; and (C) by inserting after clause (iii) the following: (iv) (I) agrees to offer the applicable standardized option under paragraph (5) for each level of coverage offered by the issuer that is the bronze, silver, or gold level of coverage; and (II) with respect to offering coverage that is the bronze, silver, or gold level of coverage through an Exchange that is operated by the Secretary, agrees to offer only the applicable standardized option under paragraph (5) and not any other plan for such levels of coverage; and ; and (2) by adding at the end the following: (5) Standardized options (A) Definition of standardized option In this section, the term standardized option means a qualified health plan— (i) with a standardized cost-sharing structure established by the applicable State, or the Secretary, in accordance with this paragraph; and (ii) that is offered through an Exchange. (B) Establishment (i) State Each State may establish a standardized option for the bronze, silver, and gold levels of coverage. (ii) Secretary The Secretary shall establish a standardized option in a State for any level of coverage described in clause (i) for which the State has not established a standardized option. (iii) Updates The Secretary shall annually update any standardized option established by the Secretary under clause (ii). (C) Deductible-exempt services (i) In general Except as provided in clause (ii), each standardized option established by the Secretary under subparagraph (B)(ii) shall provide coverage for and waive the application of a deductible for— (I) all primary care visits and specialist visits; (II) all mental health and substance use disorder outpatient services; (III) all drugs approved under section 505(j) of the Federal Food, Drug, and Cosmetic Act and biological products licensed under section 351(k) of the Public Health Service Act