,,ii #aaf? ,,congress #a/ ,session ,s4 #bdbh ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,augu/ #a1 #bjai,mr4 ,br[n 7= himself & ,ms4 ,klobu*>7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to am5d title ,,xviii ( ! ,social ,security ,act to provide = c]ta9 re=ms ) respect to ,m$ic>e supplem5tal heal? insurance policies1 & = o!r purposes4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,m$igap ,consum] ,protection ,act ( #bjai4 7b7 ,table ( cont5ts ,! table ( cont5ts ( ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4 ,sec4 #b4 ,gu>ante$ issue4 ,sec4 #c4 ,limitations on pric+ discrim9ation4 ,sec4 #d4 ,cl>ification reg>d+ /&>diz$ ,m$igap plans4 ,sec4 #e4 ,improv+ in=mation available to ,m$ic>e b5efici>ies4 ,sec4 #f4 ,brok] conflicts ( int]e/4 ,sec4 #g4 ,protect+ aga9/ high out-(-pocket exp5ditures = ,m$ic>e fee-=-s]vice b5efits4 ,sec4 #h4 ,/udy & report on v>iations among ,m$igap plans4 #b4 ,gu>ante$ issue 7a7 ,gu>ante$ issue ( ,m$igap policies to all ,m$igap-,eligible ,m$ic>e b5efici>ies 7#a7 ,9 g5]al ,section #ahhb7s7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciess7s77 is am5d$-- 7,a7 9 p>agraph 7#b77;,a71 by /rik+ #fe ye>s ( age or old] & is enroll$ = b5efits "u "p ,b & ins]t+ entitl$ to1 or enroll$ =1 b5efits "u "p ,a & enroll$ = b5efits "u "p ,b2 7,b7 9 p>agraph 7#b77;,d71 by /rik+ :o is #fe ye>s ( age or old] z ( ! date ( issuance &2 7,c7 9 p>agraph 7#c77;,b77ii71 by /rik+ is #fe ye>s ( age or old] &2 & 7,d7 9 p>agraph 7#c77;,b77vi71 by /rik+ at age #fe4 7#b7 ,effective date2 phase-,9 au?ority 7,a7 ,effective date ,subject to subp>agraph 7,b71 ! am5dm5ts made by p>agraph 7#a7 %all apply to ,m$ic>e supplem5tal policies effective on or aft] ,janu>y #a1 #bjbc4 7,b7 ,phase-,9 au?ority 7i7 ,9 g5]al ,subject to clause 7ii71 ! ,secret>y ( ,heal? & ,human ,s]vices may phase-9 ! implem5tation ( ! am5dm5ts made "u p>agraph 7#a7 7) su* phase-9 beg9n+ on or aft] ,janu>y #a1 #bjbc7 9 su* mann] z ! ,secret>y det]m9es appropriate 9 ord] to m9imize any adv]se impact on individuals enroll$ "u a ,m$ic>e supplem5tal policy4 7ii7 ,phase-,9 p]iod may n exce$ #e ye>s ,! ,secret>y ( ,heal? & ,human ,s]vices %all ensure t ! am5dm5ts made by p>agraph 7#a7 are fully implem5t$ by n lat] ?an ,janu>y #a1 #bjbh4 7#c7 ,additional enrollm5t p]iod = c]ta9 individuals 7,a7 ,"o-"t enrollm5t p]iod 7i7 ,9 g5]al ,9 ! case ( an individual describ$ 9 subp>agraph 7,b71 ! ,secret>y ( ,heal? & ,human ,s]vices %all e/abli% a "o-"t enrollm5t p]iod dur+ :i* su* an individual may enroll 9 any ,m$ic>e supplem5tal policy ( ! individual's *oos+4 7ii7 ,p]iod ,! enrollm5t p]iod e/abli%$ "u clause 7i7 %all beg9 on ! date on :i* ! phase-9 p]iod "u p>agraph 7#b7 is complet$ & end #f mon?s aft] su* date4 7,b7 ,individual describ$ ,an individual describ$ 9 ?is p>agraph is an individual :o-- 7i7 is entitl$ to hospital insurance b5efits "u "p ,a "u section #bbf7;b7 or section #bbf;,a ( ! ,social ,security ,act 7#db ,u4,s4,c4 #dbf7;b72 #dbf-a72 7ii7 is enroll$ = b5efits "u "p ,b ( su* ,act 7#db ,u4,s4,c4 #acie;j et seq472 & 7iii7 w\ld n1 b = ! provisions ( & am5dm5ts made by p>agraphs 7#a7 & 7#b71 be eligible = ! gu>ante$ issue ( a ,m$ic>e supplem5tal policy "u p>agraph 7#b7 or 7#c7 ( section #ahhb7s7 ( su* ,act 7#db ,u4,s4,c4 #aciess7s774 7b7 ,gu>ante$ issue ( ,m$igap policies = ,m$ic>e ,advantage & ,m$icaid enrollees1 c]ta9 vet]ans1 & o!r individuals det]m9$ appropriate by ! ,secret>y2 ,treatm5t ( individuals ) ,,cobra 7#a7 ,9 g5]al ,section #ahhb7s77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciess7s77#c77 is am5d$-- 7,a7 9 subp>agraph 7,b71 by add+ at ! end ! foll[+ new clauses3 7vii7 ,! individual 0 enroll$ 9 a ,m$ic>e ,advantage plan "u "p ,c = n less ?an #ab mon?s & subsequ5tly dis5roll$ f su* plan & elects to receive b5efits "u ?is title ?r\gh ! orig9al ,m$ic>e fee-=-s]vice program "u p>ts ,a & ,b4 7viii7 ,! individual-- 7,i7 is entitl$ to1 or enroll$ =1 b5efits "u "p ,a & enroll$ = b5efits "u "p ,b2 & 7,,ii7 ei!r-- 7aa7 is eligible = m$ical assi/ance "u a ,/ate plan or waiv] "u title ,,xix bas$ on a r$uction ( income ( ! individual bas$ on co/s incurr$ = m$ical or o!r rem$ial c>e & 0 enroll$ 9 su* plan or waiv]2 or 7bb7 0 o!rwise eligible = m$ical assi/ance "u a ,/ate plan or waiv] "u title ,,xix & subsequ5tly lo/ eligibility = su* m$ical assi/ance4 7ix7 ,! individual-- 7,i7 is entitl$ to1 or enroll$ =1 b5efits "u "p ,a & enroll$ = b5efits "u "p ,b2 7,,ii7 is a cov]$ b5efici>y 7z t t]m is def9$ 9 section #ajgb7e7 ( title #aj1 ,unit$ ,/ates ,code71 entitl$ to m$ical & d5tal c>e "u *apt] #ee ( t title1 :o 0 receiv+ m$ical c>e at a facility ( ! uni=m$ s]vices ?r\gh su* entitlem5t2 & 7,,iii7 no long] receives su* c>e at su* facility because-- 7aa7 su* facility has be5 clos$2 7bb7 su* facility no long] (f]s su* c>e2 7cc7 ! individual no long] meets ! requirem5ts = eligibility = su* c>e2 or 7dd7 ! individual mov$ away f ! facility4 7x7 ,! individual meets su* o!r requirem5ts t ! ,secret>y1 ?r\gh notice & comm5t rulemak+1 det]m9es appropriate4 2 7,b7 by /rik+ subp>agraph 7,c77iii7 & ins]t+ ! foll[+3 7iii7 ,subject to subsection 7v77#a71 = purposes ( an individual describ$ 9 clause 7vi71 7vii71 7viii71 7ix71 or 7x7 ( subp>agraph 7,b71 a ,m$ic>e supplem5tal policy describ$ 9 ?is subp>agraph %all include any ,m$ic>e supplem5tal policy4 2 & 7,c7 9 subp>agraph 7,e7-- 7i7 9 clause 7iv71 by /rik+ & at ! end2 7ii7 9 clause 7v71 by /rik+ ! p]iod at ! end & ins]t+ a semicolon2 & 7iii7 by add+ at ! end ! foll[+ new clauses-- 7vi7 9 ! case ( an individual describ$ 9 subp>agraph 7,b77vii71 ! annual1 coord9at$ election p]iod 7z def9$ 9 section #ahea7;e77#c77;,b77 or a cont9u\s op5 enrollm5t p]iod 7z def9$ 9 section #ahea7;e77#b77 dur+ :i* ! individual dis5rolls f a ,m$ic>e ,advantage plan "u "p ,c2 7vii7 9 ! case ( an individual describ$ 9 subp>agraph 7,b77viii7 :o is eligible = m$ical assi/ance "u a ,/ate plan or waiv] "u title ,,xix = a reason describ$ 9 item 7aa71 su* p]iod z is specifi$ by ! ,secret>y2 7viii7 9 ! case ( an individual describ$ 9 subp>agraph 7,b77viii7 :o is eligible = m$ical assi/ance "u a ,/ate plan or waiv] "u title ,,xix = a reason describ$ 9 item 7bb71 ! p]iod beg9n+ on ! date t ! individual receives a notice ( cessation ( su* individual's eligibility = m$ical assi/ance "u ! ,/ate plan or waiv] "u title ,,xix & end+ on ! date t is six mon?s aft] ! individual receives su* notice2 7ix7 9 ! case ( an individual describ$ 9 subp>agraph 7,b77ix71 dur+ ! #fc days aft] ! individual is no long] eligible to receive ! c>e f ! facility describ$ 9 su* subp>agraph2 7x7 9 ! case ( an individual describ$ 9 subp>agraph 7,b77x71 su* p]iod z is specifi$ by ! ,secret>y2 & 4 7#b7 ,treatm5t ( individuals ) ,,cobra 7,a7 ,9 g5]al ,section #ahhb7s77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciess7s77#c771 z am5d$ by subsection 7a7 & p>agraph 7#a71 is fur!r am5d$-- 7i7 9 subp>agraph 7,b77i7 by ins]t+ or1 9 ! case ( an individual enroll$ 9 su* an employee welf>e b5efit plan pursuant to a ,,cobra cont9uation provision 7z def9$ 9 section #bgia7;d77#d7 ( ! ,public ,heal? ,s]vice ,act71 t ! individual dis5rolls f su* plan & enrolls "u "p ,b be=e ! p]iod at ! end2 & 7ii7 9 subp>agraph 7,e71 z am5d$ by p>agraph 7#a71 by add+ at ! end ! foll[+ new clause3 7viii7 9 ! case ( an individual describ$ 9 subp>agraph 7,b77i7 :o enroll$ 9 an employee welf>e b5efit plan describ$ 9 su* subp>agraph pursuant to a ,,cobra cont9uation provision 7z def9$ 9 section #bgia7;d77#d7 ( ! ,public ,heal? ,s]vice ,act7 & :o dis5rolls f su* plan & enrolls "u "p ,b1 ! p]iod beg9n+ on ! date t is #fj days be=e ! effective date ( su* dis5rollm5t & end+ on ! date t is #fc days aft] su* effective date4 4 7,b7 ,te*nical correction ,section #ahhb7s77#b77;,d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciess7s77#b77;,d77 is am5d$-- 7i7 by /rik+ #bgja7;c7 & ins]t+ #bgjd7;c72 & 7ii7 by /rik+ #bgja7;a77#c7 & ins]t+ #bgjd7;a77#c74 7#c7 ,effective date ,! am5dm5ts made by p>agraphs 7#a7 & 7#b77;,a7 %all apply to ,m$ic>e supplem5tal policies effective on or aft] ,janu>y #a1 #bjbc4 7c7 ,med,p,a,c /udies & reports 7#a7 ,annual op5 enrollm5t 7,a7 ,/udy ,! ,m$ic>e ,paym5t ,advisory ,commission 79 ?is section ref]r$ to z ! ,commission7 %all conduct a /udy on provid+ an op5 enrollm5t p]iod = ,m$ic>e supplem5tal policies 7"u section #ahhb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciess77 "u :i* an individual c\ld enroll 9 su* a policy ) gu>ante$ issue protections4 ,su* /udy %all include an analysis (-- 7i7 ! impact ( ! bir?day rule 9 ,cali=nia & ,oregon1 :]e an individual c enroll ) su* protections 9 a new policy ) ! same or less] b5efits )9 #cj days ( _! bir?day2 7ii7 ! impact ( su* bir?day rule if su* rule p]mitt$ ! individual to enroll ) su* protections 9 any policy2 & 7iii7 o!r areas det]m9$ appropriate by ! ,commission4 7,b7 ,report ,n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,commission %all submit to ,congress a report on ! /udy conduct$ "u subp>agraph 7,a71 toge!r ) recomm5dations = su* legislation & adm9i/rative action z ! ,commission det]m9es appropriate4 7#b7 ,equitable relief 7,a7 ,/udy ,! ,m$ic>e ,paym5t ,advisory ,commission 79 ?is section ref]r$ to z ! ,commission7 %all conduct a /udy on ! ,secret>y ( ,heal? & ,human ,s]vices grant+ equitable relief = enrollm5t 9 a ,m$ic>e supplem5tal policy 7"u section #ahhb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciess77 9 a simil> mann] z ! ,secret>y grants su* relief = enrollm5t "u "p ,b ( ! ,m$ic>e program4 7,b7 ,report ,n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,commission %all submit to ,congress a report on ! /udy conduct$ "u subp>agraph 7,a71 toge!r ) recomm5dations = su* legislation & adm9i/rative action z ! ,commission det]m9es appropriate4 7d7 ,outrea* plan 7#a7 ,9 g5]al ,! ,secret>y ( ,heal? & ,human ,s]vices %all develop an outrea* plan to notify individuals 7includ+ individuals describ$ 9 clause 7viii7 ( section #ahhb7s77#c77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciess7s77#c77;,b771 z add$ by subsection 7b77#a77 t may be affect$ by ! provisions (1 & am5dm5ts made by1 ?is section reg>d+ su* provisions & am5dm5ts4 7#b7 ,consultation ,9 implem5t+ ! outrea* plan develop$ "u p>agraph 7#a71 ! ,secret>y ( ,heal? & ,human ,s]vices %all consult ) consum] advocates1 brok]s1 insur]s1 ! ,national ,association ( ,insurance ,commission]s1 & ,/ate ,heal? ,insurance ,assi/ance ,programs4 #c4 ,limitations on pric+ discrim9ation 7a7 ,9 g5]al ,section #ahhb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciess7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7aa7 ,developm5t ( new /&>ds relat+ to pric+ discrim9ation 7#a7 ,9 g5]al ,! ,secret>y %all reque/ ! ,national ,association ( ,insurance ,commission]s to review & revise ! /&>ds = all b5efit packages "u subsection 7p77#a71 includ+ ! core b5efit package1 9 ord] to provide cov]age consi/5t ) p>agraph 7#b74 ,su* revisions %all be made consi/5t ) ! rules applicable "u subsection 7p77#a77;,e7 7) ! ref]5ce to ! #aiia ,,naic ,model ,regulation deem$ a ref]5ce to ! ,,naic ,model ,regulation z mo/ rec5tly updat$ by ! ,national ,association ( ,insurance ,commission]s to reflect previ\s *anges 9 law & ! ref]5ce to date ( enactm5t ( ?is subsection deem$ a ref]5ce to ! date ( enactm5t ( ?is subsection74 7#b7 ,*anges 9 co/-%>+ describ$ ,"u ! revis$ /&>ds1 cov]age %all n be available "u a ,m$ic>e supplem5tal insurance policy unless ! issu] ( ! policy1 9 addition to con=m+ to ! o!r applicable requirem5ts ( ?is section-- 7,a7 does n discrim9ate 9 ! pric+ ( ! policy because ( ! age or heal? /atus ( ! individual to :om ! policy is issu$2 7,b7 does n1 to an ext5t t jeop>dizes ! access to su* policy = individuals :o are eligible to p>ticipate 9 ! program "u ?is title because ! individuals are individuals describ$ 9 p>agraph 7#b7 or 7#c7 ( section #ahaa1 discrim9ate 9 ! pric+ ( ! policy because ! individual to :om ! policy is issu$ is s eligible to p>ticipate 9 su* program because ! individual is an individual s describ$ 9 su* a p>agraph2 & 7,c7 does n e/abli% premiums applicable "u su* policy on a basis t w\ld apply to a portion (1 b n ! entirety (1 a metropolitan /ati/ical area4 7#c7 ,application date ,! revis$ /&>ds %all apply to b5efit packages sold1 issu$1 or r5ew$ "u ?is section to an individual :o fir/ become entitl$ to b5efits "u "p ,a or fir/ enrolls 9 "p ,b on or aft] ,janu>y #a1 #bjbc4 4 7b7 ,con=m+ am5dm5t ,section #ahhb7o77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciess7o77#a77 is am5d$ by /rik+ 1 & 7y7 & ins]t+ 7y71 & 7aa74 #d4 ,cl>ification reg>d+ /&>diz$ ,m$igap plans ,section #ahhb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciess71 z am5d$ by section 7#c71 is am5d$ by add+ at ! end ! foll[+ new subsection3 7bb7 ,limitation on additional b5efits ,a /&>d b5efit package e/abli%$ "u ?is section may n include b5efits t are 9 addition to ! /&>d b5efits "u ! package4 ,an issu] ( a ,m$ic>e supplem5tal policy may (f] su* additional /&>diz$ b5efits ?r\gh a sep>ate rid]4 4 #e4 ,improv+ in=mation available to ,m$ic>e b5efici>ies 7a7 ,cl>ify+ b5efici>y options on ! ,m$ic>e plan f9d] website ,section #ahjd ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#b7 is am5d$ by add+ at ! end ! foll[+ new subsections3 7e7 ,9 ! case t ! ,secret>y provides = a ,m$ic>e plan f9d] ,int]net website ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices 7or a successor website71 ! ,secret>y %all1 ) respect to su* website & 9 accordance ) subsection 7f7-- 7#a7 consult ) at lea/ "o indep5d5t entity t repres5ts consum]s 9 ! developm5t ( su* website2 7#b7 make available on su* website-- 7,a7 access to provid] networks 9 ord] to provide to individuals entitl$ to b5efits "u "p ,a or enroll$ "u "p ,b in=mation to assi/ su* individuals 9 und]/&+ ! re/rictions on provid]s & pot5tial co/s entail$ by _! decisions reg>d+ enrollm5t "u p>ts ,a & ,b1 "u "p ,c1 & 9 ,m$ic>e supplem5tal policies "u section #ahhb2 7,b7 a review ( out-(-pocket exp5ditures1 includ+ d$uctibles1 copaym5ts1 co9surance1 mon?ly premiums1 & e/imat$ annual out-(-pocket co/s1 display$ ov]all & by compon5ts1 bas$ on ! be/ available in=mation z det]m9$ by ! ,secret>y & bas$ on ! individual's specific heal? /atus2 7,c7 dur+ ! p]iod prior to ,janu>y #a1 #bjbc1 in=mation reg>d+ ! rules t1 9 ea* ,/ate1 p]ta9 to gu>ante$ issue ( ,m$ic>e supplem5tal heal? insurance policies prior to implem5tation ( ! provisions ( ! ,m$igap ,consum] ,protection ,act ( #bjai &1 9 ! case t a ,/ate has no su* rules p]ta9+ to gu>ante$ issue ( su* policies1 cle> language expla9+ ! implications ( su* lack ( rules = individuals ) pre-exi/+ conditions2 & 7,d7 cle> in=mation on local res\rces = individuals1 su* z in=mation on _! ,/ate ,heal? ,insurance ,assi/ance ,program 7,,%ip72 7#c7 n lat] ?an ,janu>y #a1 #bjba1 & p]iodically !reaft]1 p]=m a review ( su* website 9 ord] to ensure t su* website makes available to individuals entitl$ to b5efits "u "p ,a or enroll$ "u "p ,b ! in=mation t ! ,secret>y det]m9es is necess>y = su* individuals to make in=m$ *oices reg>d+ _! options "u ! program "u ?is title2 & 7#d7 n lat] ?an #ab mon?s aft] ! la/ day ( ea* p]iod = ! reque/ = in=mation "u subsection 7f71 update su* website1 tak+ into consid]ation ! in=mation collect$ pursuant to su* subsection1 to cl>ify ! pres5tation ( consum] options = ,m$ic>e supplem5tal heal? insurance policy options1 includ+ by pres5t+ su* in=mation 9 a mann] calculat$ to be und]/ood by ! av]age consum] & 9 a mann] t-- 7,a7 improves consum] access to in=mation reg>d+ ! applicable premiums "u su* policy options z ( ! date on :i* su* website is s updat$2 7,b7 facilitates consum]s' ability to comp>e & sort policy options & premium in=mation across plan (f]+s 9 a giv5 location2 7,c7 cl>ifies & expla9s diff]5ces 9 policy value2 7,d7 rates & expla9s ! f9ancial /ability ( issu]s ( su* policies2 7,e7 provides data on ! inflation rate ( diff]5t policies2 7,f7 provides in=mation reg>d+ ! gu>ante$ issue requirem5ts t apply to ,m$ic>e supplem5tal heal? insurance policies "u section #ahhb7s72 & 7,g7 includes su* g5]al in=mation z is det]m9$ by ! ,secret>y to be necess>y = individuals entitl$ to b5efits "u "p ,a or enroll$ "u "p ,b to und]/& co/s "u ,,ma plans available pursuant to "p ,c & prescription drug plans available pursuant to "p ,d4 7f7 ,n lat] ?an #f mon?s aft] ! date ( ! enactm5t ( ?is subsection & beg9n+ on ,decemb] #g ( ea* ye> !reaft]1 ! ,secret>y ( ,heal? & ,human ,s]vices %all provide an opportunity = public comm5t dur+ :i* ! ,secret>y reque/s in=mation1 includ+ recomm5dations1 f /akehold]s reg>d+ pot5tial improvem5ts to ! pres5tation ( ,m$ic>e supplem5tal heal? insurance policy options "u section #ahhb on ! ,m$ic>e plan f9d] ,int]net website ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices 7or a successor website74 7g7 ,) respect to any in=mation t ! ,secret>y makes available on ! ,m$ic>e plan f9d] ,int]net website ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices 7or a successor website7 pursuant to subsection 7e71 ! ,secret>y %all1 prior to mak+ su* in=mation available-- 7#a7 provide1 9 consultation ) ! ,national ,association ( ,insurance ,commission]s1 an opportunity = consum] te/+ ( su* in=mation2 7#b7 %>e ! results ( su* consum] te/+ ( su* in=mation ) int]e/$ /akehold]s2 & 7#c7 provide a #fj-;day public comm5t p]iod ) respect to su* in=mation4 4 7b7 ,improv$ in=mation on ,m$igap ,z ! ,secret>y ( ,heal? & ,human ,s]vices works to update ! mat]ials provid$ to ,m$ic>e b5efici>ies reg>d+ ! ,m$ic>e program & ,m$ic>e supplem5tal policies bas$ on ! provisions (1 & am5dm5ts made by1 ?is ,act1 ! ,secret>y %all consult ) at lea/ "o indep5d5t entity t repres5ts consum]s4 7c7 ,equal treatm5t betwe5 in=mation on ! ,m$ic>e fee-=-,s]vice program & ! ,m$ic>e ,advantage program ,! ,secret>y ( ,heal? & ,human ,s]vices %all ensure t-- 7#a7 any in=mation di/ribut$ or o!rwise made available to ! public & relat$ to ! ,m$ic>e program does n display a bias t[>ds ! ,m$ic>e ,advantage program ov] ! orig9al ,m$ic>e fee-=-s]vice program1 or vice v]sa2 & 7#b7 ! volume ( su* in=mation is equally weight$ betwe5 su* programs4 #f4 ,brok] conflicts ( int]e/ ,section #aabh;,g ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;h7 is am5d$-- 7#a7 9 subsection 7c77#a77;,a71 by /rik+ #bjaa1 & ins]t+ #bjaa 7or1 ) respect to in=mation requir$ to be submitt$ "u subsection 7f77#a71 n lat] ?an #f mon?s aft] ! date ( ! enactm5t ( su* subsection712 & 7#b7 by add+ at ! end ! foll[+ new subsection3 7f7 ,application to ,m$igap insurance brok]s 7#a7 ,9 g5]al ,beg9n+ n lat] ?an #ab mon?s aft] ! date ( enactm5t ( ?is subsection1 ea* issu] ( a ,m$ic>e supplem5tal heal? insurance policy %all annually submit to ! ,secret>y a report reg>d+ paym5ts or o!r transf]s ( value made dur+ ! previ\s ye> to ag5ts1 brok]s1 & o!r ?ird p>ties repres5t+ su* policy4 ,ea* su* report %all include ! foll[+ in=mation1 ) respect to su* a paym5t or o!r transf] ( value3 7,a7 ,! "n ( ! recipi5t ( ! paym5t or o!r transf] ( value4 7,b7 ,! bus9ess address ( ! recipi5t4 7,c7 ,! am\nt ( ! paym5t or o!r transf] ( value4 7,d7 ,! dates on :i* ! paym5t or transf] ( value 0 provid$4 7,e7 ,a description ( ! =m ( ! paym5t or transf] ( value4 7,f7 ,any o!r categories ( in=mation ! ,secret>y det]m9es appropriate4 7#b7 ,application ( transp>5cy sy/em ,! provisions ( subsections 7b7 ?r\gh 7d7 %all apply to an issu] describ$ 9 p>agraph 7#a71 in=mation requir$ to be report$ "u su* p>agraph1 & ag5ts1 brok]s1 & o!r ?ird p>ties describ$ 9 su* p>agraph 9 ! same mann] & to ! same ext5t z su* provisions apply to an applicable manufactur]1 in=mation requir$ to be report$ "u subsection 7a71 & a cov]$ recipi5t4 4 #g4 ,protect+ aga9/ high out-(-pocket exp5ditures = ,m$ic>e fee-=-s]vice b5efits ,title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 is am5d$ by add+ at ! end ! foll[+ new section3 #ahii;,c4 ,protection aga9/ high out-(-pocket exp5ditures 7a7 ,9 g5]al ,not)/&+ any o!r provision ( ?is title1 9 ! case ( an individual entitl$ to1 or enroll$ =1 b5efits "u "p ,a or enroll$ 9 "p ,b1 if ! am\nt ( ! out-(-pocket co/-%>+ ( su* individual = a ye> 7beg9n+ ) #bjbb7 equals or exce$s ! annual out-(-pocket limit "u subsection 7b7 = t ye>-- 7#a7 ! am\nt o!rwise payable "u "p ,a & ! total am\nt ( exp5ses incurr$ by ! individual :i* w\ld 7except = ?is section7 con/itute incurr$ exp5ses = :i* b5efits are payable "u "p ,b1 %all be #ajj p]c5t ( su* am\nt = ! rema9d] ( t ye>2 & 7#b7 ! individual %all n be responsible = out-(-pocket co/-%>+ incurr$ dur+ ! rema9d] ( t ye>4 7b7 ,annual out-(-,pocket limit 7#a7 ,9 g5]al ,! am\nt ( ! annual out-(-pocket limit "u ?is subsection %all be-- 7,a7 = #bjbb1 #e1ejj2 or 7,b7 = a subsequ5t ye>1 ! am\nt specifi$ 9 ?is subsection = ! prec$+ ye> increas$ or decreas$ by ! p]c5tage *ange 9 ! ,consum] ,price ,index = ,all ,urban ,consum]s = ! #ab-mon? p]iod end+ ) ,june ( su* prec$+ ye>4 7#b7 ,r\nd+ ,if any am\nt det]m9$ "u p>agraph 7#a77;,b7 is n a multiple ( #e1 su* am\nt %all be r\nd$ to ! ne>e/ multiple ( #e4 7c7 ,out-(-,pocket co/-,%>+ def9$ 7#a7 ,9 g5]al ,subject to p>agraphs 7#b7 & 7#c71 9 ?is section1 ! t]m out-(-pocket co/-%>+ means1 ) respect to an individual1 ! am\nt ( ! exp5ses incurr$ by ! individual t are attributable to-- 7,a7 d$uctibles1 co9surance & copaym5ts applicable "u "p ,a or ,b2 or 7,b7 = items & s]vices t w\ld h o!rwise be5 cov]$ "u "p ,a or ,b b = ! exhau/ion ( ^? b5efits4 7#b7 ,c]ta9 co/s n includ$ 7,a7 ,non-cov]$ items & s]vices ,exp5ses incurr$ = items & s]vices :i* are n cov]$ "u "p ,a or ,b %all n be consid]$ incurr$ exp5ses = purposes ( det]m9+ out-(-pocket co/-%>+ "u p>agraph 7#a74 7,b7 ,items & s]vices n furni%$ on an assignm5t-relat$ basis ,if an item or s]vice is furni%$ to an individual "u ?is title & is n furni%$ on an assignm5t-relat$ basis1 any additional exp5ses ! individual incurs above ! am\nt ! individual w\ld h incurr$ if ! item or s]vice 0 furni%$ on an assignm5t-relat$ basis %all n be consid]$ incurr$ exp5ses = purposes ( det]m9+ out-(-pocket co/-%>+ "u p>agraph 7#a74 7#c7 ,s\rce ( paym5t ,= purposes ( p>agraph 7#a71 ! ,secret>y %all consid] exp5ses to be incurr$ by ! individual )\t reg>d to :e!r ! individual or ano!r p]son1 includ+ a ,/ate program1 an employ]1 a ,m$ic>e supplem5tal policy1 or o!r ?ird-p>ty cov]age1 has paid = su* exp5ses4 7d7 ,ann\ncem5t ( ! annual out-(-,pocket limit ,! ,secret>y %all 7beg9n+ 9 #bjba7 ann\nce 79 a mann] int5d$ to provide notice to all int]e/$ p>ties7 ! annual out-(-pocket limit "u ?is section t w be applicable = ! succe$+ ye>4 4 #h4 ,/udy & report on v>iations among ,m$igap plans 7a7 ,/udy ,! ,comptroll] ,g5]al ( ! ,unit$ ,/ates 79 ?is section ref]r$ to z ! ,comptroll] ,g5]al7 %all conduct a /udy on ! v>iations among ,m$ic>e supplem5tal policies "u section #ahhb ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciess74 ,su* /udy %all include an analysis ( ! foll[+3 7#a7 ,h[ ! v>iations among su* policies impacts ,m$ic>e b5efici>ies' *oices4 7#b7 ,ways to improve /&>dization & tools to help ,m$ic>e b5efici>ies make in=m$ *oices ) respect to su* policies4 7#c7 ,o!r items det]m9$ appropriate by ! ,comptroll] ,g5]al4 7b7 ,report ,n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al %all submit to ,congress a report on ! /udy conduct$ "u subsection 7a71 toge!r ) recomm5dations = su* legislation & adm9i/rative action z ! ,comptroll] ,g5]al det]m9es appropriate4