the expected charges for furnishing such items and serv-
ices. 
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 ‘‘Fair and Honest Ad-
vance Cost Estimate for Patients Act of 2020’’. 
SEC. 2. ADVANCED EXPLANATION OF BENEFITS. 
(a) HEALTH PLAN REQUIREMENTS.— 
(1) PUBLIC
HEALTH
SERVICE
ACT
AMEND-
MENT.—Subpart II of part A of title XXVII of the 
Public Health Service Act (42 U.S.C. 300gg–11 et 
seq.) is amended by adding at the end the following 
new section: 
‘‘SEC. 2730. ADVANCED EXPLANATION OF BENEFITS. 
‘‘(a) IN GENERAL.—Beginning on January 1, 2022, 
each health plan shall, with respect to a notification sub-
mitted under section 1128A(t)(1)(B) of the Social Secu-
rity Act by a health care provider or health care facility, 
respectively, to the health plan for a participant, bene-
ficiary, or enrollee under such health plan scheduled to 
receive an item or service from the provider or facility, 
not later than 1 business day (or, in the case such item 
or service was so scheduled at least 10 business days be-
fore such item or service is to be furnished (or in the case 
such notification was made pursuant to a request by such 
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pamtmann on DSKBC07HB2PROD with BILLS
participant, beneficiary, or enrollee), 3 business days) 
after the date on which the health plan receives such noti-
fication, provide to the participant, beneficiary, or enrollee 
(through mail or electronic means, as requested by the 
participant, beneficiary, or enrollee) a notification includ-
ing the following: 
‘‘(1) Whether or not the provider or facility is 
a participating provider or a participating facility 
with respect to the health plan with respect to the 
furnishing of such item or service and— 
‘‘(A) in the case the provider or facility is 
a participating provider or facility with respect 
to the health plan with respect to the furnishing 
of such item or service, the contracted rate 
under such plan for such item or service; and 
‘‘(B) in the case the provider or facility is 
a nonparticipating provider or facility with re-
spect to such plan, a description of how such 
participant, beneficiary, or enrollee may obtain 
information on providers and facilities that, 
with respect to such health plan, are partici-
pating providers and facilities. 
‘‘(2) The good faith estimate included in the 
notification received from the provider or facility. 
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pamtmann on DSKBC07HB2PROD with BILLS
‘‘(3) A good faith estimate of the amount the 
health plan is responsible for paying for items and 
services included in the estimate described in para-
graph (2). 
‘‘(4) A good faith estimate of the amount of 
any cost-sharing (including with respect to the de-
ductible and any copayment or coinsurance obliga-
tion) for which the participant, beneficiary, or en-
rollee would be responsible for such item or service 
(as of the date of such notification). 
‘‘(5) A good faith estimate of the amount that 
the participant, beneficiary, or enrollee has incurred 
toward meeting the limit of the financial responsi-
bility (including with respect to deductibles and out- 
of-pocket maximums) under the health plan (as of 
the date of such notification). 
‘‘(6) In the case such item or service is subject 
to a medical management technique (including con-
current review, prior authorization, and step-therapy 
or fail-first protocols) for coverage under the health 
plan, a disclaimer that coverage for such item or 
service is subject to such medical management tech-
nique. 
‘‘(7) A disclaimer that the information provided 
in the notification is only an estimate based on the 
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pamtmann on DSKBC07HB2PROD with BILLS
items and services reasonably expected, at the time 
of scheduling (or requesting) the item or service, to 
be furnished and is subject to change. 
‘‘(8) Any other information or disclaimer the 
health plan determines appropriate that is consistent 
with information and disclaimers required under this 
section. 
‘‘(b) HEALTH PLAN DEFINED.—In this section, the 
term ‘health plan’ means a group health plan and health 
insurance coverage offered by a heath insurance issuer in 
the group or individual market and includes a grand-
fathered health plan (as defined in section 1251(e) of the 
Patient Protection and Affordable Care Act).’’. 
(2) INTERNAL REVENUE CODE OF 1986 AMEND-
MENT.— 
(A) IN GENERAL.—Subchapter B of chap-
ter 100 of the Internal Revenue Code of 1986 
is amended by adding at the end the following 
new section: 
‘‘SEC. 9816. ADVANCED EXPLANATION OF BENEFITS. 
‘‘(a) IN GENERAL.—Beginning on January 1, 2022, 
each health plan shall, with respect to a notification sub-
mitted under section 1128A(t)(1)(B) of the Social Secu-
rity Act by a health care provider or health care facility, 
respectively, to the health plan for a participant or bene-
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ficiary under such health plan scheduled to receive an item 
or service from the provider or facility, not later than 1 
business day (or, in the case such item or service was so 
scheduled at least 10 business days before such item or 
service is to be furnished (or in the case such notification 
was made pursuant to a request by such participant or 
beneficiary), 3 business days) after the date on which the 
health plan receives such notification, provide to the par-
ticipant or beneficiary (through mail or electronic means, 
as requested by the participant or beneficiary) a notifica-
tion including the following: 
‘‘(1) Whether or not the provider or facility is 
a participating provider or a participating facility 
with respect to the health plan with respect to the 
furnishing of such item or service and— 
‘‘(A) in the case the provider or facility is 
a participating provider or facility with respect 
to the health plan with respect to the furnishing 
of such item or service, the contracted rate 
under such plan for such item or service; and 
‘‘(B) in the case the provider or facility is 
a nonparticipating provider or facility with re-
spect to such plan, a description of how such 
participant or beneficiary may obtain informa-
tion on providers and facilities that, with re-
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pamtmann on DSKBC07HB2PROD with BILLS
spect to such health plan, are participating pro-
viders and facilities. 
‘‘(2) The good faith estimate included in the 
notification received from the provider or facility. 
‘‘(3) A good faith estimate of the amount the 
health plan is responsible for paying for items and 
services included in the estimate described in para-
graph (2). 
‘‘(4) A good faith estimate of the amount of 
any cost-sharing (including with respect to the de-
ductible and any copayment or coinsurance obliga-
tion) for which the participant or beneficiary would 
be responsible for such item or service (as of the 
date of such notification). 
‘‘(5) A good faith estimate of the amount that 
the participant or beneficiary has incurred toward 
meeting the limit of the financial responsibility (in-
cluding with respect to deductibles and out-of-pocket 
maximums) under the health plan (as of the date of 
such notification). 
‘‘(6) In the case such item or service is subject 
to a medical management technique (including con-
current review, prior authorization, and step-therapy 
or fail-first protocols) for coverage under the health 
plan, a disclaimer that coverage for such item or 
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