(a) Additional required benefits. (1) A State may require a QHP to offer benefits in addition to the essential health benefits.
(1) A State may require a QHP to offer benefits in addition to the essential health benefits.
(2) A State-required benefit enacted on or before December 31, 2011 is not considered in addition to the essential health benefits.
(3) The Exchange shall identify which state-required benefits are in excess of EHB.
(b) Payments. The State must make payments to defray the cost of additional required benefits specified in paragraph (a) of this section to one of the following:
(1) To an enrollee, as defined in Sec. 155.20 of this subchapter; or
(2) Directly to the QHP issuer on behalf of the individual described in paragraph (b)(1) of this section.
(c) Cost of additional required benefits. (1) Each QHP issuer in the State shall quantify cost attributable to each additional required benefit specified in paragraph (a) of this section.
(1) Each QHP issuer in the State shall quantify cost attributable to each additional required benefit specified in paragraph (a) of this section.
(2) A QHP issuer's calculation shall be:
(i) Based on an analysis performed in accordance with generally accepted actuarial principles and methodologies;
(ii) Conducted by a member of the American Academy of Actuaries; and
(iii) Reported to the Exchange. [78 FR 12865, Feb. 25, 2013]