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mented under subsection (a)(1)(D) may not require 
the disclosure or collection of any information relat-
ing to— 
‘‘(A) the presence or storage of a lawfully- 
possessed firearm or ammunition in the resi-
dence or on the property of an individual; or 
‘‘(B) the lawful use, possession, or storage of 
a firearm or ammunition by an individual. 
‘‘(2) LIMITATION ON DATA COLLECTION.—None 
of the authorities provided to the Secretary under the 
Patient Protection and Affordable Care Act or an 
amendment made by that Act shall be construed to 
authorize or may be used for the collection of any in-
formation relating to— 
‘‘(A) the lawful ownership or possession of 
a firearm or ammunition; 
‘‘(B) the lawful use of a firearm or ammu-
nition; or 
‘‘(C) the lawful storage of a firearm or am-
munition. 
‘‘(3) LIMITATION
ON
DATABASES
OR
DATA 
BANKS.—None of the authorities provided to the Sec-
retary under the Patient Protection and Affordable 
Care Act or an amendment made by that Act shall 
be construed to authorize or may be used to maintain
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records of individual ownership or possession of a 
firearm or ammunition. 
‘‘(4) LIMITATION ON DETERMINATION OF PRE-
MIUM RATES OR ELIGIBILITY FOR HEALTH INSUR-
ANCE.—A premium rate may not be increased, health 
insurance coverage may not be denied, and a dis-
count, rebate, or reward offered for participation in 
a wellness program may not be reduced or withheld 
under any health benefit plan issued pursuant to or 
in accordance with the Patient Protection and Afford-
able Care Act or an amendment made by that Act on 
the basis of, or on reliance upon— 
‘‘(A) the lawful ownership or possession of 
a firearm or ammunition; or 
‘‘(B) the lawful use or storage of a firearm 
or ammunition. 
‘‘(5) LIMITATION
ON
DATA
COLLECTION
RE-
QUIREMENTS FOR INDIVIDUALS.—No individual shall 
be required to disclose any information under any 
data collection activity authorized under the Patient 
Protection and Affordable Care Act or an amendment 
made by that Act relating to— 
‘‘(A) the lawful ownership or possession of 
a firearm or ammunition; or
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‘‘(B) the lawful use, possession, or storage of 
a firearm or ammunition.’’. 
(f) Section 2718 of the Public Health Service Act, as 
added by section 1001(5), is amended to read as follows: 
‘‘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 (including a grandfathered health plan) shall, 
with respect to each plan year, submit to the Secretary a 
report concerning the ratio of the incurred loss (or incurred 
claims) plus the loss adjustment expense (or change in con-
tract reserves) to earned premiums. Such report shall in-
clude the percentage of total premium revenue, after ac-
counting for collections or receipts for risk adjustment and 
risk corridors and payments of reinsurance, that such cov-
erage expends— 
‘‘(1) on reimbursement for clinical services pro-
vided to enrollees under such coverage; 
‘‘(2) for activities that improve health care qual-
ity; and 
‘‘(3) on all other non-claims costs, including an 
explanation of the nature of such costs, and excluding 
Federal and State taxes and licensing or regulatory 
fees.
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The Secretary shall make reports received under this section 
available to the public on the Internet website of the Depart-
ment of Health and Human Services. 
‘‘(b) ENSURING THAT CONSUMERS RECEIVE VALUE 
FOR THEIR PREMIUM PAYMENTS.— 
‘‘(1) REQUIREMENT
TO
PROVIDE
VALUE
FOR 
PREMIUM PAYMENTS.— 
‘‘(A) REQUIREMENT.—Beginning not later 
than January 1, 2011, a health insurance issuer 
offering group or individual health insurance 
coverage (including a grandfathered health plan) 
shall, with respect to each plan year, provide an 
annual rebate to each enrollee under such cov-
erage, on a pro rata basis, if the ratio of the 
amount of premium revenue expended by the 
issuer on costs described in paragraphs (1) and 
(2) of subsection (a) to the total amount of pre-
mium revenue (excluding Federal and State 
taxes and licensing or regulatory fees and after 
accounting for payments or receipts for risk ad-
justment, risk corridors, and reinsurance under 
sections 1341, 1342, and 1343 of the Patient 
Protection and Affordable Care Act) for the plan 
year (except as provided in subparagraph 
(B)(ii)), is less than—
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‘‘(i) with respect to a health insurance 
issuer offering coverage in the large group 
market, 85 percent, or such higher percent-
age as a State may by regulation deter-
mine; or 
‘‘(ii) with respect to a health insurance 
issuer offering coverage in the small group 
market or in the individual market, 80 per-
cent, or such higher percentage as a State 
may by regulation determine, except that 
the Secretary may adjust such percentage 
with respect to a State if the Secretary de-
termines that the application of such 80 
percent may destabilize the individual mar-
ket in such State. 
‘‘(B) REBATE AMOUNT.— 
‘‘(i) CALCULATION
OF
AMOUNT.—The 
total amount of an annual rebate required 
under this paragraph shall be in an amount 
equal to the product of— 
‘‘(I) the amount by which the per-
centage described in clause (i) or (ii) of 
subparagraph (A) exceeds the ratio de-
scribed in such subparagraph; and