(a) Every individual and small group accident and health insurance policy that provides hospital, surgical, or medical expense coverage and is not a grandfathered health plan, and every student accident and health insurance policy shall provide coverage of at least the following essential health benefits:

1. (1) ambulatory patient services, such as office visits, ambulatory surgical services, dialysis, radiology services, chemotherapy, infertility treatment, abortion services, hospice care, and diabetic equipment, supplies and self-management education;
2. (2) emergency services, such as emergency room services, urgent care services, and ambulance services;
3. (3) hospitalization, such as preadmission testing, inpatient physician and surgical services, hospital care, skilled nursing facility care, and hospice care;
4. (4) maternity and newborn care, such as delivery, prenatal and postnatal care, and breastfeeding education and equipment;
5. (5) mental health and substance use disorder services, including behavioral health treatment, such as inpatient and outpatient services for the diagnosis and treatment of mental, nervous and emotional disorders including maternal depression, screening, diagnosis and treatment for autism spectrum disorder, and inpatient and outpatient services for the diagnosis and treatment of substance use disorder;
6. (6) prescription drugs, such as coverage for generic, brand name and specialty drugs, enteral formulas, contraceptive drugs and devices, abortifacient drugs, and orally administered anti-cancer medication;
7. (7) rehabilitative and habilitative services and devices, such as durable medical equipment, medical supplies, prosthetic devices, hearing aids, chiropractic care, physical therapy, occupational therapy, speech therapy, and home health care;
8. (8) laboratory services, such as diagnostic testing;
9. (9) preventive and wellness services and chronic disease management, such as well child visits, immunizations, mammography, gynecological exams including cervical cytology screening, bone density measurements or testing, and prostate cancer screening; and
10. (10) pediatric services, including oral and vision care, such as preventive and routine pediatric vision and dental care, and prescription lenses and frames.

(c) Subject to subdivisions (d) and (e) of this section, the superintendent may select the New York Benchmark Plan in consultation with the Commissioner of Health from any of the following plans:

1. (1) small group market health plan. The largest health plan by enrollment in any of the three largest small group insurance products by enrollment in the small group market in this State;
2. (2) State employee health benefit plan. Any of the largest three employee health benefit plan options by enrollment offered and generally available to State employees in this State;
3. (3) FEHBP plan. Any of the largest three national Federal Employees Health Benefits Program (FEHBP) plan options by aggregate enrollment that is offered to all health-benefits-eligible Federal employees under 5 U.S.C. section 8903;
4. (4) HMO. The coverage plan with the largest insured commercial non-Medicaid enrollment offered by a health maintenance organization operating in this State;
5. (5) any other plan identified by the superintendent as a typical employer plan providing the coverage of essential health benefits required by this section;
6. (6) an essential health benefit benchmark plan that another state used for the 2017 plan year;
7. (7) replacing one or more categories of essential health benefits in the New York Benchmark Plan used for the 2017 plan year with the same category or categories of essential health benefits from a benchmark plan that another state used for the 2017 plan year; or

8. (8) any other set of benefits that the superintendent selects that would become the New York Benchmark Plan.

   (d)

9. (1) In order to be eligible to be selected as the New York Benchmark Plan, a plan shall provide coverage of at least the categories of benefits identified in subdivision (a) of this section.

10. (2) Coverage in each benefit category. A plan not providing any coverage in one or more of the categories described in paragraph (1) of this subdivision may be selected as the New York Benchmark Plan if the plan is supplemented as follows:

    1. (i) general supplementation methodology. A plan that does not include items or services within one or more of the categories described in subdivision (a) of this section shall be supplemented by the addition of the entire category of such benefits offered under any other benchmark plan option described in subdivision (c) of this section unless otherwise described in this subdivision;

    2. (ii) supplementing pediatric oral services. A plan lacking the category of pediatric oral services shall be supplemented by the addition of the entire category of pediatric oral benefits from one of the following:

       1. (a) the Federal Employees Dental/Vision Program (FEDVIP) dental plan with the largest national enrollment that is described in and offered to Federal employees under 5 U.S.C. section 8952; or
       2. (b) the benefits available under that State's separate Children’s Health Insurance Program (CHIP) plan, if a separate CHIP plan exists, to the eligibility group with the highest enrollment;

    3. (iii) supplementing pediatric vision services. A plan lacking the category of pediatric vision services shall be supplemented by the addition of the entire category of pediatric vision benefits from one of the following:

       1. (a) the FEDVIP vision plan with the largest national enrollment that is offered to Federal employees under 5 U.S.C. section 8982; or
       2. (b) the benefits available under the State's separate CHIP plan, if a separate CHIP plan exists, to the eligibility group with the highest enrollment.