172 
‘‘(II) For purposes of this subparagraph, a de-
scription of compensation or cost may be expressed 
as a monetary amount, formula, or a per capita 
charge for each enrollee or, if the compensation or 
cost cannot reasonably be expressed in such terms, 
by any other reasonable method, including a disclo-
sure that additional compensation may be earned 
but may not be calculated at the time of contract if 
such a disclosure includes a description of the cir-
cumstances under which the additional compensation 
may be earned and a reasonable and good faith esti-
mate if the covered service provider cannot otherwise 
readily describe compensation or cost and explains 
the methodology and assumptions used to prepare 
such estimate. Any such description shall contain 
sufficient information to permit evaluation of the 
reasonableness of the compensation or cost. 
‘‘(III) No person or entity is a ‘covered service 
provider’ within the meaning of subclause (I)(bb) 
solely on the basis of providing services as an affil-
iate or a subcontractor that is performing one or 
more of the services described in subitem (AA) or 
(BB) of such subclause under the contract or ar-
rangement with the covered plan. 
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‘‘(iii) A covered service provider shall disclose to 
a responsible plan fiduciary, in writing, the fol-
lowing: 
‘‘(I) A description of the services to be pro-
vided to the covered plan pursuant to the con-
tract or arrangement. 
‘‘(II) If applicable, a statement that the 
covered service provider, an affiliate, or a sub-
contractor will provide, or reasonably expects to 
provide, services pursuant to the contract or ar-
rangement directly to the covered plan as a fi-
duciary (within the meaning of section 3(21)). 
‘‘(III) A description of all direct compensa-
tion, either in the aggregate or by service, that 
the covered service provider, an affiliate, or a 
subcontractor reasonably expects to receive in 
connection with the services described in sub-
clause (I). 
‘‘(IV)(aa) A description of all indirect com-
pensation that the covered service provider, an 
affiliate, or a subcontractor reasonably expects 
to receive in connection with the services de-
scribed in subclause (I)— 
‘‘(AA) including compensation from a 
vendor to a brokerage firm based on a 
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174 
structure of incentives not solely related to 
the contract with the covered plan; and 
‘‘(BB) not including compensation re-
ceived by an employee from an employer 
on account of work performed by the em-
ployee. 
‘‘(bb) A description of the arrangement be-
tween the payer and the covered service pro-
vider, an affiliate, or a subcontractor, as appli-
cable, pursuant to which such indirect com-
pensation is paid. 
‘‘(cc) Identification of the services for 
which the indirect compensation will be re-
ceived, if applicable. 
‘‘(dd) Identification of the payer of the in-
direct compensation. 
‘‘(V) A description of any compensation 
that will be paid among the covered service pro-
vider, an affiliate, or a subcontractor, in con-
nection with the services described in subclause 
(I) if such compensation is set on a transaction 
basis (such as commissions, finder’s fees, or 
other similar incentive compensation based on 
business placed or retained), including identi-
fication of the services for which such com-
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175 
pensation will be paid and identification of the 
payers and recipients of such compensation (in-
cluding the status of a payer or recipient as an 
affiliate or a subcontractor), regardless of 
whether such compensation also is disclosed 
pursuant to subclause (III) or (IV). 
‘‘(VI) A description of any compensation 
that the covered service provider, an affiliate, or 
a subcontractor reasonably expects to receive in 
connection with termination of the contract or 
arrangement, and how any prepaid amounts 
will be calculated and refunded upon such ter-
mination. 
‘‘(iv) A covered service provider shall disclose to 
a responsible plan fiduciary, in writing a description 
of the manner in which the compensation described 
in clause (iii), as applicable, will be received. 
‘‘(v)(I) A covered service provider shall disclose 
the information required under clauses (iii) and (iv) 
to the responsible plan fiduciary not later than the 
date that is reasonably in advance of the date on 
which the contract or arrangement is entered into, 
and extended or renewed. 
‘‘(II) A covered service provider shall disclose 
any change to the information required under clause 
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pamtmann on DSKBC07HB2PROD with BILLS
176 
(iii) and (iv) as soon as practicable, but not later 
than 60 days from the date on which the covered 
service provider is informed of such change, unless 
such disclosure is precluded due to extraordinary cir-
cumstances beyond the covered service provider’s 
control, in which case the information shall be dis-
closed as soon as practicable. 
‘‘(vi)(I) Upon the written request of the respon-
sible plan fiduciary or covered plan administrator, a 
covered service provider shall furnish any other in-
formation relating to the compensation received in 
connection with the contract or arrangement that is 
required for the covered plan to comply with the re-
porting and disclosure requirements under this Act. 
‘‘(II) The covered service provider shall disclose 
the information required under clause (iii)(I) reason-
ably in advance of the date upon which such respon-
sible plan fiduciary or covered plan administrator 
states that it is required to comply with the applica-
ble reporting or disclosure requirement, unless such 
disclosure is precluded due to extraordinary cir-
cumstances beyond the covered service provider’s 
control, in which case the information shall be dis-
closed as soon as practicable. 
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pamtmann on DSKBC07HB2PROD with BILLS
177 
‘‘(vii) No contract or arrangement will fail to be 
reasonable under this subparagraph solely because 
the covered service provider, acting in good faith and 
with reasonable diligence, makes an error or omis-
sion in disclosing the information required pursuant 
to clause (iii) (or a change to such information dis-
closed pursuant to clause (v)(II)) or clause (vi), pro-
vided that the covered service provider discloses the 
correct information to the responsible plan fiduciary 
as soon as practicable, but not later than 30 days 
from the date on which the covered service provider 
knows of such error or omission. 
‘‘(viii)(I) Pursuant to subsection (a), subpara-
graphs (C) and (D) of section 406(a)(1) shall not 
apply to a responsible plan fiduciary, notwith-
standing any failure by a covered service provider to 
disclose information required under clause (iii), if 
the following conditions are met: 
‘‘(aa) The responsible plan fiduciary did 
not know that the covered service provider 
failed or would fail to make required disclosures 
and reasonably believed that the covered service 
provider disclosed the information required to 
be disclosed. 
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178 
‘‘(bb) The responsible plan fiduciary, upon 
discovering that the covered service provider 
failed to disclose the required information, re-
quests in writing that the covered service pro-
vider furnish such information. 
‘‘(cc) If the covered service provider fails 
to comply with a written request described in 
subclause (II) within 90 days of the request, 
the responsible plan fiduciary notifies the Sec-
retary of the covered service provider’s failure, 
in accordance with subclauses (II) and (III). 
‘‘(II) A notice described in subclause (I)(cc) 
shall contain— 
‘‘(aa) the name of the covered plan; 
‘‘(bb) the plan number used for the annual 
report on the covered plan; 
‘‘(cc) the plan sponsor’s name, address, 
and employer identification number; 
‘‘(dd) the name, address, and telephone 
number of the responsible plan fiduciary; 
‘‘(ee) the name, address, phone number, 
and, if known, employer identification number 
of the covered service provider; 
‘‘(ff) a description of the services provided 
to the covered plan; 
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pamtmann on DSKBC07HB2PROD with BILLS
179 
‘‘(gg) a description of the information that 
the covered service provider failed to disclose; 
‘‘(hh) the date on which such information 
was requested in writing from the covered serv-
ice provider; and 
‘‘(ii) a statement as to whether the covered 
service provider continues to provide services to 
the plan. 
‘‘(III) A notice described in subclause (I)(cc) 
shall be filed with the Department not later than 30 
days following the earlier of— 
‘‘(aa) The covered service provider’s re-
fusal to furnish the information requested by 
the written request described in subclause 
(I)(bb); or 
‘‘(bb) 90 days after the written request re-
ferred to in subclause (I)(cc) is made. 
‘‘(IV) If the covered service provider fails to 
comply with the written request under subclause 
(I)(bb) within 90 days of such request, the respon-
sible plan fiduciary shall determine whether to ter-
minate or continue the contract or arrangement 
under section 404. If the requested information re-
lates to future services and is not disclosed promptly 
after the end of the 90-day period, the responsible 
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180 
plan fiduciary shall terminate the contract or ar-
rangement as expeditiously as possible, consistent 
with such duty of prudence. 
‘‘(ix) Nothing in this subparagraph shall be 
construed to supersede any provision of State law 
that governs disclosures by parties that provide the 
services described in this section, except to the ex-
tent that such law prevents the application of a re-
quirement of this section.’’. 
(2) APPLICABILITY
OF
EXISTING
REGULA-
TIONS.—Nothing in the amendments made by para-
graph (1) shall be construed to affect the applica-
bility of section 2550.408b–2 of title 29, Code of 
Federal Regulations (or any successor regulations), 
with respect to any applicable entity other than a 
covered plan or a covered service provider (as de-
fined in section 408(b)(2)(B)(ii) of the Employee 
Retirement Income Security Act of 1974, as amend-
ed by paragraph (1)). 
(3) INDIVIDUAL MARKET COVERAGE.—Subpart 
1 of part B of title XXVII of the Public Health 
Service Act (42 U.S.C. 300gg–41 et seq.) is amend-
ed by adding at the end the following: 
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181 
‘‘SEC. 2746. DISCLOSURE TO ENROLLEES OF INDIVIDUAL 
MARKET COVERAGE. 
‘‘(a) IN GENERAL.—A health insurance issuer offer-
ing individual health insurance coverage shall make disclo-
sures to enrollees in such coverage, as described in sub-
section (b), and reports to the Secretary, as described in 
subsection (c), regarding direct or indirect compensation 
provided to an agent or broker associated with enrolling 
individuals in such coverage. 
‘‘(b) DISCLOSURE.—A health insurance issuer de-
scribed in subsection (a) shall disclose to an enrollee the 
amount of direct or indirect compensation provided to an 
agent or broker for services provided by such agent or 
broker associated with plan selection and enrollment. Such 
disclosure shall be— 
‘‘(1) made prior to the individual finalizing plan 
selection; and 
‘‘(2) included on any documentation confirming 
the individual’s enrollment. 
‘‘(c) REPORTING.—A health insurance issuer de-
scribed in subsection (a) shall annually report to the Sec-
retary, prior to the beginning of open enrollment, any di-
rect or indirect compensation provided to an agent or 
broker associated with enrolling individuals in such cov-
erage. 
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182 
‘‘(d) RULEMAKING.—Not later than 1 year after the 
date of enactment of the Ban Surprise Billing Act, the 
Secretary shall finalize, through notice-and-comment rule-
making, the form and manner in which issuers described 
in subsection (a) are required to make the disclosures de-
scribed in subsection (b) and the reports described in sub-
section (c). Such rulemaking may also include adjustments 
to notice requirements to reflect the different processes 
for plan renewals, in order to provide enrollees with full, 
timely information.’’. 
(4) TRANSITION RULE.—No contract executed 
prior to the effective date described in paragraph (5) 
by a group health plan subject to the requirements 
of section 408(b)(2)(B) of the Employee Retirement 
Income Security Act of 1974 (as amended by para-
graph (1)) or by a health insurance issuer subject to 
the requirements of section 2746 of the Public 
Health Service Act (as added by paragraph (3)) 
shall be subject to the requirements of such section 
408(b)(2)(B) or such section 2746, as applicable. 
(5) EFFECTIVE DATE.—The amendments made 
by paragraphs (1) and (3) shall apply beginning one 
year after the date of enactment of this Act. 
(b) STANDARDIZED REPORTING FORMAT.—Section 
716 of the Employee Retirement Income Security Act of 
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pamtmann on DSKBC07HB2PROD with BILLS
183 
1974, as added by section 2 and amended by section 3(c), 
is further amended by adding at the end the following new 
subsection: 
‘‘(i) STANDARDIZED REPORTING FORMAT.— 
‘‘(1) IN GENERAL.—Not later than 1 year after 
the date of enactment of this subsection, the Sec-
retary shall establish a standardized reporting for-
mat for the reporting, by group health plans (or 
health insurance coverage offered in connection with 
such a plan) to State All Payer Claims Databases, 
of medical claims, pharmacy claims, dental claims, 
and eligibility and provider files that are collected 
from private and public payers, and shall provide 
guidance to States on the process by which States 
may collect such data from such plans or coverage 
in the standardized reporting format. 
‘‘(2) DEFINITION.—In this subsection, the term 
‘State All Payer Claims Database’ means, with re-
spect to a State, a database that may include med-
ical claims, pharmacy claims, dental claims, and eli-
gibility and provider files, which are collected from 
private and public payers.’’. 
SEC. 8. ACCESS TO COST-SHARING INFORMATION. 
(a) INSURER AND PLAN REQUIREMENTS.— 
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184 
(1) PHSA.—Part A of title XXVII of the Pub-
lic Health Service Act (42 U.S.C. 300gg–11 et seq.), 
as amended by section 6(a), is further amended by 
inserting after section 2730 the following: 
‘‘SEC. 2731. PROVISION OF COST-SHARING INFORMATION. 
‘‘A group health plan or a health insurance issuer of-
fering group or individual health insurance coverage shall 
provide a participant, beneficiary, or enrollee in the plan 
or coverage with a good faith estimate of the enrollee’s 
cost-sharing (including deductibles, copayments, and coin-
surance) for which the participant, beneficiary, or enrollee 
may be responsible for paying with respect to a specific 
health care service (including any service that is reason-
ably expected to be provided in conjunction with such spe-
cific service), as soon as practicable and not later than 
2 business days after a request for such information by 
a participant, beneficiary, or enrollee.’’. 
(2) ERISA.—Subpart B of part 7 of subtitle B 
of title I of the Employee Retirement Income Secu-
rity Act of 1974 (29 U.S.C. 1185 et seq.), as 
amended by section 6(b), is further amended by add-
ing at the end the following: 
‘‘SEC. 718. PROVISION OF COST-SHARING INFORMATION. 
‘‘A group health plan (or health insurance coverage 
offered in connection with such a plan) shall provide a par-
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pamtmann on DSKBC07HB2PROD with BILLS
185 
ticipant or beneficiary in the plan or coverage with a good 
faith estimate of the participant’s or beneficiary’s cost- 
sharing (including deductibles, copayments, and coinsur-
ance) for which the participant or beneficiary may be re-
sponsible for paying with respect to a specific health care 
service (including any service that is reasonably expected 
to be provided in conjunction with such specific service), 
as soon as practicable and not later than 2 business days 
after a request for such information by a participant or 
beneficiary.’’. 
(3) IRC.—Subchapter B of chapter 100 of the 
Internal Revenue Code of 1986, as amended by sec-
tion 6(c), is further amended by adding at the end 
the following: 
‘‘SEC. 9818. PROVISION OF COST-SHARING INFORMATION. 
‘‘A group health plan shall provide a participant or 
beneficiary in the plan with a good faith estimate of the 
participant’s or beneficiary’s cost-sharing (including 
deductibles, copayments, and coinsurance) for which the 
participant or beneficiary may be responsible for paying 
with respect to a specific health care service (including any 
service that is reasonably expected to be provided in con-
junction with such specific service), as soon as practicable 
and not later than 2 business days after a request for such 
information by a participant or beneficiary.’’. 
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186 
(4) CLERICAL AMENDMENTS.— 
(A) ERISA.—The table of contents in sec-
tion 1 of the Employee Retirement Income Se-
curity Act of 1974 (29 U.S.C. 1001 et seq.), as 
amended by section 8(b)(4), is further amended 
by inserting after the item relating to section 
717 the following new item: 
‘‘Sec. 718. Provision of cost-sharing information.’’. 
(B) IRC.—The table of sections for sub-
chapter B of chapter 100 of the Internal Rev-
enue Code of 1986, as amended by section 
8(b)(4), is further amended by adding at the 
end the following new item: 
‘‘Sec. 9818. Provision of cost-sharing information.’’. 
(b) PROVIDER REQUIREMENTS.—Part D of title 
XXVII of the Public Health Service Act, as added by sec-
tion 3 and amended by section 6, is further amended by 
inserting before section 2799A–7 the following new sec-
tion: 
‘‘SEC. 2799A–6. PROVISION OF COST-SHARING INFORMA-
TION. 
‘‘A provider that is in-network with respect to a 
group health plan or a health insurance issuer offering 
group or individual health insurance coverage shall, upon 
request by a participant, beneficiary, or enrollee, provide 
to a participant, beneficiary, or enrollee in the plan or cov-
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pamtmann on DSKBC07HB2PROD with BILLS
187 
erage the following information, together with accurate 
and complete information about the participant’s, bene-
ficiary’s, or enrollee’s coverage under the applicable plan 
or coverage: 
‘‘(1) As soon as practicable and not later than 
2 business days after the participant, beneficiary, or 
enrollee requests such information, a good faith esti-
mate of the expected participant, beneficiary, or en-
rollee cost-sharing for the provision of a particular 
health care service (including any service that is rea-
sonably expected to be provided in conjunction with 
such specific service). 
‘‘(2) As soon as practicable and not later than 
2 business days after a participant, beneficiary, or 
enrollee requests such information, the contact infor-
mation for any ancillary providers for a scheduled 
health care service.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
subsections (a) and (b) shall apply with respect to plan 
years beginning on or after the date that is 18 months 
after the date of enactment of this Act. 
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188 
SEC. 9. TRANSPARENCY REGARDING IN-NETWORK AND 
OUT-OF-NETWORK DEDUCTIBLES AND OUT- 
OF-POCKET LIMITATIONS. 
(a) PHSA.—Section 2719A of the Public Health 
Service Act, as amended by section 2, is further amended 
by adding at the end the following new subsection: 
‘‘(g) TRANSPARENCY REGARDING IN-NETWORK AND 
OUT-OF-NETWORK DEDUCTIBLES AND OUT-OF-POCKET 
LIMITATIONS.— 
‘‘(1) IN GENERAL.—A group health plan or a 
health insurance issuer offering group or individual 
health insurance coverage and providing or covering 
any benefit with respect to items or services shall in-
clude, in clear writing, on any plan or insurance 
identification card issued to enrollees in the plan or 
coverage the amount of the in-network and out-of- 
network deductibles and the in-network and out-of- 
network out-of-pocket maximum limitation that 
apply to such plan or coverage. 
‘‘(2) GUIDANCE.—The Secretary, in consulta-
tion with the Secretary of Labor and Secretary of 
the Treasury, shall issue guidance to implement 
paragraph (1).’’. 
(b) ERISA.—Section 716 of the Employee Retire-
ment Income Security Act of 1974, as added by section 
2 and as amended by sections 3(c) and 7(b), is further 
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189 
amended by adding at the end the following new sub-
section: 
‘‘(j) TRANSPARENCY REGARDING IN-NETWORK AND 
OUT-OF-NETWORK DEDUCTIBLES AND OUT-OF-POCKET 
LIMITATIONS.— 
‘‘(1) IN GENERAL.—A group health plan or a 
health insurance issuer offering group health insur-
ance coverage and providing or covering any benefit 
with respect to items or services shall include, in 
clear writing, on any plan or insurance identification 
card issued to participants or beneficiaries in the 
plan or coverage the amount of the in-network and 
out-of-network deductibles and the in-network and 
out-of-network out-of-pocket maximum limitation 
that apply to such plan or coverage. 
‘‘(2) GUIDANCE.—The Secretary, in consulta-
tion with the Secretary of Health and Human Serv-
ices and Secretary of the Treasury, shall issue guid-
ance to implement paragraph (1).’’. 
(c) IRC.—Section 9816 of the Internal Revenue Code 
of 1986, as added by section 2, is further amended by 
adding at the end the following new subsection: 
‘‘(h) TRANSPARENCY REGARDING IN-NETWORK AND 
OUT-OF-NETWORK DEDUCTIBLES AND OUT-OF-POCKET 
LIMITATIONS.— 
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190 
‘‘(1) IN GENERAL.—A group health plan pro-
viding or covering any benefit with respect to items 
or services shall include, in clear writing, on any 
plan or insurance identification card issued to par-
ticipants or beneficiaries in the plan the amount of 
the in-network and out-of-network deductibles and 
the in-network and out-of-network out-of-pocket 
maximum limitation that apply to such plan. 
‘‘(2) GUIDANCE.—The Secretary, in consulta-
tion with the Secretary of Health and Human Serv-
ices and Secretary of Labor, shall issue guidance to 
implement paragraph (1).’’. 
(d) EFFECTIVE DATE.—The amendments made by 
this subsection shall apply with respect to plan years be-
ginning on or after January 1, 2022. 
Æ 
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