Sec. 309. Ensuring enrollee access to cost-sharing information
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/bill/116/s/1895/is/section-309·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 306, is further amended by adding at the end the following: A provider that is in-network with respect to a group health plan or a health insurance issuer offering group or individual health insurance coverage shall provide to an enrollee in the plan or coverage who submits a request for the information described in paragraph
(1)or (2), together with accurate and complete information about the enrollee’s coverage under the applicable plan or coverage— as soon as practicable and not later than 2 business days after the enrollee requests such information, a good faith estimate of the expected enrollee cost-sharing for the provision of a particular health care service (including any service that is reasonably expected to be provided in conjunction with such specific service); and as soon as practicable and not later than 2 business days after an enrollee requests such information, the contact information for any ancillary providers for a scheduled health care service. 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 health care service (including any service that is reasonably expected to be provided in conjunction with such specific service), as soon as practicable and not later than 2 business days after receiving a request for such information by an enrollee. Subject to paragraph (2), a health care provider that violates a requirement under subsection
(a)shall be subject to a civil monetary penalty of not more than $10,000 for each act constituting such violation. The provisions of section 1128A of the Social Security Act, other than subsections
(a)and
(b)and the first sentence of subsection (c)(1) of such section, shall apply to civil money penalties under this subsection in the same manner as such provisions apply to a penalty or proceeding under section 1128A of the Social Security Act. . Section 2729G 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.
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- 42 USC 300gg–11
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Sec. 309
Ensuring enrollee access to cost-sharing information
Cite42 USC 300gg–11
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