fits offered by insurance health insurance and 
understand the extent of those medical benefits 
(or exceptions to those benefits). 
‘‘(3) 
STANDARDIZATION
OF
INSURANCE 
FORMS.—The Secretary shall provide for the devel-
opment of standards for the forms used in connec-
tion with group health insurance coverage, including 
for— 
‘‘(A) applications for health insurance cov-
erage; 
‘‘(B) explanations of benefits for such cov-
erage; 
‘‘(C) filing of complaints, grievances, and 
appeals respecting such coverage; and 
‘‘(D) other common functions relating to 
such coverage as the Secretary deems appro-
priate. 
‘‘(4) COVERAGE FACTS LABELS FOR PATIENT 
CLAIMS
SCENARIOS.—The Secretary shall develop 
standards for coverage facts labels based on the pa-
tient 
claims 
scenarios 
described 
in 
section 
2794(b)(4), which include information on estimated 
out-of-pocket cost-sharing and significant exclusions 
or benefit limits for such scenarios. 
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‘‘(5) PERSONALIZED
STATEMENT.—The Sec-
retary shall develop standards for an annual person-
alized statement that summarizes use of health care 
services and payment of claims with respect to an 
enrollee (and covered dependents) under group 
health insurance coverage in the preceding year. 
‘‘(6) APPLICATION OF STANDARDS.—No group 
health insurance coverage may be offered for sale 
after the date that is two years after date of the en-
actment of this section unless— 
‘‘(A) the benefits and other terms of cov-
erage are consistent with the definitional stand-
ards developed under paragraph (2); 
‘‘(B) the application and form of coverage 
and related forms are consistent with the stand-
ardized forms developed under paragraph (3); 
and 
‘‘(C) there is provided coverage facts labels 
described in paragraph (4) with respect to the 
coverage. 
‘‘(7) PERIODIC REVIEW AND UPDATING.—The 
Secretary shall periodically review and update, as 
appropriate, the standards developed under this sub-
section. 
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‘‘(8) 
EVALUATION
OF
INFORMATION
RE-
SOURCES.—In developing, reviewing, and updating 
standards under this subsection, the Secretary shall 
provide for testing and evaluation of information re-
sources in general and to specific audiences includ-
ing those with low literacy skills. 
‘‘(9) CONSULTATION.—In developing reviewing, 
and updating standards under this subsection, the 
Secretary shall consult with, among others, the Na-
tional Association of Insurance Commissioners, 
health care professionals, researchers, health insur-
ance issuers, group health plans, patient advocates, 
and literacy experts. 
‘‘(b) QUALITY ASSURANCES FOR HEALTH INSUR-
ANCE.— 
‘‘(1) IN GENERAL.—The Secretary shall provide 
for the development of standards to assure the qual-
ity of benefits under group health insurance cov-
erage. Such standards shall include standards relat-
ing to at least— 
‘‘(A) network adequacy and stability; 
‘‘(B) guaranteed coverage for one year of 
contracted benefits; 
‘‘(C) adequacy and stability of prescription 
drug networks; 
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‘‘(D) utilization control systems; and 
‘‘(E) grievances and appeals. 
‘‘(2) APPLICATION OF PROVISIONS.—The provi-
sions of paragraphs (5) through (9) of subsection 
(a) apply to standards developed under this sub-
section in the same manner as such provisions apply 
to standards developed under subsection (a). 
‘‘(c) MARKETING.— 
‘‘(1) IN GENERAL.—The Secretary shall provide 
for the development of standards for the marketing 
of group health insurance coverage. Such standards 
shall include standards for at least— 
‘‘(A) marketing materials; and 
‘‘(B) sales commissions. 
‘‘(2) NONDISCRIMINATION.—No group health 
insurance coverage may be offered for sale after the 
date that is two years after date of the enactment 
of this section unless the issuer provides the Sec-
retary with a written certification that all marketing 
materials, seminars, and other outreach efforts in 
connection with the offering of such coverage do not 
discriminate on the basis of income, race, gender, 
ethnicity, or other demographic factors as deter-
mined by the Secretary. 
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‘‘(3) APPLICATION OF PROVISIONS.—The provi-
sions of paragraphs (7) through (9) of subsection 
(a) apply to standards developed under this sub-
section in the same manner as such provisions apply 
to standards developed under subsection (a). 
‘‘(d) HONESTY IN COVERAGE OF OUT-OF-NETWORK 
PROVIDERS.—The Secretary shall provide for the develop-
ment of standards for the accuracy and clarity of coverage 
for out-of-network providers, including cost sharing and 
payments to such providers, for health insurance issuers 
in group health insurance coverage that provide such cov-
erage.’’. 
(b) APPLICATION IN THE INDIVIDUAL MARKET.— 
Such title is further amended by inserting after section 
2745 the following new section: 
‘‘SEC. 2746. STANDARDS FOR HEALTH INSURANCE INSUR-
ANCE FORMS, QUALITY, FAIR MARKETING, 
AND HONESTY IN OUT-OF-NETWORK COV-
ERAGE. 
‘‘The provisions of section 2708 shall apply under 
this part to individual health insurance coverage and en-
rollees in such coverage in the same manner as such provi-
sions apply under part A in the case of group health insur-
ance coverage and group health plans and participants 
and beneficiaries.’’. 
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(c) APPLICATION TO THE MEDICARE ADVANTAGE 
PROGRAM
AND
THE MEDICARE PRESCRIPTION DRUG 
PROGRAM.— 
(1) MEDICARE ADVANTAGE PROGRAM.—Section 
1852 of the Social Security Act (42 U.S.C. 1395w– 
22) is amended by adding at the end the following 
new subsection: 
‘‘(m) STANDARDS FOR HEALTH INSURANCE FORMS, 
QUALITY, FAIR MARKETING, AND HONESTY IN OUT-OF- 
NETWORK COVERAGE.—The provisions of section 2708(a) 
of the Public Health Service Act shall apply to Medicare 
Advantage organizations, Medicare Advantage plans, and 
enrollees in such plans in the same manner as such provi-
sions apply under such section to group health insurance 
coverage and group health plans and participants and 
beneficiaries.’’. 
(2) MEDICARE
PRESCRIPTION
DRUG
PRO-
GRAM.—Section 1860D–4 of the Social Security Act 
(42 U.S.C. 1395w–104) is amended by adding at 
the end the following new subsection: 
‘‘(m) STANDARDS FOR HEALTH INSURANCE FORMS, 
QUALITY, FAIR MARKETING, AND HONESTY IN OUT-OF- 
NETWORK COVERAGE.—The provisions of section 2708(a) 
of the Public Health Service Act shall apply to PDP spon-
sors, prescription drug plans, and enrollees in such plans 
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in the same manner as such provisions apply under such 
section to group health insurance coverage and group 
health plans and participants and beneficiaries.’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to plan years begin-
ning after the date that is 2 years after the date of 
the enactment of this Act. 
(d) APPLICATION TO FEHBP.—The provisions of 
section 2708(a) of the Public Health Service Act shall 
apply to the Federal Employees Health Benefits Program 
under chapter 89 of title 5, United States Code, and to 
contractors, health plans, and enrollees in such plans in 
the same manner as such provisions apply under such sec-
tion to group health insurance coverage and group health 
plans and participants and beneficiaries. 
SEC. 4. HEALTH INSURANCE ACCOUNTABILITY INITIA-
TIVES. 
(a) IMPROVED
HEALTH
INSURANCE
ACCOUNT-
ABILITY.—Title XXVII of the Public Health Service Act 
is amended by adding at the end the following new section: 
‘‘SEC. 2793. ACCOUNTABILITY INITIATIVES. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Office of Health Insurance Oversight established 
under section 2795, shall undertake activities in accord-
ance with this section to promote accountability of health 
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insurance issuers in meeting Federal health insurance re-
quirements, regardless of whether this relates to health in-
surance in the individual or group market. 
‘‘(b) COMPLIANCE EXAMINATIONS AND AUDITS.— 
‘‘(1) IN GENERAL.—Without regard to whether 
or not there is a determination under section 
2722(a)(2) or 2761(a)(2) with respect to a health 
insurance issuer, in carrying out this section, the 
Secretary shall conduct independent market conduct 
examinations and audits to monitor and verify the 
compliance of an health insurance issuer with Fed-
eral health insurance requirements. Such audits may 
include random compliance audits and targeted au-
dits in response to complaints or other suspected 
non-compliance. 
‘‘(2) RECOUPMENT OF COSTS.—In connection 
with such examinations and audits, the Secretary is 
authorized to recoup from health insurance issuers 
reimbursement for the costs of such examinations 
and audits of such issuers. 
‘‘(3) RELATION TO OTHER AUTHORITY.—The 
authorities under this section are in addition to any 
authorities of the Secretary, including authorities 
under sections 2722(b) and 2761(b). 
‘‘(c) DATA COLLECTION AND REVIEW.— 
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‘‘(1) IN GENERAL.—The Secretary shall collect 
and review data from health insurance issuers on 
health insurance coverage to monitor compliance 
with Federal health insurance requirements applica-
ble to such issuers and coverage. Upon request by 
the Secretary, such issuers shall provide such data 
to the Secretary on a timely basis. 
‘‘(2) ELEMENTS TO REVIEW.—In carrying out 
this subsection, the Secretary shall review at least 
the following: 
‘‘(A) Underwriting guidelines to ensure 
compliance with applicable Federal health in-
surance requirements. 
‘‘(B) Rating practices to ensure compliance 
with such requirements. 
‘‘(C) Enrollment and disenrollment data, 
including information the Secretary may need 
to detect patterns of discrimination against in-
dividuals based on health status or other char-
acteristics, to ensure compliance with such re-
quirements 
(including 
nondiscrimination 
in 
group coverage, guaranteed issue, guaranteed 
renewability requirements applicable in all mar-
kets). 
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‘‘(D) Post-claims underwriting and rescis-
sion practices to ensure compliance with such 
requirements relating to guaranteed renew-
ability. 
‘‘(E) Marketing materials and agent guide-
lines to ensure compliance with applicable Fed-
eral health insurance requirements. 
‘‘(F) Data on the imposition of pre-exist-
ing condition exclusion periods and claims sub-
jected to such exclusion periods. 
‘‘(G) Information on issuance of certifi-
cates of creditable coverage. 
‘‘(H) Information on cost-sharing and pay-
ments with respect to any out-of-network cov-
erage. 
‘‘(I) Such other information as the Sec-
retary may determine to be necessary to verify 
compliance with requirements of this title. 
‘‘(J) The application to issuers of penalties 
for violation of such requirements, including the 
failure to produce requested information. 
‘‘(3) TREATMENT OF PROPRIETARY INFORMA-
TION.—The Secretary may request under this sub-
section information that is proprietary or that re-
veals a trade secret, but such information shall not 
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be subject to further disclosure to the general public 
in a manner that reveals proprietary information or 
a trade secret. 
‘‘(4) FORM AND MANNER OF INFORMATION.— 
Information under paragraph (1) shall be pro-
vided— 
‘‘(A) in a form and manner specified by 
the Secretary; and 
‘‘(B) within 30 days of the date of receipt 
of the request for the information, or within 
such longer time period as the Secretary deems 
appropriate. 
‘‘(5) ENFORCEMENT.—The Secretary shall have 
the same authority in relation to enforcement of re-
quests for data under paragraph (1) as the Sec-
retary has under section 2722(b). 
‘‘(6) COORDINATION WITH STATES.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
coordinate with State insurance regulators so 
that data with respect to health insurance 
issuers and coverage are collected and reported 
in a common format. 
‘‘(B) 
CLEARINGHOUSE.—The 
Secretary 
shall establish a clearinghouse for the sharing 
of data reported by health insurance issuers 
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and for the findings from audits and investiga-
tions. Such clearinghouse may be established in 
conjunction with the National Association of In-
surance Commissioners. 
‘‘(7) COORDINATION
WITH
DEPARTMENTS
OF 
LABOR AND TREASURY.—The Secretary shall coordi-
nate with the Secretaries of Labor and Treasury 
with respect to requirements to report data that af-
fect health insurance coverage sold in connection 
with group health plans. 
‘‘(d) HEALTH INSURANCE ACCOUNTABILITY GRANTS 
TO STATES.— 
‘‘(1) IN GENERAL.—The Secretary shall provide 
for grants to Departments of Insurance in States to 
strengthen their enforcement of Federal health in-
surance requirements with respect to health insur-
ance issuers operating in such States. Such a grant 
shall only be made pursuant to an application made 
to the Secretary. 
‘‘(2) FUNDING.— 
‘‘(A) IN GENERAL.—Of the funds appro-
priated under subparagraph (B) for grants 
under this subsection, the Secretary shall pro-
vide a grant to each State with an application 
approved under paragraph (1). 
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‘‘(B) 
ALLOCATION.—Funds 
so 
appro-
priated for any fiscal year shall be apportioned 
among the States in accordance with a formula 
determined by the Secretary that takes into ac-
count the scope of health insurance subject to 
regulation under this title in each State and 
such other factors as the Secretary may specify. 
‘‘(C) APPROPRIATIONS
AND
AUTHORIZA-
TIONS.—There is hereby appropriated, out of 
any funds in the Treasury not otherwise appro-
priated for the first fiscal year in which this 
section is in effect, $10,000,000 for grants 
under this subsection, to be available until ex-
pended. For each subsequent fiscal year there is 
authorized to be appropriated such sums as 
may be necessary for such grants. 
‘‘(e) FEDERAL HEALTH INSURANCE REQUIREMENTS 
DEFINED.—In this part, the term ‘Federal health insur-
ance requirements’ means the requirements under this 
title insofar as they relate to health insurance issuers and 
health insurance coverage, whether in the individual or 
group market, and includes other requirements imposed 
under Federal law specifically in relation to the offering 
of health insurance coverage by health insurance issuers.’’. 
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SEC. 5. HEALTH INSURANCE TRANSPARENCY INITIATIVES. 
(a) IN GENERAL.—Title XXVII of the Public Health 
Service Act, as amended by section 3, is further amended 
by adding at the end the following new section: 
‘‘SEC. 2794. TRANSPARENCY INITIATIVES. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Office of Health Insurance Oversight established 
under section 2795, shall undertake activities in accord-
ance with this section to promote transparency in costs, 
market practices, and other factors for health insurance 
coverage, regardless of whether the coverage is offered or 
in effect in the individual or group market. 
‘‘(b) DEVELOPMENT AND DISCLOSURE OF STAND-
ARDIZED INFORMATION.— 
‘‘(1) IN GENERAL.—In carrying out this sec-
tion, the Secretary shall provide for the development 
of— 
‘‘(A) standards for information about 
health insurance issuers, their health insurance 
policies, and their market practices with respect 
to such policies; and 
‘‘(B) standards for the disclosure of such 
information in a timely, consistent, and accu-
rate manner by health insurance issuers about 
each health insurance policy marketed and in 
force. 
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‘‘(2) INFORMATION TO BE DISCLOSED.— 
‘‘(A) IN GENERAL.—In carrying out this 
section, the Secretary shall require health insur-
ance issuers to disclose to enrollees, potential 
enrollees, in-network health care providers, and 
others through a publicly available Internet 
website and other appropriate means at least 
the following concerning each policy of health 
insurance coverage marketed or in force, in 
such standardized manner as the Secretary 
specifies: 
‘‘(i) Full policy contract language. 
‘‘(ii) A summary of the information 
described in paragraph (3). 
‘‘(iii) For each of the scenarios devel-
oped under paragraph (4), the coverage 
facts label information developed under 
section 2709(a)(4). 
‘‘(B) 
PERSONALIZED
STATEMENT.—In 
carrying out this section, the Secretary shall re-
quire health insurance issuers to disclose to en-
rollees, in such standardized manner as the 
Secretary specifies, an annual personalized 
statement described in section 2708(a)(5). 
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‘‘(3) INFORMATION TO BE DISCLOSED.—The in-
formation described in this paragraph is at least the 
following: 
‘‘(A) Data on the price of each new policy 
of health insurance coverage and renewal rating 
practices. 
‘‘(B) Information on claims payment poli-
cies and practices, including how many and how 
quickly claims were paid. 
‘‘(C) Information on provider fee schedules 
and usual, customary, and reasonable fees (for 
both network and out-of-network providers). 
‘‘(D) Information on provider participation 
and provider directories. 
‘‘(E) Information on loss ratios, including 
detailed information about amount and type of 
non-claims expenses. 
‘‘(F) Information on covered benefits, cost- 
sharing, and amount of payment provided to-
ward each type of service identified as a covered 
benefit, including preventive care services rec-
ommended by the United States Preventive 
Services Task Force. 
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‘‘(G) Information on civil or criminal ac-
tions successfully concluded against the issuer 
by any governmental entity. 
‘‘(H) Benefit exclusions and limits. 
‘‘(4) DEVELOPMENT OF PATIENT CLAIMS SCE-
NARIOS.— 
‘‘(A) IN GENERAL.—In order to improve 
the ability of individuals and group health plans 
to compare the coverage and value provided 
under different health insurance coverage, the 
Secretary shall develop a series of patient 
claims scenarios under which benefits (including 
out-of-pocket costs) under such coverage can be 
simulated for certain common or expensive con-
ditions or courses of treatment, such as mater-
nity care, breast cancer, heart disease, diabetes 
management, and well-child visits. 
‘‘(B) CONSULTATION
AND
BASIS.—The 
Secretary shall develop the scenarios under this 
paragraph— 
‘‘(i) in consultation with the National 
Institutes of Health, the Centers for Dis-
ease Control and Prevention, the Agency 
for Healthcare Research and Quality, 
health professional societies, patient advo-
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