,i  #aaith ,,congress  #b;d ,session    
,h4 ,r4 #icig  ,,in ,,the ,,house ,,of  
,,representatives  ,june #bc1 #bjbf,mr4 
,pfluger 7for himself and ,mr4 ,moran7  
introduced the following bill2 which was
 referred to the ,committee on ,energy  
and ,commerce1 and in addition to the   
,committee on ,ways and ,means1 for a   
period to be subsequently determined by 
the ,speaker1 in each case for          
consideration of such provisions as fall
 within the jurisdiction of the         
committee concerned  ,a ,,bill  ,to     
amend title ,,xxvii of the ,public      
,health ,service ,act and title ,,xviii 
of the ,social ,security ,act to ensure 
health insurer accountability through   
publishing of overhead costs and claim  
payments1 and to direct the ,secretary  
of ,health and ,human ,services to issue
 guidance on the provision of certain   
insurance information4  #a4 ,short title
 ,this ,act may be cited as the ,premium
 ,transparency ,act4  #b4 ,ensuring     
health insurer accountability through   

publishing of overhead costs and claim  
payments  7a7 ,in general ,section      
#bgah7;a7 of the ,public ,health        
,service ,act 7#db ,u4,s4,c4            
#cjj;gg-#ah7;a77 is amended--  7#a7 by  
redesignating paragraphs 7#a7 through   
7#c7 as subparagraphs 7,a7 through 7,c71
 and adjusting the margins accordingly2 
7#b7 by striking ,a health insurance    
issuer and inserting the following3     
7#a7 ,in general ,a health insurance    
issuer  2 and  7#c7 by adding at the end
 the following new paragraph3  7#b7     
,overhead costs and claim payment       
information  7,a7 ,in general ,a health 
insurance issuer offering group or      
individual health insurance coverage    
7including a grandfathered health plan7 
shall1 with respect to each plan year   
beginning on or after ,january #a1      
#bjbg1 submit to the ,secretary 7and1 in
 the case such coverage was offered     
through an ,exchange established under  
subtitle ,d of title ,i of the ,patient 
,protection and ,affordable ,care ,act1 

to such ,exchange7 and publish on the   
public website of such issuer the       
following information in a              
consumer-friendly format specified by   
the ,secretary3 7i7 the percentage of   
total premium revenue expended for each 
category described in subparagraphs 7,a7
 through 7,c7 of paragraph 7#a72  7ii7  
the explanation described in paragraph  
7#a77;,c72 and  7iii7 the percentage of 
total premium revenue not expended and  
retained by such issuer4  7,b7 ,manner  
of publication ,information submitted   
and published by a health insurance     
issuer under subparagraph 7,a7 shall be 
so submitted and published at the       
coverage level and shall in addition1 if
 determined appropriate by the          
,secretary1 be so submitted and         
published in the aggregate in such      
manner as specified by the ,secretary   
7such as across all such coverage       
offered by such issuer that are offered 
within the same insurance market 7as    
specified in subclause 7,i71 7,,ii71    

7,,iii71 or 7,,iv7 of section           
#bgii;,a-#a7;a77#c77;,e77iv7774  4  7b7 
,medicare ,advantage ,section #aheg7;e7 
of the ,social ,security ,act 7#db      
,u4,s4,c4 #aciew-#bg7;e77 is amended by 
adding at the end the following new     
paragraph3  7#g7 ,overhead costs and    
claim payment information  7,a7 ,in     
general ,beginning with plan years      
beginning on or after ,january #a1      
#bjbg1 a contract under this section    
with an ,,ma organization shall require 
the organization1 with respect to each  
,,ma plan offered by such organization  
during such plan year1 to submit to the 
,secretary and publish on the public    
website of such organization the        
following information in a              
consumer-friendly format specified by   
the ,secretary3 7i7 ,the amount of total
 revenue 7as determined under section   
#dbb4bdbj7;c7 of title #db1 ,code of    
,federal ,regulations 7or a successor   
regulation77 collected under such plan4 
7ii7 ,the amount and percentage of such 

revenue expended on incurred claims 7as 
determined in accordance with paragraphs
 7#b7 through 7#d7 of section           
#dbb4bdbj7;b7 of title #db1 ,code of    
,federal ,regulations 7or a successor   
regulation774  7iii7 ,the amount and    
percentage of such revenue expended on  
non-claims costs 7as defined in section 
#dbb4bdja of title #db1 ,code of        
,federal ,regulations 7or a successor   
regulation774  7iv7 ,the amount of the  
difference between the ,,mlr numerator  
7as determined under paragraph 7b7 of   
section #dbb4bdbj of title #db1 ,code of
 ,federal ,regulations 7or a successor  
regulation77 and the ,,mlr denominator  
7as determined under paragraph 7c7 of   
such section 7or a successor            
regulation774  7v7 ,the amount described
 in clause 7iv71 expressed as a         
percentage of such revenue4  7,b7       
,manner of publication ,information     
submitted and published by an ,,ma      
organization under subparagraph 7,a7    
shall be so submitted and published at  

the ,,ma plan level and shall in        
addition1 if determined appropriate by  
the ,secretary1 be so submitted and     
published in the aggregate in such      
manner as specified by the ,secretary   
7such as across all ,,ma plans offered  
by such organization74  4  #c4          
,promoting comparability of qualified   
health plans offered through an         
,exchange ,section #acaa7;d77#d77;,c7 of
 the ,patient ,protection and           
,affordable ,care ,act 7#db ,u4,s4,c4   
#ahjca7;d77#d77;,c77 is amended-- 7#a7  
by striking website through which and   
inserting the following3  website-- 7i7 
through which  2  7#b7 in clause 7i71 as
 so inserted1 by striking the semicolon 
and inserting 2 and2 and  7#c7 by adding
 at the end the following new clause3   
7ii7 that includes1 as part of such     
comparative information for enrollments 
for plan years beginning on or after    
,january #a1 #bjbi1 in the case a       
qualified health plan offered through   
such ,exchange for such plan year was   

offered through such ,exchange for a    
previous plan year1 the most recent     
information submitted to such ,exchange 
with respect to such plan by the health 
insurance issuer of such plan under     
section #bgah7;a77#b7 of the ,public    
,health ,service ,act2  4  #d4 ,guidance
 on provision of certain insurance      
information in standardized1 plain      
,english format  7a7 ,in general ,not   
later than ,january #a1 #bjbh1 the      
,secretary shall issue guidance to group
 health plans1 health insurance issuers 
offering group or individual health     
insurance coverage1 and ,medicare       
,advantage organizations offering an    
,,ma plan on providing information on   
the benefits and coverage available     
under the applicable plan or coverage1  
consistent with the relevant            
requirements under section #bgae of the 
,public ,health ,service ,act 7#db      
,u4,s4,c4 #cjj;gg-#ae71 section         
#ahea7;d7 of the ,social ,security ,act 
7#db ,u4,s4,c4 #aciew-#ba7;d771 and     

section #aheb7;c7 of such ,act 7#db     
,u4,s4,c4 #aciew-#bb7;c774 ,such        
guidance shall include standards for    
providing information in a standardized1
 plain ,english format with respect to  
the following aspects of the plan or    
coverage 7to the extent applicable73    
7#a7 ,any monthly premium4  7#b7 ,any   
annual deductible4  7#c7 ,any maximum   
limitations on out-of-pocket expenses4  
7#d7 ,the type of provider network used 
by the plan or coverage4  7#e7 ,the plan
 or coverage share of the total allowed 
costs of benefits provided under the    
plan or coverage4  7#f7 ,the standard   
cost-sharing amounts for in-network     
care1 including for the following types 
of care3  7,a7 ,primary care4  7,b7     
,specialist care4  7,c7 ,urgent care4   
7,d7 ,emergency department care4  7,e7  
,imaging4  7,f7 ,inpatient hospital     
care4  7,g7 ,outpatient facility care4  
7,h7 ,laboratory services4  7,i7        
,preferred brand name drugs4  7,j7      
,generic drugs4  7#g7 ,additional       

features of the plan or coverage1       
including the following3 7,a7           
,specialist referral policies4  7,b7    
,the availability of wellness programs4 
7,c7 ,the availability of disease       
management programs4  7,d7 ,whether an  
individual enrolled in such plan or     
coverage is an eligible individual for  
purposes of section #bbc of the         
,internal ,revenue ,code of #aihf       
7relating to health savings accounts74  
7,e7 ,coverage of preventive care       
services4  7#h7 ,such other aspects of  
the plan or coverage as the ,secretary  
may specify4  7b7 ,consultation ,in     
developing the guidance under subsection
 7a71 the ,secretary shall consult with 
the ,secretary of ,labor and the        
,secretary of the ,treasury4  7c7 ,rule 
of construction ,nothing in this section
 shall be construed as requiring a group
 health plan1 a health insurance issuer 
offering group or individual health     
insurance coverage1 or a ,medicare      
,advantage organization offering an ,,ma

 plan to offer any of the plan features 
described in subsection 7a74  7d7       
,definitions ,in this section3  7#a7    
,medicare ,advantage terms ,the terms   
,medicare ,advantage organization and   
,,ma plan have the meanings given each  
such term for purposes of part ,c of    
title ,,xviii of the ,social ,security  
,act 7#db ,u4,s4,c4 #aciew-#ba et seq474
  7#b7 ,private health insurance terms  
,the terms group health plan1 health    
insurance coverage1 health insurance    
issuer1 group health insurance coverage1
 and individual health insurance        
coverage have the meanings given each   
such term in section #bgia of the       
,public ,health ,service ,act 7#db      
,u4,s4,c4 #cjj;gg-#ia74  7#c7 ,secretary
 ,the term ,secretary means the         
,secretary of ,health and ,human        
,services4