I 

113TH CONGRESS 

1ST SESSION H. R. 1205 

To amend title XXVII of the Public Health Service Act to require health 

insurance issuers and group health plans to disclose information regarding how certain taxes and fees impact the amount of premiums, and 

for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 14, 2013 

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

Committee on Energy and Commerce 

A BILL 

To amend title XXVII of the Public Health Service Act 

to require health insurance issuers and group health 

plans to disclose information regarding how certain taxes 

and fees impact the amount of premiums, and for other 

purposes. 

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 ‘‘Patients Right to 

5 Know Act of 2013’’. 

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1 SEC. 2. PROTECTION OF CERTAIN HEALTH INSURANCE DIS2 CLOSURES. 

3 (a) IN GENERAL.—Section 2715 of the Public Health 

4 Service Act (42 U.S.C. 300gg–15) is amended by adding 

5 at the end the following new subsection: 

6 ‘‘(h) PROTECTION OF DISCLOSURE OF FEE AND

7 OTHER ADDITIONAL INFORMATION.— 

8 ‘‘(1) IN GENERAL.—A health insurance issuer 

9 or sponsor of a group health plan, with respect to 

10 its annual summary of benefits and coverage expla11 nation provided under subsection (d)— 

12 ‘‘(A) shall include (effective for plan years 

13 beginning on or after January 1, 2016, and in 

14 addition to the information required to be dis15 closed under this section)— 

16 ‘‘(i) the applicable additional informa17 tion relating to fees described in paragraph 

18 (2); and 

19 ‘‘(ii) the applicable additional infor20 mation included under paragraph (3)(D); 

21 and 

22 ‘‘(B) shall not be subject to any adminis23 trative action by the Secretary or by a State 

24 authority with respect to any disclosure made 

25 on or after the date of the enactment of this 

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1 mation if the disclosure is made based upon a 

2 good faith estimate of such information and is 

3 in accordance with such standards as the Sec4 retary may establish to carry out this sub5 section. 

6 ‘‘(2) FEE INFORMATION.—The additional infor7 mation described in this paragraph, with respect to 

8 a health insurance issuer issuing health insurance 

9 coverage in the individual, small, or large group 

10 market and with respect to the sponsor of a group 

11 health plan, is as follows: 

12 ‘‘(A) FEE ON HEALTH INSURANCE PRO13 VIDERS.—The annual fee on health insurance 

14 providers under section 9010 of the Patient 

15 Protection and Affordable Care Act (26 U.S.C. 

16 4001 note). 

17 ‘‘(B) PCORI TAX.—Fees imposed under 

18 subchapter B of chapter 34 of the Internal Rev19 enue Code of 1986 (relating to funding the Pa20 tient-Centers Outcome Research Institute). 

21 ‘‘(C) REINSURANCE CONTRIBUTIONS.—Re22 insurance contributions required under section 

23 1341(b) of the Patient Protection and Afford24 able Care Act (42 U.S.C. 18061(b)). 

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1 ‘‘(D) PROPOSED HEALTH INSURANCE EX2 CHANGE USER FEE.—Fees imposed on health 

3 plans relating to participation in an Exchange 

4 under subtitle D of title I of the Patient Protec5 tion and Affordable Care Act (42 U.S.C. 18021 

6 et seq.). 

7 ‘‘(E) RISK CORRIDOR PAYMENTS.—Risk 

8 corridor payments required under section 

9 1342(b)(2) of the Patient Protection and Af10 fordable Care Act (42 U.S.C. 18062(b)(2)). 

11 ‘‘(F) RISK ADJUSTMENT CHARGES.—Risk 

12 adjustment charges imposed under section 

13 1343(a)(1) of the Patient Protection and Af14 fordable Care Act (42 U.S.C. 18063(a)(1)). 

15 In the case of health insurance coverage, such costs 

16 may be calculated separately for such coverage in 

17 the individual market, in the small group market, 

18 and in the large group market for the health insur19 ance issuer involved. 

20 ‘‘(3) OTHER INFORMATION.— 

21 ‘‘(A) STUDY.—The Comptroller General of 

22 the United States shall conduct a study of 

23 methods of calculating the impact on average 

24 premium costs associated with each of the fol25 lowing: 

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1 ‘‘(i) MARKET IMPACT OF GUARAN2 TEED ISSUE AND COMMUNITY RATING.— 

3 The requirement for guaranteed issuance 

4 of coverage under section 2702 and com5 munity rated premiums under section 

6 2701. 

7 ‘‘(ii) AGE RATING IMPACT.—The re8 quirement of section 2701(a)(1)(A)(iii) (re9 lating to limitations on age rating). 

10 ‘‘(iii) WOMEN’S PREVENTIVE SERV11 ICES.—The requirement for coverage of 

12 women’s preventive services under section 

13 2713. 

14 ‘‘(iv) MINIMUM ESSENTIAL HEALTH

15 BENEFITS COVERAGE.—The requirement 

16 that coverage provide for at least 60 per17 cent of the actuarial value of essential 

18 health benefits under section 1302(d) of 

19 the Patient Protection and Affordable Care 

20 Act. (42 U.S.C. 18022(d)). 

21 ‘‘(B) CONSULTATION.—In conducting such 

22 study, the Comptroller General shall consult 

23 with health insurance issuers and State health 

24 insurance commissioners. 

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1 ‘‘(C) REPORT.—Not later than October 1, 

2 2014, the Comptroller General shall submit to 

3 each House of Congress and the Secretary a re4 port on the study conducted under subpara5 graph (A). 

6 ‘‘(D) INCLUSION OF ADDITIONAL INFOR7 MATION.—After submission of such report, the 

8 Secretary may also include in the information 

9 required to be disclosed under paragraph 

10 (1)(A)(ii) information on the impact on pre11 miums of each of the requirements described in 

12 subparagraph (A). 

13 ‘‘(4) RETENTION OF STATE RATE SETTING AU14 THORITY.—Nothing in this subsection shall be con15 strued to preempt State authority to regulate, reject, 

16 alter, or require additional information in support of 

17 rates for health insurance coverage or oversight au18 thority of the Secretary.’’. 

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