24

vidual or group market, in the same manner as such provi- 1

sions apply to health insurance coverage offered in the 2
large group market. 3
SEC. 115. ENSURING ADEQUACY OF PROVIDER NETWORKS. 4
(a) IN GENERAL.A qualified health benefits plan 5
that uses a provider network for items and services shall 6
meet such standards respecting provider networks as the 7
Commissioner may establish to assure the adequacy of 8
such networks in ensuring enrollee access to such items 9
and services and transparency in the cost-sharing differen- 10
tials between in-network coverage and out-of-network cov- 11
erage. 12
(b) PROVIDER NETWORK DEFINED.In this divi- 13
sion, the term provider network means the providers 14
with respect to which covered benefits, treatments, and 15
services are available under a health benefits plan. 16
SEC. 116. ENSURING VALUE AND LOWER PREMIUMS. 17
(a) IN GENERAL.A qualified health benefits plan 18
shall meet a medical loss ratio as defined by the Commis- 19
sioner. For any plan year in which the qualified health 20
benefits plan does not meet such medical loss ratio, QHBP 21
offering entity shall provide in a manner specified by the 22
Commissioner for rebates to enrollees of payment suffi- 23
cient to meet such loss ratio. 24
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