Sec. 6. Ensuring enrollee access to cost-sharing information
378 words·~2 min read·
/bill/116/s/1531/is/section-6·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Subpart II of part A of title XXVII of the Public Health Service Act ( 42 U.S.C. 300gg–11 et seq.), as amended by section 5, is further amended by adding at the end the following: A group health plan or a health insurance issuer offering group or individual health insurance coverage shall not contract with a health care provider with respect to the plan or coverage unless the provider agrees to provide an enrollee in the plan or coverage, at the time of scheduling an elective health care service, or not later than 48 hours of the enrollee requesting such information, the expected enrollee cost-sharing for the provision of a particular health care service involved (including any service that is reasonably expected to be provided in conjunction with such specific service, such as expected cost-sharing of laboratory services).
A group health plan or a health insurance issuer offering group or individual health insurance coverage shall provide an enrollee in the plan or coverage with a good faith estimate of the enrollee’s cost-sharing (including deductibles, copayments, and coinsurance) for which the enrollee would be responsible for paying with respect to a specific elective health care service (including any service that is reasonably expected to be provided in conjunction with such specific service such as expected cost-sharing of laboratory services), not later than 48 hours after receiving a request for such information by an enrollee.
A group health plan or a health insurance issuer offering group or individual health insurance coverage shall provide to enrollees the out-of-pocket costs and benefits information at all sites of care and for all providers included in the plan network. Such information shall be made available to enrollees through an internet website or an application. Information about the availability of such price information through such means shall be provided to each enrollee upon enrollment, or renewal, in the health plan or health insurance coverage. .
Subsection (a)(1) of section 2729E of the Public Health Service Act, as added by subsection (a), shall apply with respect to plan years beginning on or after January 1, 2020. Subsection
(b)of section 2729E of the Public Health Service Act, as added by subsection (a), shall apply with respect to plan years beginning on or after January 1, 2021.
Connections1 off-index
1 reference not yet in our index
- 42 USC 300gg–11
Citation graph
cites case law
Sec. 6
Ensuring enrollee access to cost-sharing information
Cite42 USC 300gg–11
Cites 1Cited by 0 across 0 sources