,i  #aaf? ,,congress  #b;d ,session  ,h4
 ,r4 #ehag  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,febru>y #g1 #bjbj,mr4
 ,nunes 7= himself & ,mr4 ,pascrell7    
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce1 & 9 
addition to ! ,committees on ,ways &    
,means1 & ,education & ,labor1 = a p]iod
 to be subsequ5tly det]m9$ by ! ,speak]1
 9 ea* case = consid]ation ( su*        
provisions z fall )9 ! jurisdiction ( ! 
committee conc]n$  ,a ,,bill  ,to am5d  
title ,,xxvii ( ! ,public ,heal? ,s]vice
 ,act1 ! ,int]nal ,rev5ue ,code ( #aihf1
 & ! ,employee ,retirem5t ,income       
,security ,act ( #aigd to require heal? 
plans to provide to p>ticipants1        
b5efici>ies1 & enrollees an advanc$     
explanation ( b5efits ) respect to items
 & s]vices s*$ul$ to be receiv$ f       
provid]s & facilities & to am5d title   
,,xi ( ! ,social ,security ,act to      
require heal? c>e provid]s & heal? c>e  
facilities to provide good fai? e/imates
 ( ! expect$ *>ges = furni%+ su* items &

 s]vices4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,fair & ,hone/ ,advance    
,co/ ,e/imate = ,pati5ts ,act ( #bjbj4  
#b4 ,advanc$ explanation ( b5efits  7a7 
,heal? plan requirem5ts  7#a7 ,public   
,heal? ,s]vice ,act am5dm5t ,subp>t ,,ii
 ( "p ,a ( title ,,xxvii ( ! ,public    
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#cjj;gg-#aa et seq47 is am5d$ by add+ at
 ! end ! foll[+ new section3  #bgcj4    
,advanc$ explanation ( b5efits  7a7 ,9  
g5]al ,beg9n+ on ,janu>y #a1 #bjbb1 ea* 
heal? plan %all1 ) respect to a         
notification submitt$ "u section        
#aabh;,a7t77#a77;,b7 ( ! ,social        
,security ,act by a heal? c>e provid] or
 heal? c>e facility1 respectively1 to ! 
heal? plan = a p>ticipant1 b5efici>y1 or
 enrollee "u su* heal? plan s*$ul$ to   
receive an item or s]vice f ! provid] or
 facility1 n lat] ?an #a bus9ess day    
7or1 9 ! case su* item or s]vice 0 s    
s*$ul$ at lea/ #aj bus9ess days be=e su*
 item or s]vice is to be furni%$ 7or 9 !
 case su* notification 0 made pursuant  

to a reque/ by su* p>ticipant1          
b5efici>y1 or enrollee71 #c bus9ess     
days7 aft] ! date on :i* ! heal? plan   
receives su* notification1 provide to ! 
p>ticipant1 b5efici>y1 or enrollee      
7?r\gh mail or electronic means1 z      
reque/$ by ! p>ticipant1 b5efici>y1 or  
enrollee7 a notification includ+ !      
foll[+3  7#a7 ,:e!r or n ! provid] or   
facility is a p>ticipat+ provid] or a   
p>ticipat+ facility ) respect to ! heal?
 plan ) respect to ! furni%+ ( su* item 
or s]vice &--  7,a7 9 ! case ! provid]  
or facility is a p>ticipat+ provid] or  
facility ) respect to ! heal? plan )    
respect to ! furni%+ ( su* item or      
s]vice1 ! contract$ rate "u su* plan =  
su* item or s]vice2 &  7,b7 9 ! case !  
provid] or facility is a nonp>ticipat+  
provid] or facility ) respect to su*    
plan1 a description ( h[ su* p>ticipant1
 b5efici>y1 or enrollee may obta9       
in=mation on provid]s & facilities t1 ) 
respect to su* heal? plan1 are          
p>ticipat+ provid]s & facilities4  7#b7 

,! good fai? e/imate includ$ 9 !        
notification receiv$ f ! provid] or     
facility4  7#c7 ,a good fai? e/imate ( !
 am\nt ! heal? plan is responsible =    
pay+ = items & s]vices includ$ 9 !      
e/imate describ$ 9 p>agraph 7#b74  7#d7 
,a good fai? e/imate ( ! am\nt ( any    
co/-%>+ 7includ+ ) respect to !         
d$uctible & any copaym5t or co9surance  
obligation7 = :i* ! p>ticipant1         
b5efici>y1 or enrollee w\ld be          
responsible = su* item or s]vice 7z ( ! 
date ( su* notification74  7#e7 ,a good 
fai? e/imate ( ! am\nt t ! p>ticipant1  
b5efici>y1 or enrollee has incurr$ t[>d 
meet+ ! limit ( ! f9ancial              
responsibility 7includ+ ) respect to    
d$uctibles & out-(-pocket maximums7 "u !
 heal? plan 7z ( ! date ( su*           
notification74  7#f7 ,9 ! case su* item 
or s]vice is subject to a m$ical        
managem5t te*nique 7includ+ concurr5t   
review1 prior au?orization1 & /ep-!rapy 
or fail-fir/ protocols7 = cov]age "u !  
heal? plan1 a disclaim] t cov]age = su* 

item or s]vice is subject to su* m$ical 
managem5t te*nique4  7#g7 ,a disclaim] t
 ! in=mation provid$ 9 ! notification is
 only an e/imate bas$ on ! items &      
s]vices reasonably expect$1 at ! "t (   
s*$ul+ 7or reque/+7 ! item or s]vice1 to
 be furni%$ & is subject to *ange4  7#h7
 ,any o!r in=mation or disclaim] ! heal?
 plan det]m9es appropriate t is consi/5t
 ) in=mation & disclaim]s requir$ "u ?is
 section4  7b7 ,heal? plan def9$ ,9 ?is 
section1 ! t]m heal? plan means a gr\p  
heal? plan & heal? insurance cov]age    
(f]$ by a hea? insurance issu] 9 ! gr\p 
or individual m>ket & includes a        
gr&fa!r$ heal? plan 7z def9$ 9 section  
#abea7;e7 ( ! ,pati5t ,protection &     
,af=dable ,c>e ,act74  4  7#b7 ,int]nal 
,rev5ue ,code ( #aihf am5dm5t  7,a7 ,9  
g5]al ,sub*apt] ,b ( *apt] #ajj ( !     
,int]nal ,rev5ue ,code ( #aihf is am5d$ 
by add+ at ! end ! foll[+ new section3  
#ihaf4 ,advanc$ explanation ( b5efits   
7a7 ,9 g5]al ,beg9n+ on ,janu>y #a1     
#bjbb1 ea* heal? plan %all1 ) respect to

 a notification submitt$ "u section     
#aabh;,a7t77#a77;,b7 ( ! ,social        
,security ,act by a heal? c>e provid] or
 heal? c>e facility1 respectively1 to ! 
heal? plan = a p>ticipant or b5efici>y  
"u su* heal? plan s*$ul$ to receive an  
item or s]vice f ! provid] or facility1 
n lat] ?an #a bus9ess day 7or1 9 ! case 
su* item or s]vice 0 s s*$ul$ at lea/   
#aj bus9ess days be=e su* item or s]vice
 is to be furni%$ 7or 9 ! case su*      
notification 0 made pursuant to a reque/
 by su* p>ticipant or b5efici>y71 #c    
bus9ess days7 aft] ! date on :i* ! heal?
 plan receives su* notification1 provide
 to ! p>ticipant or b5efici>y 7?r\gh    
mail or electronic means1 z reque/$ by !
 p>ticipant or b5efici>y7 a notification
 includ+ ! foll[+3  7#a7 ,:e!r or n !   
provid] or facility is a p>ticipat+     
provid] or a p>ticipat+ facility )      
respect to ! heal? plan ) respect to !  
furni%+ ( su* item or s]vice &--  7,a7 9
 ! case ! provid] or facility is a      
p>ticipat+ provid] or facility ) respect

 to ! heal? plan ) respect to ! furni%+ 
( su* item or s]vice1 ! contract$ rate  
"u su* plan = su* item or s]vice2 &     
7,b7 9 ! case ! provid] or facility is a
 nonp>ticipat+ provid] or facility )    
respect to su* plan1 a description ( h[ 
su* p>ticipant or b5efici>y may obta9   
in=mation on provid]s & facilities t1 ) 
respect to su* heal? plan1 are          
p>ticipat+ provid]s & facilities4  7#b7 
,! good fai? e/imate includ$ 9 !        
notification receiv$ f ! provid] or     
facility4  7#c7 ,a good fai? e/imate ( !
 am\nt ! heal? plan is responsible =    
pay+ = items & s]vices includ$ 9 !      
e/imate describ$ 9 p>agraph 7#b74  7#d7 
,a good fai? e/imate ( ! am\nt ( any    
co/-%>+ 7includ+ ) respect to !         
d$uctible & any copaym5t or co9surance  
obligation7 = :i* ! p>ticipant or       
b5efici>y w\ld be responsible = su* item
 or s]vice 7z ( ! date ( su*            
notification74  7#e7 ,a good fai?       
e/imate ( ! am\nt t ! p>ticipant or     
b5efici>y has incurr$ t[>d meet+ ! limit

 ( ! f9ancial responsibility 7includ+ ) 
respect to d$uctibles & out-(-pocket    
maximums7 "u ! heal? plan 7z ( ! date ( 
su* notification74  7#f7 ,9 ! case su*  
item or s]vice is subject to a m$ical   
managem5t te*nique 7includ+ concurr5t   
review1 prior au?orization1 & /ep-!rapy 
or fail-fir/ protocols7 = cov]age "u !  
heal? plan1 a disclaim] t cov]age = su* 
item or s]vice is subject to su* m$ical 
managem5t te*nique4  7#g7 ,a disclaim] t
 ! in=mation provid$ 9 ! notification is
 only an e/imate bas$ on ! items &      
s]vices reasonably expect$1 at ! "t (   
s*$ul+ 7or reque/+7 ! item or s]vice1 to
 be furni%$ & is subject to *ange4  7#h7
 ,any o!r in=mation or disclaim] ! heal?
 plan det]m9es appropriate t is consi/5t
 ) in=mation & disclaim]s requir$ "u ?is
 section4  7b7 ,heal? plan def9$ ,9 ?is 
section1 ! t]m heal? plan means a gr\p  
heal? plan1 includ+ any gr\p heal? plan 
t is a gr&fa!r$ heal? plan 7z def9$ 9   
section #abea7;e7 ( ! ,pati5t           
,protection & ,af=dable ,c>e ,act74  4  

7,b7 ,con=m+ am5dm5t ,section #ihae7;a7 
( ! ,int]nal ,rev5ue ,code ( #aihf is   
am5d$-- 7i7 9 p>agraph 7#a71 by /rik+ 7z
 am5d$ by ! ,pati5t ,protection &       
,af=dable ,c>e ,act7 & ins]t+ 7o!r ?an !
 provisions ( section #bgcj ( su* ,act72
 &  7ii7 9 p>agraph 7#b71 by ins]t+ 7o!r
 ?an ! provisions ( section #bgcj ( su* 
,act7 aft] a provision ( su* "p ,a4     
7,c7 ,cl]ical am5dm5t ,! table (        
sections = su* sub*apt] is am5d$ by add+
 at ! end ! foll[+ new item3  ,sec4     
#ihaf4 ,advanc$ explanation ( b5efits4  
4  7#c7 ,employee ,retirem5t ,income    
,security ,act ( #aigd am5dm5t  7,a7 ,9 
g5]al ,subp>t ,b ( "p #g ( subtitle ,b (
 title ,i ( ! ,employee ,retirem5t      
,income ,security ,act ( #aigd 7#bi     
,u4,s4,c4 #aahe et seq47 is am5d$ by    
add+ at ! end ! foll[+ new section3     
#gaf4 ,advanc$ explanation ( b5efits    
7a7 ,9 g5]al ,beg9n+ on ,janu>y #a1     
#bjbb1 ea* heal? plan %all1 ) respect to
 a notification submitt$ "u section     
#aabh;,a7t77#a77;,b7 ( ! ,social        

,security ,act by a heal? c>e provid] or
 heal? c>e facility1 respectively1 to ! 
heal? plan = a p>ticipant or b5efici>y  
"u su* heal? plan s*$ul$ to receive an  
item or s]vice f ! provid] or facility1 
n lat] ?an #a bus9ess day 7or1 9 ! case 
su* item or s]vice 0 s s*$ul$ at lea/   
#aj bus9ess days be=e su* item or s]vice
 is to be furni%$ 7or 9 ! case su*      
notification 0 made pursuant to a reque/
 by su* p>ticipant or b5efici>y71 #c    
bus9ess days7 aft] ! date on :i* ! heal?
 plan receives su* notification1 provide
 to ! p>ticipant or b5efici>y 7?r\gh    
mail or electronic means1 z reque/$ by !
 p>ticipant or b5efici>y7 a notification
 includ+ ! foll[+3  7#a7 ,:e!r or n !   
provid] or facility is a p>ticipat+     
provid] or a p>ticipat+ facility )      
respect to ! heal? plan ) respect to !  
furni%+ ( su* item or s]vice &--  7,a7 9
 ! case ! provid] or facility is a      
p>ticipat+ provid] or facility ) respect
 to ! heal? plan ) respect to ! furni%+ 
( su* item or s]vice1 ! contract$ rate  

"u su* plan = su* item or s]vice2 &     
7,b7 9 ! case ! provid] or facility is a
 nonp>ticipat+ provid] or facility )    
respect to su* plan1 a description ( h[ 
su* p>ticipant or b5efici>y may obta9   
in=mation on provid]s & facilities t1 ) 
respect to su* heal? plan1 are          
p>ticipat+ provid]s & facilities4  7#b7 
,! good fai? e/imate includ$ 9 !        
notification receiv$ f ! provid] or     
facility4  7#c7 ,a good fai? e/imate ( !
 am\nt ! heal? plan is responsible =    
pay+ = items & s]vices includ$ 9 !      
e/imate describ$ 9 p>agraph 7#b74  7#d7 
,a good fai? e/imate ( ! am\nt ( any    
co/-%>+ 7includ+ ) respect to !         
d$uctible & any copaym5t or co9surance  
obligation7 = :i* ! p>ticipant or       
b5efici>y w\ld be responsible = su* item
 or s]vice 7z ( ! date ( su*            
notification74  7#e7 ,a good fai?       
e/imate ( ! am\nt t ! p>ticipant or     
b5efici>y has incurr$ t[>d meet+ ! limit
 ( ! f9ancial responsibility 7includ+ ) 
respect to d$uctibles & out-(-pocket    

maximums7 "u ! heal? plan 7z ( ! date ( 
su* notification74  7#f7 ,9 ! case su*  
item or s]vice is subject to a m$ical   
managem5t te*nique 7includ+ concurr5t   
review1 prior au?orization1 & /ep-!rapy 
or fail-fir/ protocols7 = cov]age "u !  
heal? plan1 a disclaim] t cov]age = su* 
item or s]vice is subject to su* m$ical 
managem5t te*nique4  7#g7 ,a disclaim] t
 ! in=mation provid$ 9 ! notification is
 only an e/imate bas$ on ! items &      
s]vices reasonably expect$1 at ! "t (   
s*$ul+ 7or reque/+7 ! item or s]vice1 to
 be furni%$ & is subject to *ange4  7#h7
 ,any o!r in=mation or disclaim] ! heal?
 plan det]m9es appropriate t is consi/5t
 ) in=mation & disclaim]s requir$ "u ?is
 section4  7b7 ,heal? plan def9$ ,9 ?is 
section1 ! t]m heal? plan means a gr\p  
heal? plan & heal? insurance cov]age    
(f]$ by a heal? insurance issu] 9 ! gr\p
 m>ket & includes a gr&fa!r$ heal? plan 
7z def9$ 9 section #abea7;e7 ( ! ,pati5t
 ,protection & ,af=dable ,c>e ,act7 t is
 su* a plan or cov]age4  4  7,b7 ,con=m+

 am5dm5t ,section #gae7;a7 ( ! ,employee
 ,retirem5t ,income ,security ,act (    
#aigd 7#bi ,u4,s4,c4 #aahe;d7a77 is     
am5d$--  7i7 9 p>agraph 7#a71 by /rik+  
7z am5d$ by ! ,pati5t ,protection &     
,af=dable ,c>e ,act7 & ins]t+ 7o!r ?an !
 provisions ( section #bgcj ( su* ,act72
 &  7ii7 9 p>agraph 7#b71 by ins]t+ 7o!r
 ?an ! provisions ( section #bgcj ( su* 
,act7 aft] a provision ( su* "p ,a4     
7,c7 ,cl]ical am5dm5t ,! table ( cont5ts
 9 section #a ( ! ,employee ,retirem5t  
,income ,security ,act ( #aigd is am5d$ 
by ins]t+ aft] ! item relat+ to section 
#gad ! foll[+ new items3  ,sec4 #gae4   
,additional m>ket re=ms4 ,sec4 #gaf4    
,advanc$ explanation ( b5efits4  4  7b7 
,heal? c>e provid]s & facilities        
,section #aabh;,a ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acbj;a-#g;a7 is    
am5d$ by add+ at ! end ! foll[+ new     
subsection3  7t7  7#a7 ,ea* heal? c>e   
provid] & heal? c>e facility %all1      
beg9n+ ,janu>y #a1 #bjbb1 9 ! case ( an 
individual :o s*$ules an item or s]vice 

to be furni%$ to su* individual by su*  
provid] or facility at lea/ #c bus9ess  
days be=e ! date su* item or s]vice is  
to be s furni%$1 n lat] ?an #a bus9ess  
day aft] ! date ( su* s*$ul+ 7or1 9 !   
case ( su* an item or s]vice s*$ul$ at  
lea/ #aj bus9ess days be=e ! date su*   
item or s]vice is to be s furni%$ 7or if
 reque/$ by ! individual71 n lat] ?an #c
 bus9ess days aft] ! date ( su* s*$ul+  
or su* reque/7--  7,a7 inquire if su*   
individual is enroll$ 9 a gr\p heal?    
plan1 gr\p or individual heal? insurance
 cov]age (f]$ by a heal? insurance      
issu]1 or a ,f$]al heal? c>e program 7& 
if is s enroll$ 9 su* plan or cov]age1  
seek+ to h a claim = su* item or s]vice 
submitt$ to su* plan or cov]age72 &     
7,b7 provide a notification ( ! good    
fai? e/imate ( ! expect$ *>ges = furni%+
 su* item or s]vice 7includ+ any item or
 s]vice t is reasonably expect$ to be   
provid$ 9 conjunction ) su* s*$ul$ item 
or s]vice7 to--  7i7 9 ! case !         
individual is enroll$ 9 su* a plan or   

su* cov]age 7& is seek+ to h a claim =  
su* item or s]vice submitt$ to su* plan 
or cov]age71 su* plan or issu] ( su*    
cov]age2 &  7ii7 9 ! case ! individual  
is n describ$ 9 clause 7i7 & n enroll$ 9
 a ,f$]al heal? c>e program1 !          
individual4  7#b7 ,ea* heal? c>e provid]
 or heal? c>e facility t fails to       
provide ! e/imate z requir$ "u p>agraph 
7#a7 %all be subject to a civil monet>y 
p5alty 9 an am\nt n to exce$ #aj1jjj =  
ea* su* failure4 ,! provisions ( ?is    
section 7o!r ?an subsection 7a71        
subsection 7b71 ! fir/ s5t5ce (         
subsection 7c77#a71 & subsection 7o77   
%all apply to a civil monet>y p5alty    
impos$ "u ! prec$+ s5t5ce 9 ! same mann]
 z su* provisions apply to a p5alty or  
proce$+ "u subsection 7a74  7#c7 ,9 ?is 
subsection-- 7,a7 ! t]ms heal? insurance
 issu]1 gr\p heal? plan1 gr\p heal?     
insurance cov]age1 & individual heal?   
insurance cov]age h ! mean+ giv5 su*    
t]ms1 respectively1 9 section #bgia ( ! 
,public ,heal? ,s]vice ,act2 &  7,b7 !  

t]m ,f$]al heal? c>e program has ! mean+
 giv5 su* t]m 9 section #aabh;,b7f74  4