The Affordable Care Act establishes requirements and options for states that build on existing state regulation of health insurance. These include standard-price insurance coverage for individuals with pre-existing conditions, family coverage that includes dependent members up to age 26, expanded review of premium rates, required ratios of insurer expenditures on health services, consumer assistance or ombudsman offices and patients’ rights to appeal denied coverage. A dozen such provisions are in place for 2010-2013, including optional federal grants to states. In 2011-13 at least 45 states considered related bills. A major focus for 2013 is more uniform mandated "essential health benefits" based on latest HHS regulations. Future provisions include preventive screenings and services with no co-payments, no lifetime or annual limits on standard policies and options for multi-state or out-of-state health insurance purchasing.