I 

113TH CONGRESS 

2D SESSION H. R. 4796 

To direct the Secretary of Health and Human Services to conduct outreach 

efforts to provide certain health insurance information to individuals 

enrolled in qualified health plans offered through an Exchange established under title I of the Patient Protection and Affordable Care Act 

or State plans under the Medicaid program under title XIX of the 

Social Security Act, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JUNE 2, 2014 

Ms. JACKSON LEE (for herself, Ms. CLARKE of New York, Ms. BROWN of 

Florida, Mr. CLAY, Mr. RANGEL, and Ms. NORTON) introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To direct the Secretary of Health and Human Services to 

conduct outreach efforts to provide certain health insurance information to individuals enrolled in qualified 

health plans offered through an Exchange established 

under title I of the Patient Protection and Affordable 

Care Act or State plans under the Medicaid program 

under title XIX of the Social Security Act, 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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Keeping Well by Using 

3 Your Patient Protection and Affordable Care Act Plan’’. 

4 SEC. 2. OUTREACH TO CERTAIN INDIVIDUALS ON CERTAIN 

5 HEALTH INSURANCE INFORMATION. 

6 (a) IN GENERAL.—Beginning not later than 90 days 

7 after the date of the enactment of this Act, the Secretary 

8 of Health and Human Services shall conduct outreach ef9 forts to provide, using the most effective means (as deter10 mined by the Secretary), the health insurance information 

11 described in subsection (b) to— 

12 (1) individuals enrolled in qualified health plans 

13 offered through an Exchange established under title 

14 I of the Patient Protection and Affordable Care Act 

15 (Public Law 111–148); and 

16 (2) individuals enrolled in State plans (or under 

17 a waiver of such a plan) under the Medicaid pro18 gram under title XIX of the Social Security Act. 

19 (b) INFORMATION DESCRIBED.—For purposes of 

20 subsection (a), the information described in this sub21 section is any information, the availability of which the 

22 Secretary of Health and Human Services determines will 

23 encourage the utilization of primary care or preventive 

24 services by the individuals described in such subsection, 

25 including the following: 


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1 (1) Information on the extent to which the es2 sential health benefits specified in section 

3 1302(b)(1) of the Patient Protection and Affordable 

4 Care Act (42 U.S.C. 18022(b)(1)) are provided by 

5 a plan described in subsection (a). 

6 (2) Information on which preventive health 

7 services are covered under such a plan without the 

8 application of any cost-sharing (such as a copayment 

9 or coinsurance), including screenings for certain con10 ditions such as diabetes and high blood pressure, 

11 vaccinations for adults against influenza, measles, 

12 mumps, rubella, and other infectious diseases, and 

13 well-woman visits. 

14 (3) With respect to qualified health plans de15 scribed in subsection (a)(1), the following informa16 tion presented in a manner that allows for compari17 son of plans within each State: 

18 (A) Information on the rates of reimburse19 ment recognized under each such qualified 

20 health plan with respect to items and services 

21 (as specified by the Secretary) that are fur22 nished to individuals enrolled in such plan by 

23 health care providers participating in the net24 work of the plan, such as rates of reimburse25 ment applicable to emergency care services, labVerDate Mar 15 2010 03:06 Jun 05, 2014 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4796.IH H4796

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1 oratory tests, diagnostic tests, and physician 

2 services. 

3 (B) Information on any cost-sharing re4 quired under each such plan with respect to 

5 such items and services furnished to such indi6 viduals by such providers and an explanation on 

7 the extent to which such cost-sharing is based 

8 on such recognized rates of reimbursement. 

9 (C) A statement that— 

10 (i) the rates of reimbursement that 

11 are collectable by health care providers not 

12 participating in the network of such a plan 

13 for furnishing such items and services to 

14 such individuals may be more than the 

15 rates of reimbursement recognized under 

16 such plan for such items and services fur17 nished to such individuals by health care 

18 providers participating in the network of 

19 such plan; and 

20 (ii) any cost-sharing required under 

21 such a plan with respect to such items and 

22 services furnished to such individuals by 

23 health care providers not participating in 

24 the network of such plan may be more 

25 than such cost-sharing with respect to such 


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1 items and services furnished to such indi2 viduals by health care providers partici3 pating in the network of such plan. 

4 (4) An explanation of basic health insurance 

5 terms (as determined by the Secretary), including 

6 deductibles, cost-sharing, copayment, and coinsur7 ance, and the application of such terms to an indi8 vidual enrolled in a plan described in subsection (a), 

9 illustrated with examples of the application of such 

10 terms with respect to such individuals under dif11 ferent circumstances and in different health care 

12 settings. 

13 (c) REPORT ON OUT-OF-POCKET COSTS.—Not later 

14 than 180 days after the date of the enactment of this Act, 

15 with respect to the most recent plan year for which infor16 mation is available, the Secretary of Health and Human 

17 Services shall submit to the Committee on Energy and 

18 Commerce of the House of Representatives and the Com19 mittee on Health, Education, Labor, and Pensions of the 

20 Senate a report that— 

21 (1) contains information, for each State (includ22 ing the District of Columbia), on the median cost23 sharing responsibility, with respect to qualified 

24 health plans offered through an Exchange in such 

25 State, of health care services— 


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1 (A) the number of which and types of 

2 which are determined appropriate by the Sec3 retary to be included in the report; and 

4 (B) that have been identified by the Sec5 retary as services— 

6 (i) for which, with respect to such 

7 plan year, payment may only be made 

8 under such a plan after satisfaction of the 

9 deductible applicable under such plan; and 

10 (ii) for which reimbursement under 

11 such plan is made most frequently during 

12 such plan year; and 

13 (2) describes the best method for making the 

14 information referred to in paragraph (1) available to 

15 the public. 

Æ 


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