available to such individual through a self-service 
tool that meets the requirements of paragraph (3) 
or, at the option of such individual, through a paper 
disclosure or phone or other electronic disclosure (as 
selected by such individual and provided at no cost 
to such individual) that meets such requirements as 
the Secretary may specify. 
‘‘(2) SPECIFIED INFORMATION.—For purposes 
of paragraph (1), the information specified in this 
paragraph is, with respect to an item or service for 
which benefits are available under a group health 
plan or group health insurance coverage furnished 
by a health care provider to a participant or bene-
ficiary of such plan, or enrollee in such coverage, the 
following: 
‘‘(A) If such provider is a participating 
provider with respect to such item or service, 
the in-network rate (as defined in subsection 
(c)) for such item or service. 
‘‘(B) If such provider is not described in 
subparagraph 
(A), 
the 
maximum 
allowed 
amount for such item or service. 
‘‘(C) The estimated amount of cost sharing 
(including deductibles, copayments, and coin-
surance) that the participant or beneficiary will 
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incur for such item or service (which, in the 
case such item or service is to be furnished by 
a provider described in subparagraph (B), shall 
be calculated using the maximum amount de-
scribed in such subparagraph). 
‘‘(D) The amount the participant, bene-
ficiary, or enrollee has already accumulated 
with respect to any deductible or out of pocket 
maximum, whether for items and services fur-
nished by a participating provider or for items 
and services furnished by a provider that is not 
a participating provider, under the plan or cov-
erage (broken down, in the case separate 
deductibles or maximums apply to separate par-
ticipants, beneficiaries or enrollees enrolled in 
the plan or coverage, by such separate 
deductibles or maximums, in addition to any 
cumulative deductible or maximum). 
‘‘(E) In the case such plan or coverage im-
poses any frequency or volume limitations with 
respect to such item or service (excluding med-
ical necessity determinations), the amount that 
such participant, beneficiary, or enrollee has ac-
crued towards such limitation with respect to 
such item or service. 
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‘‘(F) Any prior authorization, concurrent 
review, step therapy, fail first, or similar re-
quirements applicable to coverage of such item 
or service under such plan or coverage. 
The Secretary may provide that information de-
scribed in any of subparagraphs (A) through (F) not 
be treated as information specified in this para-
graph, and specify additional information that shall 
be treated as information specified in this para-
graph, if determined appropriate by the Secretary. 
‘‘(3) SELF-SERVICE
TOOL.—For purposes of 
paragraph (1), a self-service tool established by a 
group health plan or group health insurance cov-
erage meets the requirements of this paragraph if 
such tool— 
‘‘(A) is based on an Internet website; 
‘‘(B) provides for real-time responses to re-
quests described in paragraph (1); 
‘‘(C) is updated in a manner such that in-
formation provided through such tool is timely 
and accurate at the time such request is made; 
‘‘(D) allows such a request to be made 
with respect to an item or service furnished 
by— 
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‘‘(i) a specific provider that is a par-
ticipating provider with respect to such 
item or service; 
‘‘(ii) all providers that are partici-
pating providers with respect to such item 
or service; or 
‘‘(iii) a provider that is not described 
in clause (ii); 
‘‘(E) provides that such a request may be 
made with respect to an item or service through 
use of the billing code for such item or service 
or through use of a descriptive term for such 
item or service; and 
‘‘(F) meets any other requirement deter-
mined appropriate by the Secretary. 
The Secretary may require such tool, as a condition 
of complying with subparagraph (E), to link multiple 
billing codes to a single descriptive term if the Sec-
retary determines that the billing codes to be so 
linked correspond to similar items and services. 
‘‘(b) RATE AND PAYMENT INFORMATION.— 
‘‘(1) IN GENERAL.—For plan years beginning 
on or after the date that is 2 years after the date 
of the enactment of this section, each group health 
plan (other than a grandfathered health plan (as de-
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fined in section 1251(e) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18011(e))) or 
group health insurance coverage, shall, not less fre-
quently than once every 3 months (or, in the case 
of information described in paragraph (2)(B), not 
less frequently than monthly), make available to the 
public the rate and payment information described 
in paragraph (2) in accordance with paragraph (3). 
‘‘(2) RATE
AND
PAYMENT
INFORMATION
DE-
SCRIBED.—For purposes of paragraph (1), the rate 
and payment information described in this para-
graph is, with respect to a group health plan or 
group health insurance coverage, the following: 
‘‘(A) With respect to each item or service 
(other than a drug) for which benefits are avail-
able under such plan or coverage, the in-net-
work rate in effect with each provider that is a 
participating provider with respect to such item 
or service, other than such a rate in effect with 
a provider that, during the 1-year period ending 
10 business days before the date of the publica-
tion of such information, did not submit any 
claim for such item or service to such plan or 
coverage. 
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‘‘(B) With respect to each drug (identified 
by national drug code) for which benefits are 
available under such plan, the average amount 
paid by such plan or coverage (net of rebates, 
discounts, and price concessions) for such drug 
dispensed or administered during the 90-day 
period beginning 180 days before such date of 
publication to each provider that was a partici-
pating provider with respect to such drug, bro-
ken down by each such provider, other than 
such an amount paid to a provider that, during 
such period, submitted fewer than 20 claims for 
such drug to such plan or coverage. 
‘‘(C) With respect to each item or service 
for which benefits are available under such plan 
or coverage, the amount billed, and the amount 
allowed by the plan or coverage, for each such 
item or service furnished during the 90-day pe-
riod specified in subparagraph (B) by a pro-
vider that was not a participating provider with 
respect to such item or service, broken down by 
each such provider, other than items and serv-
ices with respect to which fewer than 20 claims 
for such item or service were submitted to such 
plan or coverage during such period. 
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