•AMDT. NO. 2786 
evidence based medicine, and health informa-
tion technology under the plan or coverage; and 
‘‘(D) implement wellness and health pro-
motion activities. 
‘‘(2) REPORTING REQUIREMENTS.— 
‘‘(A) IN GENERAL.—A group health plan 
and a health insurance issuer offering group or 
individual health insurance coverage shall annu-
ally submit to the Secretary, and to enrollees 
under the plan or coverage, a report on whether 
the benefits under the plan or coverage satisfy 
the elements described in subparagraphs (A) 
through (D) of paragraph (1). 
‘‘(B) TIMING
OF
REPORTS.—A report 
under subparagraph (A) shall be made available 
to an enrollee under the plan or coverage dur-
ing each open enrollment period. 
‘‘(C) AVAILABILITY
OF
REPORTS.—The 
Secretary shall make reports submitted under 
subparagraph (A) available to the public 
through an Internet website 
‘‘(D) PENALTIES.—In developing the re-
porting requirements under paragraph (1), the 
Secretary may develop and impose appropriate 
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•AMDT. NO. 2786 
penalties for non-compliance with such require-
ments. 
‘‘(E) EXCEPTIONS.—In developing the re-
porting requirements under paragraph (1), the 
Secretary may provide for exceptions to such 
requirements for group health plans and health 
insurance issuers that substantially meet the 
goals of this section. 
‘‘(b) WELLNESS AND PREVENTION PROGRAMS.—For 
purposes of subsection (a)(1)(D), wellness and health pro-
motion activities may include personalized wellness and 
prevention services, which are coordinated, maintained or 
delivered by a health care provider, a wellness and preven-
tion plan manager, or a health, wellness or prevention 
services organization that conducts health risk assess-
ments or offers ongoing face-to-face, telephonic or web- 
based intervention efforts for each of the program’s par-
ticipants, and which may include the following wellness 
and prevention efforts: 
‘‘(1) Smoking cessation. 
‘‘(2) Weight management. 
‘‘(3) Stress management. 
‘‘(4) Physical fitness. 
‘‘(5) Nutrition. 
‘‘(6) Heart disease prevention. 
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•AMDT. NO. 2786 
‘‘(7) Healthy lifestyle support. 
‘‘(8) Diabetes prevention. 
‘‘(c) REGULATIONS.—Not later than 2 years after the 
date of enactment of the Patient Protection and Afford-
able Care Act, the Secretary shall promulgate regulations 
that provide criteria for determining whether a reimburse-
ment structure is described in subsection (a). 
‘‘(d) STUDY AND REPORT.—Not later than 180 days 
after the date on which regulations are promulgated under 
subsection (c), the Government Accountability Office shall 
review such regulations and conduct a study and submit 
to the Committee on Health, Education, Labor, and Pen-
sions of the Senate and the Committee on Energy and 
Commerce of the House of Representatives a report re-
garding the impact the activities under this section have 
had on the quality and cost of health care. 
‘‘SEC. 2718. BRINGING DOWN THE COST OF HEALTH CARE 
COVERAGE. 
‘‘(a) CLEAR ACCOUNTING FOR COSTS.—A health in-
surance issuer offering group or individual health insur-
ance coverage shall, with respect to each plan year, submit 
to the Secretary a report concerning the percentage of 
total premium revenue that such coverage expends— 
‘‘(1) on reimbursement for clinical services pro-
vided to enrollees under such coverage; 
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•AMDT. NO. 2786 
‘‘(2) for activities that improve health care 
quality; and 
‘‘(3) on all other non-claims costs, including an 
explanation of the nature of such costs, and exclud-
ing State taxes and licensing or regulatory fees. 
The Secretary shall make reports received under this sec-
tion available to the public on the Internet website of the 
Department of Health and Human Services. 
‘‘(b) ENSURING THAT CONSUMERS RECEIVE VALUE 
FOR THEIR PREMIUM PAYMENTS.— 
‘‘(1) REQUIREMENT TO PROVIDE VALUE FOR 
PREMIUM PAYMENTS.—A health insurance issuer of-
fering group or individual health insurance coverage 
shall, with respect to each plan year, provide an an-
nual rebate to each enrollee under such coverage, on 
a pro rata basis, in an amount that is equal to the 
amount by which premium revenue expended by the 
issuer on activities described in subsection (a)(3) ex-
ceeds— 
‘‘(A) with respect to a health insurance 
issuer offering coverage in the group market, 
20 percent, or such lower percentage as a State 
may by regulation determine; or 
‘‘(B) with respect to a health insurance 
issuer offering coverage in the individual mar-
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•AMDT. NO. 2786 
ket, 25 percent, or such lower percentage as a 
State may by regulation determine, except that 
such percentage shall be adjusted to the extent 
the Secretary determines that the application of 
such percentage with a State may destabilize 
the existing individual market in such State. 
‘‘(2) CONSIDERATION
IN
SETTING
PERCENT-
AGES.—In determining the percentages under para-
graph (1), a State shall seek to ensure adequate par-
ticipation by health insurance issuers, competition in 
the health insurance market in the State, and value 
for consumers so that premiums are used for clinical 
services and quality improvements. 
‘‘(3) TERMINATION.—The provisions of this 
subsection shall have no force or effect after Decem-
ber 31, 2013. 
‘‘(c) STANDARD HOSPITAL CHARGES.—Each hospital 
operating within the United States shall for each year es-
tablish (and update) and make public (in accordance with 
guidelines developed by the Secretary) a list of the hos-
pital’s standard charges for items and services provided 
by the hospital, including for diagnosis-related groups es-
tablished under section 1886(d)(4) of the Social Security 
Act. 
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