Sec. 102. Ensuring that consumers get value for their dollars
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Section 2794 of the Public Health Service Act ( 42 U.S.C. 300gg–94 ) is amended— in subsection (a)— in paragraph (1), by striking subsection (b)(2)(A) and inserting subsections (b)(2)(A) and (b)(3) ; and in paragraph (2), by adding at the end the following: Notwithstanding any other provision of law, a health insurance issuer may not exclude from such disclosure information that is a trade secret or commercial or financial information described in section 552(b)(4) of title 5, United States Code. ; in subsection (b)— in paragraph (2)(A), by inserting and paragraph
(3)after subsection (a)(2) ; and by adding at the end the following: Beginning with plan years beginning in 2020, the Secretary, or a State pursuant to an effective rate review program meeting the requirements under paragraph (4)— shall, consistent with subsection (a)(2) and paragraph (2), review increases in health insurance premiums that are subject to review pursuant to section 154.200 of title 45, Code of Federal Regulations (or any successor regulation), and determine whether such increases are unreasonable; and may prohibit a health insurance issuer from implementing such an increase that is unreasonable. In determining whether an increase in health insurance premiums is unreasonable under subparagraph (A)(i)— the Secretary shall consider whether the increase is excessive, unjustified, discriminatory, or inadequate; and the State, pursuant to an effective rate review program meeting the requirements under paragraph (4), shall apply applicable State law for making such determination. A State effective rate review program meets the requirements under this paragraph if— the program carries out the reviews described in paragraph (3)(A)(i) and ensures that such reviews are a meaningful, effective, and timely review of the data and documentation (including any contracts or documents described in subparagraph (E)) submitted by health insurance issuers in support of proposed increases in health insurance premiums; such reviews include an examination of— the affordability of proposed increases in health insurance premiums; the quality improvement activities carried out by health insurance issuers proposing the increases; and the cost containment activities of health insurance issuers proposing the increases; the program establishes a mechanism for receiving public comments on proposed increases in health insurance premiums reviewed by the State; such reviews include a review of all public comments received under subparagraph (C); the program requires each health insurance issuer proposing an increase in health insurance premiums to submit to the State any provider contracts that may be affected, including any documents incorporated by reference into such contracts; and the program requires the State to provide the Secretary its determination of whether each increase reviewed is unreasonable, in a form and manner prescribed by the Secretary. ; and in subsection (c)— in paragraph (1)— in the heading, by striking and inserting 2010 through 2014 ; and 2020 through 2024 in the matter preceding subparagraph (A), by striking 2010 and inserting 2020 ; and in paragraph (2)(B), by striking 2014 and inserting 2024 .
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- 42 USC 300gg–94
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Sec. 102
Ensuring that consumers get value for their dollars
Cite42 USC 300gg–94
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