Sec. 9. Transparency requirements on insurance
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Part C of title XXVII of the Public Health Service Act ( 42 U.S.C. 300gg–91 et seq.) is amended by adding at the end the following: Each group health plan and health insurance issuer offering group or individual health insurance coverage shall annually report to the Secretary of Health and Human Services and the Secretary of Labor, with respect to the applicable plan or coverage for the applicable plan year— the total claims that were submitted by in-network health care providers with respect to enrollees under the plan or coverage, and the number of such claims that were paid and the number of such claims that were denied; the total claims that were submitted by out-of-network health care providers with respect to enrollees under the plan or coverage, and the number of such claims that were paid and the number of such claims that were denied; with respect to each out-of-network claim, the out-of-pocket costs, including applicable cost-sharing amounts, to the enrollee for the services, and the difference between the billed charge and the amount the plan pays, adjusted by any balance billing limitation through State and Federal regulatory and statutory requirements that might apply; the number of out-of-network claims reported under paragraph
(2)that are for emergency services; and the number of out-of-network claims reported under paragraph
(2)that relate to care at in-network hospitals or facilities provided by out-of-network providers. The information required to be submitted under this section shall be in addition to the information required to be submitted under section 2715A. .
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- 42 USC 300gg–91
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Sec. 9
Transparency requirements on insurance
Cite42 USC 300gg–91
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