Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Informed Consumer Choices in Health Care Act of 
2009’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Findings. 
Sec. 3. New minimum Federal standards for health insurance forms, quality, 
fair marketing, and honesty in out-of-network coverage. 
Sec. 4. Health Insurance accountability initiatives. 
Sec. 5. Health insurance transparency initiatives. 
Sec. 6. Office of Health Insurance Oversight. 
Sec. 7. Standards and accountability and transparency initiatives for group 
health plans through Departments of Labor and the Treasury. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Effective competition in private health in-
surance markets requires that consumers must have 
extensive and meaningful information about what 
health insurance covers, what it costs, and how it 
works. 
(2) Based on the information currently provided 
by health insurers, patients are unable to predict 
what their health insurance coverage limits or out- 
of-pocket costs would be if they had a serious illness. 
72 million adults under age 65 had problems paying 
medical bills or were paying off medical debt in 
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2007, and 61 percent of those were insured at the 
time care was provided. 
(3) It is difficult to impossible for consumers to 
obtain a copy of a health insurance policy from an 
insurance company before they purchase it. 
(4) Consumers often find it difficult to navigate 
and evaluate their choices in today’s health insur-
ance markets and many select a sub-optimal plan as 
a result. 
(5) The Institute of Medicine of the National 
Academy of Sciences has estimated that nearly half 
of all American adults—90 million people—have dif-
ficulty understanding and using health information. 
(6) The Office of Disease Prevention and 
Health Promotion in the Department of Health and 
Human Services reports that only 12 percent of the 
population using a table can calculate an employee’s 
share of health insurance costs for a year. 
(7) A RAND Corporation study found that 
making it easier to get information about insurance 
products and simplifying the applications process 
would increase purchase rates as much as modest 
subsidies would, and all these reports prove the need 
for a fundamental improvement in the way insurance 
choices are made available to consumers. 
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(8) Insurance forms provided to patients and 
providers are often confusing, difficult to reconcile 
with medical bills, and vary widely from insurer to 
insurer, thereby adding complexity and administra-
tive waste to the health care system. 
(9) Research indicates that physicians divert 
substantial resources, as much as 14 percent of their 
total revenue, to ensure accurate insurance pay-
ments for their services. Hospitals spend as much as 
11 percent of their total revenue on billing and in-
surance-related costs. These include time spent de-
termining patient insurance eligibility and benefit 
structure. One study found that paperwork adds at 
least 30 minutes to every hour of patient care. 
(10) According to the American Medical Asso-
ciation, there is wide variation in how often health 
insurers pay nothing in response to a physician 
claim and in how they explain the reason for the de-
nial. There is no consistency in the application of 
codes used to explain the denials, making it ex-
tremely expensive for physician practices to deter-
mine how to respond. 
(11) According to the American Medical Asso-
ciation, more than half of health insurers in a recent 
study did not provide physicians with the trans-
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parency necessary for an efficient claims processing 
system. 
(12) According to the American Medical Asso-
ciation, payers vary widely on how often they use 
proprietary rather than public claims edits to reduce 
payments (ranging from zero to as high as nearly 72 
percent). The use of undisclosed proprietary edits in-
hibits the flow of transparent information to physi-
cians, adding additional administrative costs to rec-
oncile claims. 
(13) The Federal government currently lacks 
capacity to carry out responsibility for oversight and 
enforcement of current law requirements on health 
insurance issuers and to provide States with tech-
nical assistance in effectively enforcing Federal min-
imum standards for health insurance. 
(14) In order to improve the functioning of the 
private health insurance market, assure the applica-
tion of existing requirements to health insurance 
coverage, and reduce administrative hassles for pa-
tients and providers, there is a need for periodic ex-
aminations and audits of such coverage, for greater 
disclosure of information regarding the terms and 
conditions of such coverage, and for the establish-
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ment of a Federal oversight office to ensure enforce-
ment of standards. 
SEC. 3. NEW MINIMUM FEDERAL STANDARDS FOR HEALTH 
INSURANCE FORMS, QUALITY, FAIR MAR-
KETING, AND HONESTY IN OUT-OF-NETWORK 
COVERAGE. 
(a) GROUP HEALTH INSURANCE.—Title XXVII of 
the Public Health Service Act is amended by inserting 
after section 2707 the following new section: 
‘‘SEC. 2708. STANDARDS FOR HEALTH INSURANCE FORMS, 
QUALITY, FAIR MARKETING, AND HONESTY 
IN OUT-OF-NETWORK COVERAGE. 
‘‘(a) DEFINING INSURANCE TERMS; STANDARDIZING 
INSURANCE FORMS.— 
‘‘(1) IN GENERAL.—The Secretary shall provide 
for the development of standards for the information 
that health insurance issuers are required to provide 
to group health plans to promote informed choice of 
health insurance coverage by such plans. 
‘‘(2) STANDARD
DEFINITIONS
OF
INSURANCE 
AND MEDICAL TERMS.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
provide for the development of standards for 
the definitions of terms used in group health in-
surance coverage, including insurance-related 
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