Mr. Armstrong

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6. Strengthening health coverage transparency requirements Section 2715A of the Public Health Service Act (42 U.S.C. 300gg-15a) is amended— by striking A Group health and inserting the following: (a)In generalA group health; and A group health by ending at the end the following: (b)Additional transparency requirements(1)Specified information required(A)In generalA group health plan or health insu…

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10. Requirement for explanation of benefits Section 2799A–1(f) of the Public Health Service Act (42 U.S.C. 300gg–111(f)) is amended— in paragraph (1)— by striking subparagraph (C) and inserting the following: (C)A good faith estimate of the amount the plan or coverage is responsible for paying for items and services included in the estimate described in subparagraph (B), including a plain languag…

This clause tightens a reporting or study requirement and a compliance mandate: Requires health plans to provide itemized explanation of benefits within 45 days of receiving payment requests, including billing codes, cost-sharing amounts, and accumulator information. It is likely beneficial for Health plan participants and enrollees (cost down). It likely creates costs, burdens, barriers, or risks for Group health plans and health insurers (compliance burden up).

This clause tightens a reporting or study requirement and a compliance mandate: Strengthens health plan transparency requirements by mandating disclosure of in-network rates, maximum allowed amounts for out-of-network, and patient cost-sharing through self-service tools. It is likely beneficial for Individual health insurance consumers (cost down). It likely creates costs, burdens, barriers, or risks for Health insurance exchanges and qualified health plans (compliance burden up).