,i #aai? ,,congress #b;d ,session ,h4 ,r4 #icig ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,june #bc1 #bjbf,mr4 ,pflug] 7= himself & ,mr4 ,moran7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce1 & 9 addition to ! ,committee on ,ways & ,means1 = 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 ,act & title ,,xviii ( ! ,social ,security ,act to ensure heal? insur] acc\ntability ?r\gh publi%+ ( ov]head co/s & claim paym5ts1 & to direct ! ,secret>y ( ,heal? & ,human ,s]vices to issue guidance on ! provision ( c]ta9 insurance in=mation4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,premium ,transp>5cy ,act4 #b4 ,ensur+ heal? insur] acc\ntability ?r\gh publi%+ ( ov]head co/s & claim paym5ts 7a7 ,9 g5]al ,section #bgah7;a7 ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ah7;a77 is am5d$-- 7#a7 by r$esignat+ p>agraphs 7#a7 ?r\gh 7#c7 z subp>agraphs 7,a7 ?r\gh 7,c71 & adju/+ ! m>g9s accord+ly2 7#b7 by /rik+ ,a heal? insurance issu] & ins]t+ ! foll[+3 7#a7 ,9 g5]al ,a heal? insurance issu] 2 & 7#c7 by add+ at ! end ! foll[+ new p>agraph3 7#b7 ,ov]head co/s & claim paym5t in=mation 7,a7 ,9 g5]al ,a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age 7includ+ a gr&fa!r$ heal? plan7 %all1 ) respect to ea* plan ye> beg9n+ on or aft] ,janu>y #a1 #bjbg1 submit to ! ,secret>y 7&1 9 ! case su* cov]age 0 (f]$ ?r\gh an ,ex*ange e/abli%$ "u subtitle ,d ( title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act1 to su* ,ex*ange7 & publi% on ! public website ( su* issu] ! foll[+ in=mation 9 a consum]-fri5dly =mat specifi$ by ! ,secret>y3 7i7 ! p]c5tage ( total premium rev5ue exp5d$ = ea* category describ$ 9 subp>agraphs 7,a7 ?r\gh 7,c7 ( p>agraph 7#a72 7ii7 ! explanation describ$ 9 p>agraph 7#a77;,c72 & 7iii7 ! p]c5tage ( total premium rev5ue n exp5d$ & reta9$ by su* issu]4 7,b7 ,mann] ( publication ,in=mation submitt$ & publi%$ by a heal? insurance issu] "u subp>agraph 7,a7 %all be s submitt$ & publi%$ at ! cov]age level & %all 9 addition1 if det]m9$ appropriate by ! ,secret>y1 be s submitt$ & publi%$ 9 ! aggregate 9 su* mann] z specifi$ by ! ,secret>y 7su* z across all su* cov]age (f]$ by su* issu] t are (f]$ )9 ! same insurance m>ket 7z specifi$ 9 subclause 7,i71 7,,ii71 7,,iii71 or 7,,iv7 ( section #bgii;,a-#a7;a77#c77;,e77iv7774 4 7b7 ,m$ic>e ,advantage ,section #aheg7;e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bg7;e77 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#g7 ,ov]head co/s & claim paym5t in=mation 7,a7 ,9 g5]al ,beg9n+ ) plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbg1 a contract "u ?is section ) an ,,ma organization %all require ! organization1 ) respect to ea* ,,ma plan (f]$ by su* organization dur+ su* plan ye>1 to submit to ! ,secret>y & publi% on ! public website ( su* organization ! foll[+ in=mation 9 a consum]-fri5dly =mat specifi$ by ! ,secret>y3 7i7 ,! am\nt ( total rev5ue 7z det]m9$ "u section #dbb4bdbj7;c7 ( title #db1 ,code ( ,f$]al ,regulations 7or a successor regulation77 collect$ "u su* plan4 7ii7 ,! am\nt & p]c5tage ( su* rev5ue exp5d$ on incurr$ claims 7z det]m9$ 9 accordance ) p>agraphs 7#b7 ?r\gh 7#d7 ( section #dbb4bdbj7;b7 ( title #db1 ,code ( ,f$]al ,regulations 7or a successor regulation774 7iii7 ,! am\nt & p]c5tage ( su* rev5ue exp5d$ on non-claims co/s 7z def9$ 9 section #dbb4bdja ( title #db1 ,code ( ,f$]al ,regulations 7or a successor regulation774 7iv7 ,! am\nt ( ! diff]5ce betwe5 ! ,,mlr num]ator 7z det]m9$ "u p>agraph 7b7 ( section #dbb4bdbj ( title #db1 ,code ( ,f$]al ,regulations 7or a successor regulation77 & ! ,,mlr d5om9ator 7z det]m9$ "u p>agraph 7c7 ( su* section 7or a successor regulation774 7v7 ,! am\nt describ$ 9 clause 7iv71 express$ z a p]c5tage ( su* rev5ue4 7,b7 ,mann] ( publication ,in=mation submitt$ & publi%$ by an ,,ma organization "u subp>agraph 7,a7 %all be s submitt$ & publi%$ at ! ,,ma plan level & %all 9 addition1 if det]m9$ appropriate by ! ,secret>y1 be s submitt$ & publi%$ 9 ! aggregate 9 su* mann] z specifi$ by ! ,secret>y 7su* z across all ,,ma plans (f]$ by su* organization74 4 #c4 ,promot+ comp>ability ( qualifi$ heal? plans (f]$ ?r\gh an ,ex*ange ,section #acaa7;d77#d77;,c7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7#db ,u4,s4,c4 #ahjca7;d77#d77;,c77 is am5d$-- 7#a7 by /rik+ website ?r\gh :i* & ins]t+ ! foll[+3 website-- 7i7 ?r\gh :i* 2 7#b7 9 clause 7i71 z s ins]t$1 by /rik+ ! semicolon & ins]t+ 2 &2 & 7#c7 by add+ at ! end ! foll[+ new clause3 7ii7 t includes1 z "p ( su* comp>ative in=mation = enrollm5ts = plan ye>s beg9n+ on or aft] ,janu>y #a1 #bjbi1 9 ! case a qualifi$ heal? plan (f]$ ?r\gh su* ,ex*ange = su* plan ye> 0 (f]$ ?r\gh su* ,ex*ange = a previ\s plan ye>1 ! mo/ rec5t in=mation submitt$ to su* ,ex*ange ) respect to su* plan by ! heal? insurance issu] ( su* plan "u section #bgah7;a77#b7 ( ! ,public ,heal? ,s]vice ,act2 4 #d4 ,guidance on provision ( c]ta9 insurance in=mation 9 /&>diz$1 pla9 ,engli% =mat 7a7 ,9 g5]al ,n lat] ?an ,janu>y #a1 #bjbh1 ! ,secret>y %all issue guidance to gr\p heal? plans1 heal? insurance issu]s (f]+ gr\p or individual heal? insurance cov]age1 & ,m$ic>e ,advantage organizations (f]+ an ,,ma plan on provid+ in=mation on ! b5efits & cov]age available "u ! applicable plan or cov]age1 consi/5t ) ! relevant requirem5ts "u section #bgae ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ae71 section #ahea7;d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba7;d771 & section #aheb7;c7 ( su* ,act 7#db ,u4,s4,c4 #aciew-#bb7;c774 ,su* guidance %all include /&>ds = provid+ in=mation 9 a /&>diz$1 pla9 ,engli% =mat ) respect to ! foll[+ aspects ( ! plan or cov]age 7to ! ext5t applicable73 7#a7 ,any mon?ly premium4 7#b7 ,any annual d$uctible4 7#c7 ,any maximum limitations on out-(-pocket exp5ses4 7#d7 ,! type ( provid] network us$ by ! plan or cov]age4 7#e7 ,! plan or cov]age %>e ( ! total all[$ co/s ( b5efits provid$ "u ! plan or cov]age4 7#f7 ,! /&>d co/-%>+ am\nts = 9-network c>e1 includ+ = ! foll[+ types ( c>e3 7,a7 ,prim>y c>e4 7,b7 ,speciali/ c>e4 7,c7 ,urg5t c>e4 7,d7 ,em]g5cy dep>tm5t c>e4 7,e7 ,imag+4 7,f7 ,inpati5t hospital c>e4 7,g7 ,outpati5t facility c>e4 7,h7 ,laboratory s]vices4 7,i7 ,pref]r$ br& "n drugs4 7,j7 ,g5]ic drugs4 7#g7 ,additional features ( ! plan or cov]age1 includ+ ! foll[+3 7,a7 ,speciali/ ref]ral policies4 7,b7 ,! availability ( wellness programs4 7,c7 ,! availability ( disease managem5t programs4 7,d7 ,:e!r an individual enroll$ 9 su* plan or cov]age is an eligible individual = purposes ( section #bbc ( ! ,int]nal ,rev5ue ,code ( #aihf 7relat+ to heal? sav+s acc\nts74 7,e7 ,cov]age ( prev5tive c>e s]vices4 7#h7 ,su* o!r aspects ( ! plan or cov]age z ! ,secret>y may specify4 7b7 ,consultation ,9 develop+ ! guidance "u subsection 7a71 ! ,secret>y %all consult ) ! ,secret>y ( ,labor & ! ,secret>y ( ! ,treasury4 7c7 ,rule ( con/ruction ,no?+ 9 ?is section %all be con/ru$ z requir+ a gr\p heal? plan1 a heal? insurance issu] (f]+ gr\p or individual heal? insurance cov]age1 or a ,m$ic>e ,advantage organization (f]+ an ,,ma plan to (f] any ( ! plan features describ$ 9 subsection 7a74 7d7 ,def9itions ,9 ?is section3 7#a7 ,m$ic>e ,advantage t]ms ,! t]ms ,m$ic>e ,advantage organization & ,,ma plan h ! mean+s giv5 ea* su* t]m = purposes ( "p ,c ( title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba et seq474 7#b7 ,private heal? insurance t]ms ,! t]ms gr\p heal? plan1 heal? insurance cov]age1 heal? insurance issu]1 gr\p heal? insurance cov]age1 & individual heal? insurance cov]age h ! mean+s giv5 ea* su* t]m 9 section #bgia ( ! ,public ,heal? ,s]vice ,act 7#db ,u4,s4,c4 #cjj;gg-#ia74 7#c7 ,secret>y ,! t]m ,secret>y means ! ,secret>y ( ,heal? & ,human ,s]vices4