I 
114TH CONGRESS 
2D SESSION 
H. R. 4506 
To amend the Public Health Service Act to help health care consumers 
comparison shop for medical services based on quality and cost. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 9, 2016 
Mr. FORTENBERRY introduced the following bill; which was referred to the 
Committee on Energy and Commerce 
A BILL 
To amend the Public Health Service Act to help health 
care consumers comparison shop for medical services 
based on quality and cost. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Know Before You Go 
Act of 2016’’. 
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SEC. 
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)) is amended— 
(1) by striking ‘‘Not later than’’ and inserting 
the following: 
‘‘(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
QUAL-
ITY.— 
‘‘(A) IN GENERAL.—In the case of a health 
insurance issuer offering group or individual 
health insurance coverage, in applying this sec-
tion to such issuer with respect to a plan year 
beginning after the date of the enactment of 
this paragraph, the activities described in sub-
section (a)(2) shall include implementing, pro-
moting, maintaining, or improving a trans-
parency 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 
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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 obli-
gations 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 indi-
vidual seeking enrollment under health in-
surance 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) of the Internal Revenue Code of 
1986). 
‘‘(B) TRANSPARENCY TOOL.—For the pur-
poses of subparagraph (A), a transparency tool, 
with respect to a health insurance issuer offer-
ing group or individual health insurance cov-
erage, 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: 
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‘‘(i) Comparisons among in-network 
providers with respect to quality of care. 
‘‘(ii) Comparisons among different 
types of in-network providers of the esti-
mated cost-sharing obligation, before appli-
cation of any deductible, of an enrollee 
under such coverage for each such episode 
of care. 
‘‘(iii) The estimated cost-sharing obli-
gation, after application of any deductible, 
of an enrollee under such coverage for each 
such episode of care at a specific in-net-
work provider.’’. 
Æ 
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