,i  #aai? ,,congress  #b;d ,session  ,h4
 ,r4 #iged  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,july #af1 #bjbf,mrs4 
,mc,bath introduc$ ! foll[+ bill2 :i* 0 
ref]r$ to ! ,committee on ,education &  
,work=ce  ,a ,,bill  ,to direct !       
,secret>y ( ,labor to require gr\p heal?
 plans include c]ta9 in=mation on claim 
d5ials 9 annual reports1 & = o!r        
purposes4  #a4 ,%ort title ,?is ,act may
 be cit$ z ! ,heal? ,claim ,d5ial       
,transp>5cy ,act4  #b4 ,claim d5ial     
transp>5cy regulation  7a7 ,regulation  
7#a7 ,9 g5]al ,n lat] ?an #a ye> aft] ! 
date ( enactm5t ( ?is ,act & subject to 
p>agraph 7#b71 ! ,secret>y ( ,labor %all
 promulgate a regulation requir+ all    
gr\p heal? plans1 z "p ( ! annual report
 requir$ "u section #ajd7;a77#a7 ( !    
,employee ,retirem5t ,income ,security  
,act ( #aigd 7#bi ,u4,s4,c4             
#ajbd7;a77#a771 to include1 ) respect to
 ! plan ye> ( ! annual report1 ! foll[+3
  7,a7 ,! total numb] ( claims =        
b5efits-- 7i7 submitt$ dur+ ! plan ye>2 

7ii7 approv$ dur+ ! plan ye>2  7iii7    
d5i$ dur+ ! plan ye>2  7iv7 appeal$ dur+
 ! plan ye>2 &  7v7 ( ! claims describ$ 
9 clause 7iv71 ! numb] ( claim d5ials   
rev]s$ 9 :ole or 9 "p dur+ ! appeals    
process4  7,b7 ,! numb] ( pre-s]vice1   
po/-s]vice1 & urg5t c>e claims-- 7i7    
submitt$ dur+ ! plan ye>2  7ii7 approv$ 
dur+ ! plan ye>2  7iii7 d5i$ dur+ ! plan
 ye>2 &  7iv7 appeal$ dur+ ! plan ye>4  
7,c7 ,! numb] ( 9-pati5t & out-pati5t   
claims--  7i7 submitt$ dur+ ! plan ye>2 
7ii7 approv$ dur+ ! plan ye>2  7iii7    
d5i$ dur+ ! plan ye>2 &  7iv7 appeal$   
dur+ ! plan ye>4  7,d7 ,subject to      
p>agraph 7#b71 ! numb] ( claims =       
prescription drugs-- 7i7 submitt$ dur+ !
 plan ye>2  7ii7 d5i$ dur+ ! plan ye>2  
7iii7 approv$ dur+ ! plan ye>2 &  7iv7  
appeal$ dur+ ! plan ye>4  7,e7 ,subject 
to p>agraph 7#b71 ! numb] ( claims =    
m5tal heal? & sub/ance use disord]      
b5efits--  7i7 submitt$ dur+ ! plan ye>2
  7ii7 d5i$ dur+ ! plan ye>2  7iii7     
approv$ dur+ ! plan ye>2 &  7iv7 appeal$

 dur+ ! plan ye>4  7,f7 ,subject to     
p>agraph 7#b71 ! numb] ( claims = m$ical
 & surgical b5efits relat+ to !         
diagnosis or treatm5t ( canc]-- 7i7     
submitt$ dur+ ! plan ye>2  7ii7 d5i$    
dur+ ! plan ye>2  7iii7 approv$ dur+ !  
plan ye>2 &  7iv7 appeal$ dur+ ! plan   
ye>4  7,g7 ,! total doll> am\nt (--  7i7
 claims paid dur+ ! plan ye>2 &  7ii7   
claims d5i$ dur+ ! plan ye>4  7,h7 ,!   
total numb] ( claims t 7 n adjudicat$ )9
 ! "t frame requir$ by ! claims proc$ure
 process ( ! plan1 e/abli%$ pursuant to 
section #ejc ( ! ,employee ,retirem5t   
,income ,security ,act ( #aigd 7#bi     
,u4,s4,c4 #aacc74  7,i7 ,! basis =      
d5ials1 includ+ ! total numb] ( claims  
d5i$ due to--  7i7 m$ical necessity     
requirem5ts2  7ii7 lack ( ref]ral2      
7iii7 lack ( prior au?orization2  7iv7  
s]vices exclud$2  7v7 adm9i/rative      
reasons2 &  7vi7 o!r reasons det]m9$ by 
! ,secret>y4  7,j7 ,! numb] ( claims    
process$ 9 :i* artificial intellig5ce or
 o!r automat$ decision-mak+ tools are   

utiliz$1 includ+ ! numb] ( su* claims-- 
7i7 paid dur+ ! plan ye>2 &  7ii7 d5i$  
dur+ ! plan ye>4  7#b7 ,exception =     
c]ta9 data f small plans ,! ,secret>y   
may n require t ! annual report include1
 & a gr\p heal? plan may n include 9 su*
 report1 ! numb] ( claims z describ$ "u 
subp>agraph 7,d71 7,e71 or 7,f7 (       
p>agraph 7#a7 if ! plan has receiv$ #bj 
or few] unique claims describ$ "u !     
applicable p>agraph dur+ ! plan ye>4    
7b7  ,am5d+ regulations  ,z "p ( !      
promulgation describ$ 9 subsection 7a71 
! ,secret>y %all am5d section           
#bebj4ajd-df7;b77#b7 ( title #bi1 ,code 
( ,f$]al ,regulations1 to require a gr\p
 heal? plan ) few] ?an #ajj p>ticipants 
to comply ) ! report+ requirem5ts (     
subsection 7a74  7c7 ,waiv] ( m9imum    
requirem5ts ,9 ! case t ! ,secret>y     
all[s a gr\p heal? plan to file a       
simplifi$ report pursuant to section    
#ajd7;a77#c7 ( ! ,employee ,retirem5t   
,income ,security ,act 7#bi ,u4,s4,c4   
#ajbd7;a77#c771 ! ,secret>y %all1 at a  

m9imum1 require ! gr\p heal? plan to    
include all ( ! in=mation 9 subsection  
7a7 9 su* simplifi$ report4  7d7        
,def9itions ,9 ?is section3  7#a7       
,d5ial  ,! t]m d5ial has ! mean+ giv5 ! 
t]m adv]se b5efit det]m9ation 9 section 
#befj4ejc-a7m77#d7 ( title #bi1 ,code ( 
,f$]al ,regulations4  7#b7 ,gr\p heal?  
plan ,! t]m gr\p heal? plan has ! mean+ 
giv5 ! t]m 9 section #gcc7;a77#a7 ( !   
,employee ,retirem5t ,income ,security  
,act ( #aigd 7#bi ,u4,s4,c4             
#aaia;b7a77#a774  7#c7 ,po/-s]vice claim
 ,! t]m po/-s]vice claim has ! mean+    
giv5 ! t]m 9 section #befj4ejc-a7m7 (   
title #bi1 ,code ( ,f$]al ,regulations4 
7#d7  ,pre-s]vice claim  ,! t]m         
pre-s]vice claim has ! mean+ giv5 ! t]m 
9 section #befj4ejc-a7m7 ( title #bi1   
,code ( ,f$]al ,regulations4  7#e7      
,urg5t c>e claim  ,! t]m urg5t c>e claim
 has ! mean+ giv5 ! t]m claim involv+   
urg5t c>e 9 section #befj4ejc-a7m77#a7 (
 title #bi1 ,code ( ,f$]al ,regulations4