The<unk>  are a minimum federal standard and "states may require that qualified health plans sold in state health insurance exchanges also cover state-mandated<unk> ." The act gives "considerable discretion" to the Secretary of Health and Human Services to determine, through regulation, what specific services within these classes are<unk> . However, the Act provides certain parameters for the secretary to consider. The secretary (1) must "ensure that such<unk>  reflect an appropriate balance among the categories ... so that<unk>  are not unduly weighted toward any category"; (2) may "not make coverage decisions, determine reimbursement rates, establish incentive programs, or design<unk>  in ways that discriminate against individuals because of their age, disability, or expected length of life"; (3) must take into account "the health care needs of diverse segments of the population, including women, children, persons with disabilities, and other groups"; and (4) must ensure that<unk><unk>  "not be subject to denial to individuals against their wishes on the basis of the individuals’ age or expected length of life or the individuals' present or predicted disability, degree of medical dependency, or quality of life." According to a Commonwealth Fund report in 2011:
Essential health benefits
Sex differences in medicine
Automotive safety
Good clinical practice
Animal rights
Component causes
Bicycle safety
Defined contribution health benefits