160 
the date of the last data update and that 
participants or beneficiaries or prospective 
participants or beneficiaries should consult 
the group health plan’s electronic provider 
directory on its website or call a specified 
customer service telephone number to ob-
tain the most current provider directory in-
formation; and 
‘‘(ii) a list of the categories of pro-
viders of ancillary services for which the 
plan or coverage has no in-network pro-
viders. 
‘‘(2) GROUP
HEALTH
PLAN
BUSINESS
PROC-
ESSES.—Beginning on the date that is one year 
after the date of enactment of this section, a group 
health plan shall establish business processes to— 
‘‘(A) verify and update, at least once every 
90 days, the provider directory information for 
all providers included in the online health care 
provider directory search tool described in para-
graph (1)(A)(ii); and 
‘‘(B) remove any provider from such online 
directory search tool if such provider has not 
verified the directory information within the 
previous 6 months or the plan or issuer has 
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pamtmann on DSKBC07HB2PROD with BILLS
161 
been unable to verify the provider’s network 
participation. 
‘‘(b) COST-SHARING LIMITATIONS.—A group health 
plan shall not apply, and shall ensure that no provider 
applies, cost-sharing to a participant or beneficiary for 
treatment or services provided by a health care provider 
in excess of the normal cost-sharing applied for such treat-
ment or services provided in-network (including any bal-
ance bill issued by the health care provider involved), if 
such participant or beneficiary, or health care provider re-
ferring such participant or beneficiary, demonstrates 
(based on the electronic, written information described in 
subsection (a)(1)(A)(i)(I), the oral confirmation described 
in subsection (a)(1)(A)(i)(II) received by the participant 
or beneficiary not more than 30 days before the date the 
treatment or services were received, or a copy of the online 
provider directory described in subsection (a)(1)(A)(ii) on 
a date not more than 30 days before the date the treat-
ment or services were received), that the participant or 
beneficiary relied on the information described in sub-
section (a)(1) for which such participant or beneficiary 
provides such documentation, that indicated that the pro-
vider is an in-network provider, if the provider was out- 
of-network at the time the treatment or service involved 
was received. 
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pamtmann on DSKBC07HB2PROD with BILLS
162 
‘‘(c) DEFINITION.—For purposes of this section, the 
term ‘provider directory information’ includes the names, 
addresses, specialty, and telephone numbers of individual 
health care providers, and the names, addresses, and tele-
phone numbers of each medical group, clinic, or facility 
contracted to participate in any of the networks of the 
group health plan involved. 
‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to preempt any provision of State 
law relating to health care provider directories.’’. 
(d) CLERICAL AMENDMENTS.— 
(1) ERISA.—The table of contents in section 1 
of the Employee Retirement Income Security Act of 
1974 (29 U.S.C. 1001 et seq.), as amended by sec-
tion 2, is further amended by inserting after the 
item relating to section 716 the following new item: 
‘‘Sec. 717. Protecting patients and improving the accuracy of provider directory 
information.’’. 
(2) IRC.—The table of sections for subchapter 
B of chapter 100 of the Internal Revenue Code of 
1986, as amended by section 2, is further amended 
by adding at the end the following new item: 
‘‘Sec. 9817. Protecting patients and improving the accuracy of provider direc-
tory information.’’. 
(e) PROVIDER REQUIREMENTS.—Part D of title 
XXVII of the Public Health Service Act (42 U.S.C. 300gg 
et seq.), as added by section 3, is amended— 
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pamtmann on DSKBC07HB2PROD with BILLS
163 
(1) by redesignating section 2799A–5 as section 
2799A–7; and 
(2) by inserting after section 2799A–4 the fol-
lowing new section: 
‘‘SEC. 2799A–5. PROVIDER REQUIREMENTS TO PROTECT PA-
TIENTS AND IMPROVE THE ACCURACY OF 
PROVIDER DIRECTORY INFORMATION. 
‘‘(a) PROVIDER BUSINESS PROCESSES.—A health 
care provider shall have in place business processes to en-
sure the timely provision of provider directory information 
to a group health plan or a health insurance issuer offer-
ing group or individual health insurance coverage to sup-
port compliance by such plans or issuers with section 
2730(a)(1), section 717(a)(1) of the Employee Retirement 
Income Security Act of 1974, or section 9817(a)(1) of the 
Internal Revenue Code of 1986 (as applicable). Such pro-
viders shall submit provider directory information to a 
plan or issuers, at a minimum— 
‘‘(1) when the provider begins a network agree-
ment with a plan or with an issuer with respect to 
certain coverage; 
‘‘(2) when the provider terminates a network 
agreement with a plan or with an issuer with respect 
to certain coverage; 
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pamtmann on DSKBC07HB2PROD with BILLS
164 
‘‘(3) when there are material changes to the 
content of provider directory information described 
in section 2730(a)(1), section 717(a)(1) of the Em-
ployee Retirement Income Security Act of 1974, or 
section 9817(a)(1) of the Internal Revenue Code of 
1986 (as applicable); and 
‘‘(4) every 90 days throughout the duration of 
the network agreement with a plan or issuer. 
‘‘(b) ENFORCEMENT.— 
‘‘(1) CIVIL PENALTIES.— 
‘‘(A) IN GENERAL.—Subject to paragraph 
(2), a health care provider that violates a re-
quirement under subsection (a) or takes actions 
that prevent a group health plan or health in-
surance issuer from complying with subsection 
(a)(1) or (b) of sections 2730, 717 of the Em-
ployee Retirement Income Security Act of 1974, 
or 9817 of the Internal Revenue Code of 1986 
(as applicable) shall be subject to a civil mone-
tary penalty of not more than $10,000 for each 
act constituting such violation. 
‘‘(B) SAFE HARBOR.—The Secretary may 
waive the penalty described under paragraph 
(1) with respect to a health care provider that 
unknowingly violates section 2730(b)(1), section 
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pamtmann on DSKBC07HB2PROD with BILLS
165 
717(b)(1) of the Employee Retirement Income 
Security Act of 1974, or section 9817(b)(1) of 
the Internal Revenue Code of 1986 (as applica-
ble) with respect to an enrollee if such provider 
rescinds the bill involved and, if applicable, re-
imburses the enrollee within 30 days of the date 
on which the provider billed the enrollee in vio-
lation of such subsection. 
‘‘(C) PROCEDURE.—The provisions of sec-
tion 1128A of the Social Security Act, other 
than subsections (a) and (b) and the first sen-
tence of subsection (c)(1) of such section, shall 
apply to civil money penalties under this sub-
section in the same manner as such provisions 
apply to a penalty or proceeding under section 
1128A of the Social Security Act. 
‘‘(2) REFUNDS
TO
ENROLLEES.—If a health 
care provider submits a bill to an enrollee based on 
cost-sharing for treatment or services provided by 
the health care provider that is in excess of the nor-
mal cost-sharing applied for such treatment or serv-
ices provided in-network, as prohibited under section 
2730(b), section 717(b) of the Employee Retirement 
Income Security Act of 1974, or section 9817(b) of 
the Internal Revenue Code of 1986 (as applicable) 
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pamtmann on DSKBC07HB2PROD with BILLS
166 
and the enrollee pays such bill, the provider shall re-
imburse the enrollee for the full amount paid by the 
enrollee in excess of the in-network cost-sharing 
amount for the treatment or services involved, plus 
interest, at an interest rate determined by the Sec-
retary. 
‘‘(c) LIMITATION.—Nothing in this section shall pro-
hibit a provider from requiring in the terms of a contract, 
or contract termination, with a group health plan or health 
insurance issuer— 
‘‘(1) that the plan or issuer remove, at the time 
of termination of such contract, the provider from a 
directory of the plan or issuer described in section 
2730(a)(1), section 717(a)(1) of the Employee Re-
tirement Income Security Act of 1974, or section 
9817(a)(1) of the Internal Revenue Code of 1986 
(as applicable); or 
‘‘(2) that the plan or issuer bear financial re-
sponsibility, including under section 2730(b), section 
717(b) of the Employee Retirement Income Security 
Act of 1974, or section 9817(b) of the Internal Rev-
enue Code of 1986 (as applicable) for providing in-
accurate network status information to an enrollee. 
‘‘(d) DEFINITION.—For purposes of this section, the 
term ‘provider directory information’ includes the names, 
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pamtmann on DSKBC07HB2PROD with BILLS
167 
addresses, specialty, and telephone numbers of individual 
health care providers, and the names, addresses, and tele-
phone numbers of each medical group, clinic, or facility 
contracted to participate in any of the networks of the 
group health plan or health insurance coverage involved. 
‘‘(e) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to preempt any provision of State 
law relating to health care provider directories.’’. 
SEC. 7. INCREASING TRANSPARENCY IN HEALTH COV-
ERAGE. 
(a) DISCLOSURE OF DIRECT AND INDIRECT COM-
PENSATION FOR BROKERS AND CONSULTANTS TO EM-
PLOYER-SPONSORED HEALTH PLANS AND ENROLLEES IN 
PLANS ON THE INDIVIDUAL MARKET.— 
(1) GROUP HEALTH PLANS.—Section 408(b)(2) 
of the Employee Retirement Income Security Act of 
1974 (29 U.S.C. 1108(b)(2)) is amended— 
(A) by striking ‘‘(2) Contracting or mak-
ing’’ and inserting ‘‘(2)(A) Contracting or mak-
ing’’; and 
(B) by adding at the end the following: 
‘‘(B)(i) No contract or arrangement for services 
between a covered plan and a covered service pro-
vider, and no extension or renewal of such a contract 
or arrangement, is reasonable within the meaning of 
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pamtmann on DSKBC07HB2PROD with BILLS
168 
this paragraph unless the requirements of this sub-
paragraph are met. 
‘‘(ii)(I) For purposes of this subparagraph: 
‘‘(aa) The term ‘covered plan’ means a 
group health plan as defined section 733(a). 
‘‘(bb) The term ‘covered service provider’ 
means a service provider that enters into a con-
tract or arrangement with the covered plan and 
reasonably expects $1,000 (or such amount as 
the Secretary may establish in regulations to 
account for inflation since the date of the enact-
ment of the Ban Surprise Billing Act, as appro-
priate) or more in compensation, direct or indi-
rect, to be received in connection with providing 
one or more of the following services, pursuant 
to the contract or arrangement, regardless of 
whether such services will be performed, or such 
compensation received, by the covered service 
provider, an affiliate, or a subcontractor: 
‘‘(AA) Brokerage services, for which 
the covered service provider, an affiliate, or 
a subcontractor reasonably expects to re-
ceive indirect compensation or direct com-
pensation described in item (dd), provided 
to a covered plan with respect to selection 
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pamtmann on DSKBC07HB2PROD with BILLS
169 
of insurance products (including vision and 
dental), recordkeeping services, medical 
management vendor, benefits administra-
tion (including vision and dental), stop-loss 
insurance, pharmacy benefit management 
services, wellness services, transparency 
tools and vendors, group purchasing orga-
nization preferred vendor panels, disease 
management vendors and products, compli-
ance services, employee assistance pro-
grams, or third party administration serv-
ices. 
‘‘(BB) Consulting, for which the cov-
ered service provider, an affiliate, or a sub-
contractor reasonably expects to receive in-
direct compensation or direct compensation 
described in item (dd), related to the devel-
opment or implementation of plan design, 
insurance or insurance product selection 
(including vision and dental), record-
keeping, medical management, benefits ad-
ministration selection (including vision and 
dental), stop-loss insurance, pharmacy ben-
efit management services, wellness design 
and management services, transparency 
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pamtmann on DSKBC07HB2PROD with BILLS
170 
tools, group purchasing organization agree-
ments and services, participation in and 
services from preferred vendor panels, dis-
ease management, compliance services, em-
ployee assistance programs, or third party 
administration services. 
‘‘(cc) The term ‘affiliate’, with respect to a 
covered service provider, means an entity that 
directly or indirectly (through one or more 
intermediaries) controls, is controlled by, or is 
under common control with, such provider, or is 
an officer, director, or employee of, or partner 
in, such provider. 
‘‘(dd)(AA) The term ‘compensation’ means 
anything of monetary value, but does not in-
clude non-monetary compensation valued at 
$250 (or such amount as the Secretary may es-
tablish in regulations to account for inflation 
since the date of enactment of the Ban Surprise 
Billing Act, as appropriate) or less, in the ag-
gregate, during the term of the contract or ar-
rangement. 
‘‘(BB) The term ‘direct compensation’ 
means compensation received directly from a 
covered plan. 
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pamtmann on DSKBC07HB2PROD with BILLS
171 
‘‘(CC) The term ‘indirect compensation’ 
means compensation received from any source 
other than the covered plan, the plan sponsor, 
the covered service provider, or an affiliate. 
Compensation received from a subcontractor is 
indirect compensation, unless it is received in 
connection with services performed under a con-
tract or arrangement with a subcontractor. 
‘‘(ee) The term ‘responsible plan fiduciary’ 
means a fiduciary with authority to cause the 
covered plan to enter into, or extend or renew, 
the contract or arrangement. 
‘‘(ff) The term ‘subcontractor’ means any 
person or entity (or an affiliate of such person 
or entity) that is not an affiliate of the covered 
service provider and that, pursuant to a con-
tract or arrangement with the covered service 
provider or an affiliate, reasonably expects to 
receive $1,000 (or such amount as the Sec-
retary may establish in regulations to account 
for inflation since the date of enactment of the 
Ban Surprise Billing Act, as appropriate) or 
more in compensation for performing one or 
more services described in item (bb) under a 
contract or arrangement with the covered plan. 
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