement 
described in subsection (a) is effective with respect to
HR 3590 EAS/PP 
the service described in such recommendation or 
guideline. 
‘‘(2) MINIMUM.—The interval described in para-
graph (1) shall not be less than 1 year. 
‘‘(c) VALUE-BASED INSURANCE DESIGN.—The Sec-
retary may develop guidelines to permit a group health 
plan and a health insurance issuer offering group or indi-
vidual health insurance coverage to utilize value-based in-
surance designs. 
‘‘SEC. 2714. EXTENSION OF DEPENDENT COVERAGE. 
‘‘(a) IN GENERAL.—A group health plan and a health 
insurance issuer offering group or individual health insur-
ance coverage that provides dependent coverage of children 
shall continue to make such coverage available for an adult 
child (who is not married) until the child turns 26 years 
of age. Nothing in this section shall require a health plan 
or a health insurance issuer described in the preceding sen-
tence to make coverage available for a child of a child re-
ceiving dependent coverage. 
‘‘(b) REGULATIONS.—The Secretary shall promulgate 
regulations to define the dependents to which coverage shall 
be made available under subsection (a). 
‘‘(c) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to modify the definition of ‘depend-
HR 3590 EAS/PP 
ent’ as used in the Internal Revenue Code of 1986 with re-
spect to the tax treatment of the cost of coverage. 
‘‘SEC. 2715. DEVELOPMENT AND UTILIZATION OF UNIFORM 
EXPLANATION OF COVERAGE DOCUMENTS 
AND STANDARDIZED DEFINITIONS. 
‘‘(a) IN GENERAL.—Not later than 12 months after the 
date of enactment of the Patient Protection and Affordable 
Care Act, the Secretary shall develop standards for use by 
a group health plan and a health insurance issuer offering 
group or individual health insurance coverage, in com-
piling and providing to enrollees a summary of benefits and 
coverage explanation that accurately describes the benefits 
and coverage under the applicable plan or coverage. In de-
veloping such standards, the Secretary shall consult with 
the National Association of Insurance Commissioners (re-
ferred to in this section as the ‘NAIC’), a working group 
composed of representatives of health insurance-related con-
sumer advocacy organizations, health insurance issuers, 
health care professionals, patient advocates including those 
representing individuals with limited English proficiency, 
and other qualified individuals. 
‘‘(b) REQUIREMENTS.—The standards for the sum-
mary of benefits and coverage developed under subsection 
(a) shall provide for the following:
HR 3590 EAS/PP 
‘‘(1) APPEARANCE.—The standards shall ensure 
that the summary of benefits and coverage is pre-
sented in a uniform format that does not exceed 4 
pages in length and does not include print smaller 
than 12-point font. 
‘‘(2) LANGUAGE.—The standards shall ensure 
that the summary is presented in a culturally and 
linguistically appropriate manner and utilizes termi-
nology understandable by the average plan enrollee. 
‘‘(3) CONTENTS.—The standards shall ensure 
that the summary of benefits and coverage includes— 
‘‘(A) uniform definitions of standard insur-
ance terms and medical terms (consistent with 
subsection (g)) so that consumers may compare 
health insurance coverage and understand the 
terms of coverage (or exception to such coverage); 
‘‘(B) a description of the coverage, includ-
ing cost sharing for— 
‘‘(i) each of the categories of the essen-
tial health benefits described in subpara-
graphs (A) through (J) of section 1302(b)(1) 
of the Patient Protection and Affordable 
Care Act; and 
‘‘(ii) other benefits, as identified by the 
Secretary;
HR 3590 EAS/PP 
‘‘(C) the exceptions, reductions, and limita-
tions on coverage; 
‘‘(D) the cost-sharing provisions, including 
deductible, coinsurance, and co-payment obliga-
tions; 
‘‘(E) the renewability and continuation of 
coverage provisions; 
‘‘(F) a coverage facts label that includes ex-
amples to illustrate common benefits scenarios, 
including pregnancy and serious or chronic med-
ical conditions and related cost sharing, such 
scenarios to be based on recognized clinical prac-
tice guidelines; 
‘‘(G) a statement of whether the plan or cov-
erage— 
‘‘(i) provides minimum essential cov-
erage (as defined under section 5000A(f) of 
the Internal Revenue Code 1986); and 
‘‘(ii) ensures that the plan or coverage 
share of the total allowed costs of benefits 
provided under the plan or coverage is not 
less than 60 percent of such costs; 
‘‘(H) a statement that the outline is a sum-
mary of the policy or certificate and that the 
coverage document itself should be consulted to
HR 3590 EAS/PP 
determine the governing contractual provisions; 
and 
‘‘(I) a contact number for the consumer to 
call with additional questions and an Internet 
web address where a copy of the actual indi-
vidual coverage policy or group certificate of cov-
erage can be reviewed and obtained. 
‘‘(c) PERIODIC REVIEW
AND UPDATING.—The Sec-
retary shall periodically review and update, as appropriate, 
the standards developed under this section. 
‘‘(d) REQUIREMENT TO PROVIDE.— 
‘‘(1) IN GENERAL.—Not later than 24 months 
after the date of enactment of the Patient Protection 
and Affordable Care Act, each entity described in 
paragraph (3) shall provide, prior to any enrollment 
restriction, a summary of benefits and coverage expla-
nation pursuant
to the standards developed by the 
Secretary under subsection (a) to— 
‘‘(A) an applicant at the time of applica-
tion; 
‘‘(B) an enrollee prior to the time of enroll-
ment or reenrollment, as applicable; and 
‘‘(C) a policyholder or certificate holder at 
the time of issuance of the policy or delivery of 
the certificate.