<?xml version='1.0' encoding='utf-8'?>
<section article="gin" article_name="Insurance" number="15-1A-20" title_number="15" title_name="Health Insurance" subtitle_number="1A" subtitle_name="Consumer Protections">
  <level label="a">
    <level label="1">
      <text>This section applies only to individual plans and small group plans.</text>
    </level>
    <level label="2">
      <text>The requirements in this section are in addition to and not in substitution of any other requirements of law related to prescription drug benefits.</text>
    </level>
  </level>
  <level label="b">
    <level label="1">
      <text>Except as provided in paragraph (2) of this subsection, an individual plan or a small group plan shall be considered to provide prescription drug essential health benefits only if the individual plan or small group plan complies with 45 C.F.R. § 156.122.</text>
    </level>
    <level label="2">
      <text>If the Commissioner adopts regulations as described in subsection (c) of this section, an individual plan or a small group plan shall be considered to provide prescription drug essential health benefits only if the individual plan or small group plan complies with the regulations adopted by the Commissioner.</text>
    </level>
  </level>
  <level label="c">
    <text>To the extent necessary, the Commissioner shall adopt regulations that:</text>
    <level label="1">
      <text>establish criteria to determine whether an individual plan or a small group plan provides prescription drug essential health benefit coverage; and</text>
    </level>
    <level label="2">
      <text>are consistent with 45 C.F.R. § 156.122 and any corresponding federal rules and guidance as those provisions were in effect December 31, 2024.</text>
    </level>
  </level>
</section>
