‘‘(3) USE
OF
UNEXPENDED
FUNDS.—Appro-
priated amounts remaining unexpended at the end of 
any year may be used to make payments under the 
Reinsurance Program in any future year. 
‘‘(4) LIMITATION
ON
USE
OF
FUNDS.—No 
funds received under the Reinsurance Program may 
be used to pay for services described in section 
1303(b)(1)(B)(i) (as in effect on the date of the en-
actment of this section). 
‘‘(c) OPERATION OF PROGRAM.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish parameters for the operation of the Reinsurance 
Program consistent with this section. 
‘‘(2) DEADLINE FOR INITIAL OPERATION.—Not 
later than 120 days after the date of the enactment, 
the Secretary shall establish sufficient parameters to 
specify how the Program will operate for 2026. 
‘‘(3) DEFINITIONS.—In this section: 
‘‘(A) COVERED PLAN.—The term ‘covered 
plan’ means individual health insurance cov-
erage (as such term is defined in section 2791 
of the Public Health Service Act)— 
‘‘(i) with respect to which the issuer 
of such coverage has made the election de-
scribed in section 1312(c)(1)(A); and 
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‘‘(ii) that does not provide coverage 
for 
services 
described 
in 
section 
1303(b)(1)(B)(i) (as in effect on the date 
of the enactment of this section). 
‘‘(B) ELIGIBLE
INDIVIDUAL.—The term 
‘eligible individual’ means an individual enrolled 
in a covered plan. 
‘‘(d) ATTACHMENT DOLLAR AMOUNT AND PAYMENT 
PROPORTION.— 
‘‘(1) IN GENERAL.—The Secretary shall annu-
ally establish an attachment point, payment propor-
tion, and reinsurance cap with respect to claims for 
eligible individuals for payments under the Reinsur-
ance Program, consistent with the following: 
‘‘(A) The attachment point for the period 
beginning January 1, 2026, and ending Decem-
ber 31, 2026, shall be $110,000. 
‘‘(B) The payment proportion for the pe-
riod beginning January 1, 2026, and ending 
December 31, 2026, shall be 90 percent. 
‘‘(C) The reinsurance cap for the period 
beginning January 1, 2026 and ending Decem-
ber 31, 2026, shall be $300,000. 
‘‘(2) ADJUSTMENT AUTHORITY.—The Secretary 
may adjust any amounts described in paragraph (1) 
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as necessary to ensure the Reinsurance Program 
does not make payment for a year in excess of the 
amount available for such year under subsection 
(b).’’. 
(b) ELECTION TO OPT OUT
OF SINGLE RISK 
POOL.— 
(1) IN
GENERAL.—Section 1312(c)(1) of the 
Patient Protection and Affordable Care Act (42 
U.S.C. 18032(c)(1)) is amended— 
(A) by striking ‘‘A health insurance 
issuer’’ and inserting the following: 
‘‘(A) IN
GENERAL.—A health insurance 
issuer’’; 
(B) in subparagraph (A), as inserted by 
paragraph (1), by inserting ‘‘and other than 
any health plan with respect to which such 
issuer has elected for this subparagraph not to 
apply’’ after ‘‘grandfathered health plans’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(B) TREATMENT OF PLANS OPTING OUT 
OF
SINGLE
RISK
POOL.—A health insurance 
issuer shall consider all enrollees in all health 
plans offered by such issuer in the individual 
market with respect to which such issuer has 
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made the election described in subparagraph 
(A) to be members of a single risk pool.’’. 
(2) PROHIBITING SINGLE RISK POOL OPT OUT 
FOR
QUALIFIED
HEALTH
PLANS.—Section 
1301(a)(1)(C) of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18021(a)(1)) is amend-
ed— 
(A) in clause (iii), by striking ‘‘and’’ at the 
end; 
(B) in clause (iv), by striking the period 
and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
clause: 
‘‘(v) has not made the election de-
scribed in section 1312(c)(1)(A) with re-
spect to such plan.’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply with respect to plan 
years beginning on or after January 1, 2026. 
(c) REMOVING AGE PREMIUM VARIATION LIMITA-
TION FOR CERTAIN PLANS.— 
(1) IN GENERAL.— 
(A) REMOVAL OF LIMITATION FOR CER-
TAIN PLANS.—Section 2701(a)(1)(A)(iii) of the 
Public 
Health 
Service 
Act 
(42 
U.S.C 
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300gg(a)(1)(A)(iii)) is amended by inserting 
‘‘or, in the case of such coverage with respect 
to which the issuer of such coverage has made 
the election described in section 1312(c)(1)(A) 
of the Patient Protection and Affordable Care 
Act, by more than an actuarially justified 
amount for adults’’ before ‘‘; and’’. 
(B) EFFECTIVE
DATE.—The amendment 
made by subparagraph (A) shall apply with re-
spect to plan years beginning on or after Janu-
ary 1, 2026. 
(2) MAINTAINING
AGE
PREMIUM
VARIATION 
LIMITATION FOR QUALIFIED HEALTH PLANS.—Sec-
tion 1301(a)(1) of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18021(a)(1)), as 
amended by subsection (b), is further amended— 
(A) in subparagraph (B), by striking 
‘‘and’’ at the end; 
(B) in subparagraph (C)(v), by striking 
the period and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(D) with respect to the premium rate 
charged by such plan, if such plan varies such 
rate by age, does not vary such rate by more 
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than 3 to 1 for adults (consistent with section 
2707(c) of the Public Health Service Act).’’. 
(d) TREATMENT OF OPT OUT PLANS IN RELATION 
TO INDIVIDUAL HEALTH COVERAGE REIMBURSEMENT 
ARRANGEMENTS.—The Secretaries of Health and Human 
Services, Labor, and the Treasury shall not fail to treat 
any individual health insurance coverage (as defined in 
section 2791 of the Public Health Service Act (42 U.S.C. 
300gg–91)) as eligible for integration with an individual 
health care reimbursement arrangement on the basis that 
the health insurance issuer (as so defined) of such cov-
erage has made the election described in section 
1312(c)(1)(A) of the Patient Protection and Affordable 
Care Act (as inserted by subsection (b)). 
SEC. 3. PROMOTION OF HIGH-VALUE CARE. 
(a) IN GENERAL.—Subpart II of part A of title 
XXVII of the Public Health Service Act (42 U.S.C. 
300gg–11 et seq.) is amended by adding at the end the 
following new section: 
‘‘SEC. 2730. APPLICATION OF CERTAIN OUT-OF-NETWORK 
COSTS TO DEDUCTIBLES AND OUT-OF-POCK-
ET MAXIMUMS. 
‘‘(a) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group or individual health 
insurance coverage, shall, in the case that an individual 
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enrolled under such plan or coverage is furnished items 
or services by a health care provider or health care facility 
that does not have in effect a contractual relationship with 
such plan or issuer for the furnishing of such items or 
services and such individual incurs any out-of-pockets 
costs with respect to such items and services, at the option 
of such individual, apply such costs to any deductible or 
out-of-pocket maximum applicable to items and services 
furnished by health care providers or health care facilities 
with contracts in effect with such plan or issuer for the 
furnishing of such items or services, but only if the fol-
lowing requirements are met: 
‘‘(1) The item or service furnished by such pro-
vider or facility without a contract in effect with 
such plan or issuer is an item or service for which 
benefits are available under such plan or coverage. 
‘‘(2) The amount charged by such provider or 
facility for such item or service is equal to or less 
than— 
‘‘(A) the lowest amount recognized by the 
plan or coverage as payment for such item or 
service out of all health care providers and 
health care facilities with a contract in effect 
with such plan or issuer to furnish such item or 
service in the same rating area (as defined for 
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purposes of section 2701) in which the item or 
service described in paragraph (1) was fur-
nished; or 
‘‘(B) the 25th percentile of charges for 
such item or service furnished in the same 
State in which the item or service described in 
paragraph (1) was furnished. 
‘‘(b) DISCLOSURE
OF
INFORMATION.—A group 
health plan, and a health insurance issuer offering group 
or individual health insurance coverage, shall, with respect 
to each item or service for which benefits are available 
under such plan or coverage, make available the lowest 
amount described in subsection (a)(2)(A) and the 25th 
percentile described in subsection (a)(2)(B) to all individ-
uals enrolled under such plan or coverage.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to plan years beginning on or 
after January 1, 2026. 
SEC. 4. DISCLOSURE OF LOWER PRICES. 
Part E of title XXVII of the Public Health Service 
Act (42 U.S.C. 300gg–131) is amended by adding at the 
end the following new section: 
‘‘SEC. 2799B–10. DISCLOSURE OF LOWER PRICES. 
‘‘(a) IN GENERAL.—Beginning January 1, 2026, 
each health care provider and health care facility shall dis-
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close to patients and prospective patients enrolled in a 
group health plan, group or individual health insurance 
coverage, or a Federal health care program (as defined 
in section 1128B but including the program established 
under chapter 89 of title 5, United States Code) being 
furnished or seeking to be furnished an item or service 
by such provider or facility for which benefits are available 
under such plan, coverage, or program, as applicable, 
whether the amount of cost sharing (including deductibles, 
copayments, and coinsurance) that would be incurred by 
such individual for such item or service under such plan, 
coverage, or program, as applicable, exceeds the charge 
that would apply for such item or service for an individual 
without benefits under any such plan, coverage, or pro-
gram for such item or service. 
‘‘(b) ADDITIONAL ENFORCEMENT.—In addition to 
any other penalty applicable with respect to a violation of 
subsection (a), an individual who is harmed by a violation 
of this section by a health care provider or health care 
facility may bring an action against such provider or facil-
ity in an appropriate district court of the United States 
for— 
‘‘(1) appropriate injunctive relief; and 
‘‘(2) damages in an amount that is equal to the 
amount provided for such harm in a civil action 
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under the law of the State in which the provider or 
facility is located.’’. 
Æ 
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