I 

111TH CONGRESS 

1ST SESSION H. R. 3681 

To provide for minimum loss ratios for health insurance coverage. 

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 30, 2009 

Mr. ELLISON (for himself and Mr. TIERNEY) introduced the following bill; 

which was referred to the Committee on Energy and Commerce 

A BILL 

To provide for minimum loss ratios for health insurance 

coverage. 

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 ‘‘Fairness in Health 

5 Insurance Act of 2009’’. 

6 SEC. 2. REQUIREMENT OF MINIMUM LOSS RATIO OF 90 

7 PERCENT FOR HEALTH INSURANCE COV8 ERAGE. 

9 (a) IN GENERAL.—A health insurance issuer shall 

10 not offer health insurance coverage unless the issuer demVerDate Nov 24 2008 03:52 Oct 01, 2009 Jkt 079200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H3681.IH H3681

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1 onstrates that such coverage has a medical loss ratio of 

2 at least 90 percent. 

3 (b) MEDICAL LOSS RATIO.— 

4 (1) IN GENERAL.—In this section, the term 

5 ‘‘medical loss ratio’’ has the meaning given such 

6 term by the Secretary of Health and Human Serv7 ices. The Secretary shall establish a uniform defini8 tion of medical loss ratio and methodology for deter9 mining how to calculate the medical loss ratio. Such 

10 methodology shall take into account the cir11 cumstances of different plans and activities related 

12 to health services such as chronic disease manage13 ment and quality assurance. 

14 (2) REPORT.—Not later than December 31, 

15 2010, the Secretary of Health and Human Services 

16 shall publish a report that describes the definition 

17 developed under paragraph (1) and the elements 

18 with respect to such definition. 

19 (c) TRANSPARENCY.— 

20 (1) SUBMISSION OF DATA.—Beginning in plan 

21 year 2011, a health insurance issuer shall provide 

22 the Secretary of Health and Human Services with 

23 data to enable the Secretary to determine whether 

24 the issuer is in compliance with subsection (a) with 


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1 respect to health insurance coverage offered by such 

2 issuer. 

3 (2) DEVELOPMENT OF ELEMENTS AND DEFINI4 TIONS.—Not later than December 31, 2010, the 

5 Secretary of Health and Human Services shall de6 velop, publish in a report, and implement the stand7 ardized data elements and definitions to be used by 

8 health insurance issuers in the reporting of data 

9 necessary for the calculation of the medical loss ratio 

10 under paragraph (1). 

11 (d) REBATES.—Each health insurance issuer that of12 fers health insurance coverage shall provide that for any 

13 plan year in which the coverage has a medical loss ratio 

14 below 90 percent, the issuer shall provide, in a manner 

15 specified by the Secretary, for rebates to enrollees of pay16 ments sufficient with respect to such loss ratio. 

17 (e) ENFORCEMENT.—The Secretary shall promulgate 

18 regulations for enforcing the provisions of this section and 

19 may provide for appropriate penalties. 

20 (f) DEFINITION.—In this section, the terms ‘‘health 

21 insurance coverage’’ and ‘‘health insurance issuer’’ shall 

22 have the meanings given such terms in section 2791 of 

23 the Public Health Service Act (42 U.S.C. 300gg–91). 

Æ 


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