Know Before You Go Act of 2016

To amend the Public Health Service Act to help health care consumers comparison shop for medical services based on quality and cost. 1. Short title This Act may be cited as the Know Before You Go Act of 2016 2. Expenditures for transparency tools treated as activities that improve health care quality for the purpose of determining medical loss ratio Section 2718(c) of the Public Health Service Act ( 42 U.S.C. 300gg–18(c) (1) by striking Not later than (1) In general Not later than ; and (2) by adding at the end the following new paragraph: (2) Spending on transparency tools as activities that improve health care quality (A) In general In the case of a health insurance issuer offering group or individual health insurance coverage, in applying this section to such issuer with respect to a plan year beginning after the date of the enactment of this paragraph, the activities described in subsection (a)(2) shall include implementing, promoting, maintaining, or improving a transparency tool with respect to such coverage if such issuer has, during such plan year— (i) significantly increased (compared to the previous plan year) the percentage of enrollees under such coverage who are using such transparency tool by such issuer; (ii) provided the estimates under subparagraph (B)(iii) of cost-sharing obligations of a similarly situated enrollee under such coverage to each individual that requests such estimate with respect to such coverage; and (iii) made available to each individual seeking enrollment under health insurance coverage offered by such issuer a list of coverage options offered by such issuer that qualify as high deductible health plans (as defined in section 223(c)(2) (B) Transparency tool For the purposes of subparagraph (A), a transparency tool, with respect to a health insurance issuer offering group or individual health insurance coverage, includes a website and telephone support that makes available to each enrollee under such coverage, with respect to common episodes of care, the following information: (i) Comparisons among in-network providers with respect to quality of care. (ii) Comparisons among different types of in-network providers of the estimated cost-sharing obligation, before application of any deductible, of an enrollee under such coverage for each such episode of care. (iii) The estimated cost-sharing obligation, after application of any deductible, of an enrollee under such coverage for each such episode of care at a specific in-network provider. .

Summary: Know Before You Go Act of 2016 This bill amends the Public Health Service Act to permit health insurers to include, for plan year accounting purposes, activities related to a transparency tool as activities that improve health care quality. (An insurer must provide a rebate to enrollees if the insurer spends less than a certain percentage of premium revenues on clinical services and activities that improve health care quality.) A transparency tool is a website and telephone support that provides quality of care and cost sharing comparisons among in-network providers. Such accounting for a plan year is permitted only for insurers that have: (1) significantly increased the percentage of enrollees using a transparency tool compared to the previous year, (2) provided cost sharing estimates for episodes of care upon request, and (3) made available a list of high deductible health plans offered by the insurer to each individual seeking coverage from the insurer.