I 
113TH CONGRESS 
1ST SESSION H. R. 1205 
To amend title XXVII of the Public Health Service Act to require health 
insurance issuers and group health plans to disclose information regard-
ing how certain taxes and fees impact the amount of premiums, and 
for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 14, 2013 
Mr. WALDEN introduced the following bill; which was referred to the 
Committee on Energy and Commerce 
A BILL 
To amend title XXVII of the Public Health Service Act 
to require health insurance issuers and group health 
plans to disclose information regarding how certain taxes 
and fees impact the amount of premiums, and for other 
purposes. 
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 ‘‘Patients Right to 
Know Act of 2013’’. 
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SEC. 2. PROTECTION OF CERTAIN HEALTH INSURANCE DIS-
CLOSURES. 
(a) IN GENERAL.—Section 2715 of the Public Health 
Service Act (42 U.S.C. 300gg–15) is amended by adding 
at the end the following new subsection: 
‘‘(h) PROTECTION
OF DISCLOSURE
OF FEE
AND 
OTHER ADDITIONAL INFORMATION.— 
‘‘(1) IN GENERAL.—A health insurance issuer 
or sponsor of a group health plan, with respect to 
its annual summary of benefits and coverage expla-
nation provided under subsection (d)— 
‘‘(A) shall include (effective for plan years 
beginning on or after January 1, 2016, and in 
addition to the information required to be dis-
closed under this section)— 
‘‘(i) the applicable additional informa-
tion relating to fees described in paragraph 
(2); and 
‘‘(ii) the applicable additional infor-
mation included under paragraph (3)(D); 
and 
‘‘(B) shall not be subject to any adminis-
trative action by the Secretary or by a State 
authority with respect to any disclosure made 
on or after the date of the enactment of this 
subsection of such applicable additional infor-
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mation if the disclosure is made based upon a 
good faith estimate of such information and is 
in accordance with such standards as the Sec-
retary may establish to carry out this sub-
section. 
‘‘(2) FEE INFORMATION.—The additional infor-
mation described in this paragraph, with respect to 
a health insurance issuer issuing health insurance 
coverage in the individual, small, or large group 
market and with respect to the sponsor of a group 
health plan, is as follows: 
‘‘(A) FEE
ON
HEALTH
INSURANCE
PRO-
VIDERS.—The annual fee on health insurance 
providers under section 9010 of the Patient 
Protection and Affordable Care Act (26 U.S.C. 
4001 note). 
‘‘(B) PCORI TAX.—Fees imposed under 
subchapter B of chapter 34 of the Internal Rev-
enue Code of 1986 (relating to funding the Pa-
tient-Centers Outcome Research Institute). 
‘‘(C) REINSURANCE CONTRIBUTIONS.—Re-
insurance contributions required under section 
1341(b) of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18061(b)). 
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‘‘(D) PROPOSED HEALTH INSURANCE EX-
CHANGE USER FEE.—Fees imposed on health 
plans relating to participation in an Exchange 
under subtitle D of title I of the Patient Protec-
tion and Affordable Care Act (42 U.S.C. 18021 
et seq.). 
‘‘(E) RISK
CORRIDOR
PAYMENTS.—Risk 
corridor 
payments 
required 
under 
section 
1342(b)(2) of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18062(b)(2)). 
‘‘(F) RISK ADJUSTMENT CHARGES.—Risk 
adjustment charges imposed under section 
1343(a)(1) of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18063(a)(1)). 
In the case of health insurance coverage, such costs 
may be calculated separately for such coverage in 
the individual market, in the small group market, 
and in the large group market for the health insur-
ance issuer involved. 
‘‘(3) OTHER INFORMATION.— 
‘‘(A) STUDY.—The Comptroller General of 
the United States shall conduct a study of 
methods of calculating the impact on average 
premium costs associated with each of the fol-
lowing: 
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‘‘(i) MARKET
IMPACT
OF
GUARAN-
TEED ISSUE AND COMMUNITY RATING.— 
The requirement for guaranteed issuance 
of coverage under section 2702 and com-
munity rated premiums under section 
2701. 
‘‘(ii) AGE RATING IMPACT.—The re-
quirement of section 2701(a)(1)(A)(iii) (re-
lating to limitations on age rating). 
‘‘(iii) WOMEN’S
PREVENTIVE
SERV-
ICES.—The requirement for coverage of 
women’s preventive services under section 
2713. 
‘‘(iv) MINIMUM
ESSENTIAL
HEALTH 
BENEFITS
COVERAGE.—The requirement 
that coverage provide for at least 60 per-
cent of the actuarial value of essential 
health benefits under section 1302(d) of 
the Patient Protection and Affordable Care 
Act. (42 U.S.C. 18022(d)). 
‘‘(B) CONSULTATION.—In conducting such 
study, the Comptroller General shall consult 
with health insurance issuers and State health 
insurance commissioners. 
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‘‘(C) REPORT.—Not later than October 1, 
2014, the Comptroller General shall submit to 
each House of Congress and the Secretary a re-
port on the study conducted under subpara-
graph (A). 
‘‘(D) INCLUSION OF ADDITIONAL INFOR-
MATION.—After submission of such report, the 
Secretary may also include in the information 
required to be disclosed under paragraph 
(1)(A)(ii) information on the impact on pre-
miums of each of the requirements described in 
subparagraph (A). 
‘‘(4) RETENTION OF STATE RATE SETTING AU-
THORITY.—Nothing in this subsection shall be con-
strued to preempt State authority to regulate, reject, 
alter, or require additional information in support of 
rates for health insurance coverage or oversight au-
thority of the Secretary.’’. 
Æ 
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