,i #aai? ,,congress #a/ ,session ,h4 ,r4 #cajc ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,april #cj1 #bjbe,mr4 ,huffman 7= himself1 ,mr4 ,rask91 ,mr4 ,ca/51 ,ms4 ,norton1 ,ms4 ,tlaib1 ,mr4 ,pocan1 ,mr4 ,m\lton1 ,mr4 ,coh51 & ,mr4 ,fro/7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce ,a ,,bill ,to am5d title ,,xxvii ( ! ,public ,heal? ,s]vice ,act to e/abli% requirem5ts = ! disclosure ( c]ta9 in=mation relat+ to heal? c>e %>+ m9i/ries1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,heal? ,%>e ,transp>5cy ,act ( #bjbe4 #b4 ,e/abli%+ requirem5ts = ! disclosure ( c]ta9 in=mation relat+ to heal? c>e %>+ m9i/ries 7a7 ,9 g5]al ,title ,,xxvii ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg et seq47 is am5d$ by add+ at ! end ! foll[+ new "p3 ,f ,heal? ,c>e ,%>+ ,m9i/ries #bgii;,c-#a4 ,disclosure ( in=mation 7a7 ,9 g5]al ,a heal? c>e %>+ m9i/ry 7z def9$ 9 section #ejjj;,a7d77#b77;,b77ii7 ( ! ,int]nal ,rev5ue ,code ( #aihf7-- 7#a7 %all1 n less frequ5tly ?an annually1 submit to ! ,secret>y1 ! ,commission] ( ,int]nal ,rev5ue1 & ! ,director ( ! ,bureau ( ,consum] ,f9ancial ,protection ! in=mation describ$ 9 subsection 7b72 7#b7 %all disclose to ea* individual seek+ to enroll 9 ! m9i/ry1 & ea* individual s enroll$1 ! in=mation describ$ 9 p>agraph 7#a7 ( subsection 7c7 9 ! mann] specifi$ 9 p>agraph 7#b7 ( su* subsection2 & 7#c7 may n ent] into a contract ) an entity = purposes ( enroll+ an individual 9 su* m9i/ry1 or o!rwise provide remun]ation to su* an entity 9 ex*ange = enroll+ an individual 9 su* m9i/ry1 unless su* entity meets ! requirem5ts describ$ 9 subsection 7d74 7b7 ,disclosure ( f9ancial & appeals in=mation 7#a7 ,9 g5]al ,= purposes ( subsection 7a77#a71 ! in=mation describ$ 9 ?is subsection is1 ) respect to a heal? c>e %>+ m9i/ry1 ! foll[+3 7,a7 ,! am\nt ( f9ancial res]ves held by su* m9i/ry4 7,b7 ,! ratio ( ! am\nt ( money collect$ f enrollees = purposes ( reimburs+ enrollees = m$ical claims t is exp5d$ by su* m9i/ry on co/s describ$ 9 p>agraphs 7#a7 & 7#b7 ( section #bgah7;a7 to ! total am\nt ( money s collect$ = ! prec$+ ye>4 7,c7 ,! numb] ( individuals enroll$ 9 su* m9i/ry4 7,d7 ,! total am\nt paid by individuals enroll$ 9 su* m9i/ry = cov]age "u su* m9i/ry ov] ! prec$+ ye>4 7,e7 ,! total am\nt paid by su* m9i/ry = items & s]vices = :i* b5efits 7 available "u su* m9i/ry ov] ! prec$+ ye>4 7,f7 ,! av]age out-(-pocket exp5ses incurr$ by individuals enroll$ "u su* m9i/ry = items & s]vices = :i* b5efits are available "u su* m9i/ry ov] ! prec$+ ye>4 7,g7 ,a li/ ( ea* ,/ate & c\nty 9 :i* individuals :o reside 9 su* ,/ate or c\nty may enroll 9 su* m9i/ry4 7,h7 ,! p]c5tage ( claims made "u su* m9i/ry dur+ ! prec$+ ye> :i* 7 d5i$4 7,i7 ,contact in=mation = ! op]ator 7or a repres5tative ( ! op]ator7 ( su* m9i/ry4 7,j7 ,a specification ( ea* heal? c>e provid] ) :i* su* m9i/ry has 9 effect a contractual relation%ip = furni%+ items & s]vices "u su* m9i/ry4 7,k7 ,! av]age am\nt ( "t su* m9i/ry took to reimburse a claim once submitt$ to su* m9i/ry dur+ ! prec$+ ye>4 7#b7 ,publication ,! ,secret>y %all publi% ! in=mation submitt$ "u subsection 7a77#a7 on a public website4 7c7 ,disclosure ( in=mation to prospective & curr5t enrollees 7#a7 ,9 g5]al ,= purposes ( subsection 7a77#b71 ! in=mation describ$ 9 ?is p>agraph is1 ) respect to a heal? c>e %>+ m9i/ry1 ! foll[+3 7,a7 ,h[ an enrollee may file a compla9t or appeal a cov]age det]m9ation1 includ+ a disclaim] t appeals may n be available to any entity o!r ?an su* m9i/ry4 7,b7 ,:e!r an enrollee mu/ use arbitration 9 appeal+ a cov]age det]m9ation or has o!r legal rec\rse4 7,c7 ,an explanation t1 unlike a gr\p heal? plan or heal? insurance cov]age1 !re is no gu>antee t an enrollee w be reimburs$ = any portion ( claims submitt$ to su* m9i/ry1 z well z a specification ( :e!r any lifetime caps on heal? c>e %>+ p] enrollee are impos$ "u su* m9i/ry4 7,d7 ,! in=mation describ$ 9 subsection 7b77#a77;,f74 7,e7 ,! av]age am\nt paid p] enrollee to su* m9i/ry = memb]%ip "u su* m9i/ry ov] ! prec$+ ye>4 7,f7 ,) respect to claims made dur+ ! prec$+ ye> = items & s]vices = :i* b5efits 7 available "u su* m9i/ry1 ! total am\nt paid by su* m9i/ry = su* claims comp>$ & ! total am\nt = :i* individuals enroll$ "u su* m9i/ry 7 responsible 9 co/ %>+4 7,g7 ,a li/ ( all items & s]vices = :i* reimbursem5t is n available "u su* m9i/ry1 z well z1 ) respect to ea* item or s]vice = :i* su* reimbursem5t is s available1 a specification ( any conditions t w\ld r5d] su* item or s]vice nonreimbursable4 7,h7 ,a li/ ( any o!r requirem5ts impos$ on claims submitt$ = heal? c>e %>+ "u su* m9i/ry4 7#b7 ,mann] ( disclosure ,= purposes ( subsection 7a77#b71 in=mation describ$ 9 p>agraph 7#a7 %all be-- 7,a7 disclos$ 9 a prom95t mann]2 7,b7 made available 9 multiple langauges2 7,c7 provid$ imm$iately be=e enrollm5t ( any individual 9 a heal? c>e %>+ m9i/ry2 & 7,d7 be writt5 9 at lea/ #ad po9t font 7or1 if su* enrollm5t is be+ made ov] ! phone1 be read out l\d74 7d7 ,entity requirem5ts ,= purposes ( subsection 7a77#c71 ! requirem5ts describ$ 9 ?is subsection are1 ) respect to an entity ) a contract 9 effect ) a heal? c>e %>+ m9i/ry = purposes ( enroll+ an individual 9 su* m9i/ry 7or o!rwise receiv+ remun]ation f su* m9i/ry 9 ex*ange = enroll+ an individual 9 su* m9i/ry71 t su* entity provides to su* individual-- 7#a7 an explanation ( any tax cr$it t may be available to su* individual "u section #cf;,b ( ! ,int]nal ,rev5ue ,code ( #aihf to pur*ase a qualifi$ heal? plan 7z def9$ 9 section #acja7;a7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act7 ?r\gh an ,ex*ange e/abli%$ pursuant to su* ,act2 7#b7 if su* individual qualifies to enroll "u a ,/ate plan 7or waiv] ( su* plan7 "u title ,,xix ( ! ,social ,security ,act1 or if su* individual is entitl$ to b5efits "u "p ,a or eligible to enroll "u "p ,b ( title ,,xviii ( su* ,act1 an explanation ( su* qualification1 entitlem5t1 or eligibility2 7#c7 an explanation ( ! types ( b5efits requir$ to be provid$ "u su* plans & o!r protections applicable "u su* plans 7su* z limitations on co/ %>+7 comp>$ to ! b5efits provid$1 & co/-%>+ requirem5ts impos$1 "u su* m9i/ry2 & 7#d7 an explanation t su* m9i/ry is n a gr\p heal? plan or heal? insurance cov]age & t b5efits provid$ "u su* m9i/ry are n gu>ante$4 7e7 ,en=cem5t ,9 ! case t ! ,secret>y det]m9es t a heal? c>e %>+ m9i/ry has fail$ to meet a requirem5t ( ?is section1 ! ,secret>y may impose a civil monet>y p5alty on su* m9i/ry 9 an am\nt n to exce$ #ajj = ea* day = ea* individual ) respect to :i* su* a failure occurs4 ,! provisions ( subp>agraphs 7,c7 ?r\gh 7,g7 ( p>agraph 7#b7 ( section #bgbc %all apply to a civil monet>y p5alty impos$ "u ?is subsection 9 ! same mann] z su* provisions apply to a civil monet>y p5alty impos$ "u su* section4 7f7 ,def9itions ,= purposes ( ?is section1 ! ,secret>y may specify ! mean+ ( any t]m us$ 9 relation to a heal? c>e %>+ m9i/ry & cl>ify ! applicability ( su* t]m to su* a m9i/ry4 4 7b7 ,disclosures by ,f$]al ,trade ,commission reg>d+ consum] compla9ts 7#a7 ,9 g5]al ,n lat] ?an ,janu>y #a & ,july #a ( ea* ye>1 ! ,f$]al ,trade ,commission %all publicly disclose on ! ,int]net website ( ! ,commission1 & transmit to ! ,secret>y ( ,heal? & ,human ,s]vices & ! ,commission] ( ,int]nal ,rev5ue-- 7,a7 ! numb] ( consum] compla9ts reg>d+ heal? c>e %>+ m9i/ries 7z def9$ 9 section #ejjj;,a7d77#b77;,b77ii7 ( ! ,int]nal ,rev5ue ,code ( #aihf7 receiv$ by ! ,commission dur+ ! p]iod cov]$ by ! disclosure2 7,b7 ! g5]al categories 7z det]m9$ by ! ,commission7 ( ! compla9ts describ$ 9 subp>agraph 7,a72 & 7,c7 ) respect to ea* compla9t describ$ 9 subp>agraph 7,a7-- 7i7 ! "n ( ! heal? c>e %>+ m9i/ry aga9/ :i* ! compla9t 0 made2 & 7ii7 su* details z ! ,commission consid]s appropriate reg>d+ ! own]%ip1 op]ation1 & executive lead]%ip ( su* m9i/ry4 7#b7 ,tim+ ( initial disclosure ,p>agraph 7#a7 %all apply beg9n+ on ! ,janu>y #a or ,july #a t fir/ occurs aft] ! date t is #ij days aft] ! date ( ! enactm5t ( ?is ,act4