I 

114TH CONGRESS 

2D SESSION H. R. 4506 

To amend the Public Health Service Act to help health care consumers 

comparison shop for medical services based on quality and cost. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 9, 2016 

Mr. FORTENBERRY introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to help health 

care consumers comparison shop for medical services 

based on quality and cost. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Know Before You Go 

5 Act of 2016’’. 


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1 SEC. 2. EXPENDITURES FOR TRANSPARENCY TOOLS 

2 TREATED AS ACTIVITIES THAT IMPROVE 

3 HEALTH CARE QUALITY FOR THE PURPOSE 

4 OF DETERMINING MEDICAL LOSS RATIO. 

5 Section 2718(c) of the Public Health Service Act (42 

6 U.S.C. 300gg–18(c)) is amended— 

7 (1) by striking ‘‘Not later than’’ and inserting 

8 the following: 

9 ‘‘(1) IN GENERAL.—Not later than’’; and 

10 (2) by adding at the end the following new 

11 paragraph: 

12 ‘‘(2) SPENDING ON TRANSPARENCY TOOLS AS

13 ACTIVITIES THAT IMPROVE HEALTH CARE QUAL14 ITY.— 

15 ‘‘(A) IN GENERAL.—In the case of a health 

16 insurance issuer offering group or individual 

17 health insurance coverage, in applying this sec18 tion to such issuer with respect to a plan year 

19 beginning after the date of the enactment of 

20 this paragraph, the activities described in sub21 section (a)(2) shall include implementing, pro22 moting, maintaining, or improving a trans23 parency tool with respect to such coverage if 

24 such issuer has, during such plan year— 

25 ‘‘(i) significantly increased (compared 

26 to the previous plan year) the percentage 


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1 of enrollees under such coverage who are 

2 using such transparency tool by such 

3 issuer; 

4 ‘‘(ii) provided the estimates under 

5 subparagraph (B)(iii) of cost-sharing obli6 gations of a similarly situated enrollee 

7 under such coverage to each individual 

8 that requests such estimate with respect to 

9 such coverage; and 

10 ‘‘(iii) made available to each indi11 vidual seeking enrollment under health in12 surance coverage offered by such issuer a 

13 list of coverage options offered by such 

14 issuer that qualify as high deductible 

15 health plans (as defined in section 

16 223(c)(2) of the Internal Revenue Code of 

17 1986). 

18 ‘‘(B) TRANSPARENCY TOOL.—For the pur19 poses of subparagraph (A), a transparency tool, 

20 with respect to a health insurance issuer offer21 ing group or individual health insurance cov22 erage, includes a website and telephone support 

23 that makes available to each enrollee under 

24 such coverage, with respect to common episodes 

25 of care, the following information: 


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1 ‘‘(i) Comparisons among in-network 

2 providers with respect to quality of care. 

3 ‘‘(ii) Comparisons among different 

4 types of in-network providers of the esti5 mated cost-sharing obligation, before appli6 cation of any deductible, of an enrollee 

7 under such coverage for each such episode 

8 of care. 

9 ‘‘(iii) The estimated cost-sharing obli10 gation, after application of any deductible, 

11 of an enrollee under such coverage for each 

12 such episode of care at a specific in-net13 work provider.’’. 

Æ 


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