‘‘(7) Information on cost-sharing and payments 
with respect to any out-of-network coverage (or with 
respect to any item and service furnished under such 
a plan or such group health insurance coverage that 
does not use a network of providers). 
‘‘(8) Information on participant and beneficiary 
rights under this part. 
‘‘(9) Rate and payment information described in 
subsection (d). 
‘‘(10) Other information as determined appro-
priate by the Secretary. 
Rate and payment information described in paragraph (9) 
shall be made available to the public not later than January 
10, 2025, and not later than the tenth day of every month 
thereafter, in the manner described in subsection (d)(2)(A), 
and, beginning on January 1, 2027, in real-time through 
an application program interface (or successor technology) 
described in subsection (d)(2)(B). 
‘‘(b) USE OF PLAIN LANGUAGE.—The information re-
quired to be submitted under subsection (a) shall be pro-
vided in plain language. The term ‘plain language’ means 
language that the intended audience, including individuals 
with limited English proficiency, can readily understand 
and use because that language is clear, concise, well-orga-
nized, accurately describes the information, and follows 
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
other best practices of plain language writing. The Sec-
retary, jointly with the Secretary of Health and Human 
Services and the Secretary of Labor, shall develop and issue 
standards for plain language writing for purposes of this 
section and shall develop a standardized reporting template 
and standardized definitions of terms to allow for compari-
son across group health plans and health insurance cov-
erage. 
‘‘(c) COST SHARING TRANSPARENCY.— 
‘‘(1) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group health insur-
ance coverage, shall, upon request of a participant or 
beneficiary and in a timely manner, provide to the 
participant or beneficiary a statement of the amount 
of cost-sharing (including deductibles, copayments, 
and coinsurance) under the participant’s or bene-
ficiary’s plan or coverage that the participant or ben-
eficiary would be responsible for paying with respect 
to the furnishing of a specific item or service by a 
provider. At a minimum, such information shall in-
clude the information specified in paragraph (2) and 
shall be made available at no cost to the participant 
or beneficiary through a self-service tool that meets 
the requirements of paragraph (3) or through a paper 
or phone disclosure, at the option of the participant 
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
or beneficiary, that meets such requirements as the 
Secretary may specify. 
‘‘(2) SPECIFIED INFORMATION.—For purposes of 
paragraph (1), the information specified in this para-
graph is, with respect to an item or service for which 
benefits are available under a group health plan or 
group health insurance coverage (as applicable) fur-
nished by a health care provider to a participant or 
beneficiary of such plan or coverage, the following: 
‘‘(A) If such provider is a participating 
provider with respect to such item or service, the 
in-network rate (as defined in subsection (f)) for 
such item or service and for any other item or 
service that is inherent in the furnishing of the 
item or service that is the subject of such request. 
‘‘(B) If such provider is not a participating 
provider, the allowed amount, percentage of 
billed charges, or other rate that such plan or 
coverage will recognize as payment for such item 
or service, along with a notice that such indi-
vidual may be liable for additional charges billed 
by such provider. 
‘‘(C) The estimated amount of cost sharing 
(including deductibles, copayments, and coinsur-
ance) that the participant or beneficiary will 
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
incur for such item or service (which, in the case 
such item or service is to be furnished by a pro-
vider described in subparagraph (B), shall be 
calculated using the amount or rate described in 
such subparagraph (or, in the case such plan or 
issuer uses a percentage of billed charges to de-
termined the amount of payment for such pro-
vider, using a reasonable estimate of such per-
centage of such charges)). 
‘‘(D) The amount the participant or bene-
ficiary has already accumulated with respect to 
any deductible or out of pocket maximum under 
the plan or coverage (broken down, in the case 
separate deductibles or maximums apply to sep-
arate participants and beneficiaries enrolled in 
the 
plan 
or 
coverage, 
by 
such 
separate 
deductibles or maximums, in addition to any cu-
mulative deductible or maximum). 
‘‘(E) Any shared savings or other benefit 
available to the participant or beneficiary with 
respect to such item or service. 
‘‘(F) In the case such plan or coverage im-
poses any frequency or volume limitations with 
respect to such item or service (excluding medical 
necessity determinations), the amount that such 
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
participant or beneficiary has accrued towards 
such limitation with respect to such item or serv-
ice. 
‘‘(G) Any prior authorization, concurrent 
review, step therapy, fail first, or similar re-
quirements applicable to coverage of such item or 
service under such plan or group health insur-
ance coverage. 
‘‘(3) SELF-SERVICE
TOOL.—For purposes of 
paragraph (1), a self-service tool established by a 
group health plan or health insurance issuer offering 
group health insurance coverage meets the require-
ments of this paragraph if such tool— 
‘‘(A) is based on an Internet website, mobile 
application, or other platform determined appro-
priate by the Secretary; 
‘‘(B) provides for real-time responses to re-
quests described in paragraph (1); 
‘‘(C) is updated in a manner such that in-
formation provided through such tool is accurate 
at the time such request is made; 
‘‘(D) allows such a request to be made with 
respect to an item or service furnished by— 
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
‘‘(i) a specific provider that is a par-
ticipating provider with respect to such 
item or service; 
‘‘(ii) all providers that are partici-
pating providers with respect to such plan 
and such item or service for purposes of fa-
cilitating price comparisons; or 
‘‘(iii) a provider that is not described 
in clause (ii); and 
‘‘(E) provides that such a request may be 
made with respect to an item or service through 
use of the billing code for such item or service or 
through use of a descriptive term for such item 
or service. 
The Secretary may require such tool, as a condition 
of complying with subparagraph (E), to link multiple 
billing codes to a single descriptive term if the Sec-
retary determines that the billing codes to be so linked 
correspond to items and services. 
‘‘(4) PROVIDER
TOOL.—A group health plan, 
and a health insurance issuer offering group health 
insurance coverage, shall permit providers to learn 
the amount of cost-sharing (including deductibles, co-
payments, and coinsurance) that would apply under 
an individual’s plan or coverage that the individual 
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
would be responsible for paying with respect to the 
furnishing of a specific item or service by another 
provider in a timely manner upon the request of the 
provider and with the consent of such individual in 
the same manner and to the same extent as if such 
request has been made by such individual. As part of 
any tool used to facilitate such requests from a pro-
vider, such plan or issuer offering health insurance 
coverage may include functionality that— 
‘‘(A) allows providers to submit the notifi-
cations to such plan or coverage required under 
section 2799B–6 of the Public Health Service 
Act; and 
‘‘(B) provides for notifications required 
under section 716(f) to such an individual. 
‘‘(d) RATE AND PAYMENT INFORMATION.— 
‘‘(1) IN GENERAL.—For purposes of subsection 
(a)(9), the rate and payment information described in 
this subsection is, with respect to a group health plan 
or group health insurance coverage (as applicable), 
the following: 
‘‘(A) With respect to each item or service 
(other than a drug) for which benefits are avail-
able under such plan or coverage, the in-network 
rate (in a dollar amount) in effect as of the first 
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
day of the plan year during which such informa-
tion is submitted with each provider (identified 
by national provider identifier) that is a partici-
pating provider with respect to such item or 
service (or, in the case such rate is not available 
in a dollar amount, such formulae, pricing 
methodologies, or other information used to cal-
culate such rate). 
‘‘(B) With respect to each dosage form and 
indication of each drug (identified by national 
drug code) for which benefits are available under 
such plan or coverage— 
‘‘(i) the in-network rate (in a dollar 
amount) in effect as of the first day of the 
plan year during which such information is 
submitted with each provider (identified by 
national provider identifier) that is a par-
ticipating provider with respect to such 
drug (or, in the case such rate is not avail-
able in a dollar amount, such formulae, 
pricing methodologies, or other information 
used to calculate such rate); and 
‘‘(ii) the average amount paid by such 
plan (net of rebates, discounts, and price 
concessions) for such drug dispensed or ad-
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
ministered during the 90-day period begin-
ning 180 days before such date of submis-
sion to each provider that was a partici-
pating provider with respect to such drug, 
broken down by each such provider (identi-
fied by national provider identifier), other 
than such an amount paid to a provider 
that, during such period, submitted fewer 
than 20 claims for such drug to such plan 
or coverage. 
‘‘(C) With respect to each item or service for 
which benefits are available under such plan or 
coverage, the amount billed, and the amount al-
lowed by the plan or coverage, for each such item 
or service furnished during the 90-day period 
specified in subparagraph (B) by a provider that 
was not a participating provider with respect to 
such item or service, broken down by each such 
provider (identified by national provider identi-
fier), other than items and services with respect 
to which fewer than 20 claims for such item or 
service were submitted to such plan or coverage 
during such period. 
Such rate and payment information shall be made 
available with respect to each individual item or serv-
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
ice, regardless of whether such item or service is paid 
for as part of a bundled payment, episode of care, 
value-based payment arrangement, or otherwise. 
‘‘(2) MANNER OF PUBLICATION.— 
‘‘(A) IN GENERAL.—Rate and payment in-
formation required to be made available under 
subsection (a)(9) shall be so made available in 
dollar amounts through 3 separate machine- 
readable files corresponding to the information 
described in each of subparagraphs (A) through 
(C) of paragraph (1) that meet such require-
ments as specified by the Secretary not later 
than 180 days after the date of the enactment of 
this paragraph through rulemaking. Such re-
quirements shall ensure that such files are lim-
ited to an appropriate size, do not include infor-
mation that is duplicative of information con-
tained in the same file or in other files made 
available under such subsection, are made avail-
able in a widely-available format that allows for 
information contained in such files to be com-
pared across group health plans and group 
health insurance coverage, and are accessible to 
individuals at no cost and without the need to 
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
establish a user account or provide other creden-
tials. 
‘‘(B) REAL-TIME PROVISION OF INFORMA-
TION.— 
‘‘(i) IN
GENERAL.—Subject to clause 
(ii), beginning January 1, 2026, rate and 
payment information required to be made 
available by a group health plan or health 
insurance issuer under subsection (a)(9) 
shall, in addition to being made available 
in the manner described in subparagraph 
(A), be made available through an applica-
tion program interface (or successor tech-
nology) that provides access to such infor-
mation in real time and that meets such 
technical standards as may be specified by 
the Secretary. 
‘‘(ii) EXEMPTION FOR CERTAIN PLANS 
OR COVERAGE.—Clause (i) shall not apply 
with respect to information described in 
such clause required to be made available by 
a group health plan or health insurance 
issuer offering health insurance coverage if 
such plan or coverage, as applicable, pro-
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
vides benefits for fewer than 500 partici-
pants and beneficiaries. 
‘‘(3) USER GUIDE.—The Secretary, Secretary of 
Health and Human Services, and Secretary of the 
Treasury shall jointly make available to the public 
instructions written in plain language explaining 
how individuals may search for information described 
in paragraph (1) in files submitted in accordance 
with paragraph (2). 
‘‘(4) ANNUAL SUMMARY.—For each year (begin-
ning with 2025), each group health plan and health 
insurance issuer offering group health insurance cov-
erage shall make public a machine-readable file meet-
ing such standards as established by the Secretary 
under paragraph (2) containing a summary of all 
rate and payment information made public by such 
plan or issuer with respect to such plan or coverage 
during such year (such as averages of all such infor-
mation so made public). 
‘‘(e) ATTESTATION.—Each group health plan and 
health insurance issuer offering group health insurance cov-
erage shall annually submit to the Secretary an attestation 
of such plan’s or such coverage’s compliance with the provi-
sions of this section along with a link to disclosures made 
in accordance with subsection (a). 
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
‘‘(f) DEFINITIONS.—In this subsection: 
‘‘(1) PARTICIPATING PROVIDER.—The term ‘par-
ticipating provider’ has the meaning given such term 
in section 716 and includes a participating facility. 
‘‘(2) IN-NETWORK RATE.—The term ‘in-network 
rate’ means, with respect to a group health plan or 
group health insurance coverage and an item or serv-
ice furnished by a provider that is a participating 
provider with respect to such plan or coverage and 
item or service, the contracted rate (reflected as a dol-
lar amount) in effect between such plan or coverage 
and such provider for such item or service.’’. 
(B) CLERICAL AMENDMENT.—The table of 
contents in section 1 of such Act is amended by 
striking the item relating to section 719 and in-
serting the following new item: 
‘‘Sec. 719. Price transparency requirements.’’. 
(2) IRC.— 
(A) IN GENERAL.—Section 9819 of the In-
ternal Revenue Code of 1986 is amended to read 
as follows: 
‘‘SEC. 9819. PRICE TRANSPARENCY REQUIREMENTS. 
‘‘(a) IN GENERAL.—A group health plan shall make 
available to the public accurate and timely disclosures of 
the following information: 
‘‘(1) Claims payment policies and practices. 
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
‘‘(2) Periodic financial disclosures. 
‘‘(3) Data on enrollment. 
‘‘(4) Data on disenrollment. 
‘‘(5) Data on the number of claims that are de-
nied. 
‘‘(6) Data on rating practices. 
‘‘(7) Information on cost-sharing and payments 
with respect to any out-of-network coverage (or with 
respect to any item and service furnished under such 
a plan that does not use a network of providers). 
‘‘(8) Information on participant and beneficiary 
rights under this part. 
‘‘(9) Rate and payment information described in 
subsection (d). 
‘‘(10) Other information as determined appro-
priate by the Secretary. 
Rate and payment information described in paragraph (9) 
shall be made available to the public not later than January 
10, 2025, and not later than the tenth day of every month 
thereafter, in the manner described in subsection (d)(2)(A), 
and, beginning on January 1, 2027, in real-time through 
an application program interface (or successor technology) 
described in subsection (d)(2)(B). 
‘‘(b) USE OF PLAIN LANGUAGE.—The information re-
quired to be submitted under subsection (a) shall be pro-
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
vided in plain language. The term ‘plain language’ means 
language that the intended audience, including individuals 
with limited English proficiency, can readily understand 
and use because that language is clear, concise, well-orga-
nized, accurately describes the information, and follows 
other best practices of plain language writing. The Sec-
retary, jointly with the Secretary of Health and Human 
Services and the Secretary of Labor, shall develop and issue 
standards for plain language writing for purposes of this 
section and shall develop a standardized reporting template 
and standardized definitions of terms to allow for compari-
son across group health plans and health insurance cov-
erage. 
‘‘(c) COST SHARING TRANSPARENCY.— 
‘‘(1) IN GENERAL.—A group health plan shall, 
upon request of a participant or beneficiary and in 
a timely manner, provide to the participant or bene-
ficiary a statement of the amount of cost-sharing (in-
cluding deductibles, copayments, and coinsurance) 
under the participant’s or beneficiary’s plan that the 
participant or beneficiary would be responsible for 
paying with respect to the furnishing of a specific 
item or service by a provider. At a minimum, such 
information shall include the information specified in 
paragraph (2) and shall be made available at no cost 
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
to the participant or beneficiary through a self-service 
tool that meets the requirements of paragraph (3) or 
through a paper or phone disclosure, at the option of 
the participant or beneficiary, that meets such re-
quirements as the Secretary may specify. 
‘‘(2) SPECIFIED INFORMATION.—For purposes of 
paragraph (1), the information specified in this para-
graph is, with respect to an item or service for which 
benefits are available under a group health plan fur-
nished by a health care provider to a participant or 
beneficiary of such plan, the following: 
‘‘(A) If such provider is a participating 
provider with respect to such item or service, the 
in-network rate (as defined in subsection (f)) for 
such item or service and for any other item or 
service that is inherent in the furnishing of the 
item or service that is the subject of such request. 
‘‘(B) If such provider is not a participating 
provider, the allowed amount, percentage of 
billed charges, or other rate that such plan will 
recognize as payment for such item or service, 
along with a notice that such individual may be 
liable for additional charges billed by such pro-
vider. 
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00019
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
‘‘(C) The estimated amount of cost sharing 
(including deductibles, copayments, and coinsur-
ance) that the participant or beneficiary will 
incur for such item or service (which, in the case 
such item or service is to be furnished by a pro-
vider described in subparagraph (B), shall be 
calculated using the amount or rate described in 
such subparagraph (or, in the case such plan 
uses a percentage of billed charges to determined 
the amount of payment for such provider, using 
a reasonable estimate of such percentage of such 
charges)). 
‘‘(D) The amount the participant or bene-
ficiary has already accumulated with respect to 
any deductible or out of pocket maximum under 
the plan (broken down, in the case separate 
deductibles or maximums apply to separate par-
ticipants and beneficiaries enrolled in the plan, 
by such separate deductibles or maximums, in 
addition to any cumulative deductible or max-
imum). 
‘‘(E) Any shared savings or other benefit 
available to the participant or beneficiary with 
respect to such item or service. 
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00020
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
‘‘(F) In the case such plan imposes any fre-
quency or volume limitations with respect to 
such item or service (excluding medical necessity 
determinations), the amount that such partici-
pant or beneficiary has accrued towards such 
limitation with respect to such item or service. 
‘‘(G) Any prior authorization, concurrent 
review, step therapy, fail first, or similar re-
quirements applicable to coverage of such item or 
service under such plan. 
‘‘(3) SELF-SERVICE
TOOL.—For purposes of 
paragraph (1), a self-service tool established by a 
group health plan meets the requirements of this 
paragraph if such tool— 
‘‘(A) is based on an Internet website, mobile 
application, or other platform determined appro-
priate by the Secretary; 
‘‘(B) provides for real-time responses to re-
quests described in paragraph (1); 
‘‘(C) is updated in a manner such that in-
formation provided through such tool is accurate 
at the time such request is made; 
‘‘(D) allows such a request to be made with 
respect to an item or service furnished by— 
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00021
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
‘‘(i) a specific provider that is a par-
ticipating provider with respect to such 
item or service; 
‘‘(ii) all providers that are partici-
pating providers with respect to such item 
or service for purposes of facilitating price 
comparisons; or 
‘‘(iii) a provider that is not described 
in clause (ii); and 
‘‘(E) provides that such a request may be 
made with respect to an item or service through 
use of the billing code for such item or service or 
through use of a descriptive term for such item 
or service. 
The Secretary may require such tool, as a condition 
of complying with subparagraph (E), to link multiple 
billing codes to a single descriptive term if the Sec-
retary determines that the billing codes to be so linked 
correspond to items and services. 
‘‘(4) PROVIDER
TOOL.—A group health plan 
shall permit providers to learn the amount of cost- 
sharing (including deductibles, copayments, and coin-
surance) that would apply under an individual’s 
plan that the individual would be responsible for pay-
ing with respect to the furnishing of a specific item 
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00022
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
or service by another provider in a timely manner 
upon the request of the provider and with the consent 
of such individual in the same manner and to the 
same extent as if such request has been made by such 
individual. As part of any tool used to facilitate such 
requests from a provider, such plan may include 
functionality that— 
‘‘(A) allows providers to submit the notifi-
cations to such plan or coverage required under 
section 2799B–6 of the Public Health Services 
Act; and 
‘‘(B) provides for notifications required 
under section 9816(f) to such an individual. 
‘‘(d) RATE AND PAYMENT INFORMATION.— 
‘‘(1) IN GENERAL.—For purposes of subsection 
(a)(9), the rate and payment information described in 
this subsection is, with respect to a group health plan, 
the following: 
‘‘(A) With respect to each item or service 
(other than a drug) for which benefits are avail-
able under such plan, the in-network rate (in a 
dollar amount) in effect as of the first day of the 
plan year during which such information is sub-
mitted with each provider (identified by national 
provider identifier) that is a participating pro-
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00023
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
vider with respect to such item or service (or, in 
the case such rate is not available in a dollar 
amount, such formulae, pricing methodologies, or 
other information used to calculate such rate). 
‘‘(B) With respect to each dosage form and 
indication of each drug (identified by national 
drug code) for which benefits are available under 
such plan— 
‘‘(i) the in-network rate (in a dollar 
amount) in effect as of the first day of the 
plan year during which such information is 
submitted with each provider (identified by 
national provider identifier) that is a par-
ticipating provider with respect to such 
drug (or, in the case such rate is not avail-
able in a dollar amount, such formulae, 
pricing methodologies, or other information 
used to calculate such rate); and 
‘‘(ii) the average amount paid by such 
plan (net of rebates, discounts, and price 
concessions) for such drug dispensed or ad-
ministered during the 90-day period begin-
ning 180 days before such date of submis-
sion to each provider that was a partici-
pating provider with respect to such drug, 
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00024
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
broken down by each such provider (identi-
fied by national provider identifier), other 
than such an amount paid to a provider 
that, during such period, submitted fewer 
than 20 claims for such drug to such plan 
or coverage. 
‘‘(C) With respect to each item or service for 
which benefits are available under such plan, the 
amount billed, and the amount allowed by the 
plan, for each such item or service furnished dur-
ing the 90-day period specified in subparagraph 
(B) by a provider that was not a participating 
provider with respect to such item or service, 
broken down by each such provider (identified by 
national provider identifier), other than items 
and services with respect to which fewer than 20 
claims for such item or service were submitted to 
such plan or coverage during such period. 
Such rate and payment information shall be made 
available with respect to each individual item or serv-
ice, regardless of whether such item or service is paid 
for as part of a bundled payment, episode of care, 
value-based payment arrangement, or otherwise. 
‘‘(2) MANNER OF PUBLICATION.— 
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00025
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
‘‘(A) IN GENERAL.—Rate and payment in-
formation required to be made available under 
subsection (a)(9) shall be so made available in 
dollar amounts through 3 separate machine- 
readable files corresponding to the information 
described in each of subparagraphs (A) through 
(C) of paragraph (1) that meet such require-
ments as specified by the Secretary not later 
than 180 days after the date of the enactment of 
this paragraph through rulemaking. Such re-
quirements shall ensure that such files are lim-
ited to an appropriate size, do not include infor-
mation that is duplicative of information con-
tained in other files made available under such 
subsection, are made available in a widely-avail-
able format that allows for information con-
tained in such files to be compared across group 
health plans, and are accessible to individuals at 
no cost and without the need to establish a user 
account or provide other credentials. 
‘‘(B) REAL-TIME PROVISION OF INFORMA-
TION.— 
‘‘(i) IN
GENERAL.—Subject to clause 
(ii), beginning January 1, 2026, rate and 
payment information required to be made 
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00026
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
available by a group health plan under sub-
section (a)(9) shall, in addition to being 
made available in the manner described in 
subparagraph 
(A), 
be 
made 
available 
through an application program interface 
(or successor technology) that provides ac-
cess to such information in real time and 
that meets such technical standards as may 
be specified by the Secretary. 
‘‘(ii) EXEMPTION FOR CERTAIN PLANS 
AND COVERAGE.—Clause (i) shall not apply 
with respect to information described in 
such clause required to be made available by 
a group health plan if such plan provides 
benefits for fewer than 500 participants and 
beneficiaries. 
‘‘(3) USER GUIDE.—The Secretary, Secretary of 
Health and Human Services, and Secretary of Labor 
shall jointly make available to the public instructions 
written in plain language explaining how individuals 
may search for information described in paragraph 
(1) in files submitted in accordance with paragraph 
(2). 
‘‘(4) ANNUAL SUMMARY.—For each year (begin-
ning with 2025), each group health plan shall make 
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00027
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
public a machine-readable file meeting such standards 
as established by the Secretary under paragraph (2) 
containing a summary of all rate and payment infor-
mation made public by such plan with respect to such 
plan or coverage during such year (such as averages 
of all such information so made public). 
‘‘(e) ATTESTATION.—Each group health plan shall an-
nually submit to the Secretary an attestation of such plan’s 
compliance with the provisions of this section along with 
a link to disclosures made in accordance with subsection 
(a). 
‘‘(f) DEFINITIONS.—In this subsection: 
‘‘(1) PARTICIPATING PROVIDER.—The term ‘par-
ticipating provider’ has the meaning given such term 
in section 9816 and includes a participating facility. 
‘‘(2) IN-NETWORK RATE.—The term ‘in-network 
rate’ means, with respect to a group health plan and 
an item or service furnished by a provider that is a 
participating provider with respect to such plan and 
item or service, the contracted rate (reflected as a dol-
lar amount) in effect between such plan and such pro-
vider for such item or service.’’. 
(B) CLERICAL AMENDMENT.—The item re-
lating to section 9819 in the table of sections for 
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00028
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
subchapter B of chapter 100 of the Internal Rev-
enue Code of 1986 is amended to read as follows: 
‘‘Sec. 9819. Price transparency requirements.’’. 
(3) PHSA.—Section 2799A–4 of the Public 
Health Service Act (42 U.S.C. 300gg–114) is amend-
ed to read as follows: 
‘‘SEC. 2799A–4. PRICE TRANSPARENCY REQUIREMENTS. 
‘‘(a) IN GENERAL.—A group health plan, and a health 
insurance issuer offering group or individual health insur-
ance coverage, shall make available to the public accurate 
and timely disclosures of the following information: 
‘‘(1) Claims payment policies and practices. 
‘‘(2) Periodic financial disclosures. 
‘‘(3) Data on enrollment. 
‘‘(4) Data on disenrollment. 
‘‘(5) Data on the number of claims that are de-
nied. 
‘‘(6) Data on rating practices. 
‘‘(7) Information on cost-sharing and payments 
with respect to any out-of-network coverage (or with 
respect to any item and service furnished under such 
a plan or such group or individual health insurance 
coverage that does not use a network of providers). 
‘‘(8) Information on enrollee rights under this 
part. 
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00029
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
‘‘(9) Rate and payment information described in 
subsection (d). 
‘‘(10) Other information as determined appro-
priate by the Secretary. 
Rate and payment information described in paragraph (9) 
shall be made available to the public not later than January 
10, 2025, and not later than the tenth day of every month 
thereafter, in the manner described in subsection (d)(2)(A), 
and, beginning on January 1, 2027, in real-time through 
an application program interface (or successor technology) 
described in subsection (d)(2)(B). 
‘‘(b) USE OF PLAIN LANGUAGE.—The information re-
quired to be submitted under subsection (a) shall be pro-
vided in plain language. The term ‘plain language’ means 
language that the intended audience, including individuals 
with limited English proficiency, can readily understand 
and use because that language is clear, concise, well-orga-
nized, accurately describes the information, and follows 
other best practices of plain language writing. The Sec-
retary, jointly with the Secretary of Labor and the Sec-
retary of the Treasury, shall develop and issue standards 
for plain language writing for purposes of this section and 
shall develop a standardized reporting template and stand-
ardized definitions of terms to allow for comparison across 
group health plans and health insurance coverage. 
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00030
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
‘‘(c) COST SHARING TRANSPARENCY.— 
‘‘(1) IN GENERAL.—A group health plan, and a 
health insurance issuer offering group or individual 
health insurance coverage, shall, upon request of an 
enrollee and in a timely manner, provide to the en-
rollee a statement of the amount of cost-sharing (in-
cluding deductibles, copayments, and coinsurance) 
under the enrollee’s plan or coverage that the enrollee 
would be responsible for paying with respect to the 
furnishing of a specific item or service by a provider. 
At a minimum, such information shall include the 
information specified in paragraph (2) and shall be 
made available at no cost to the enrollee through a 
self-service tool that meets the requirements of para-
graph (3) or through a paper or phone disclosure, at 
the option of the enrollee, that meets such require-
ments as the Secretary may specify. 
‘‘(2) SPECIFIED INFORMATION.—For purposes of 
paragraph (1), the information specified in this para-
graph is, with respect to an item or service for which 
benefits are available under a group health plan or 
group or individual health insurance coverage (as ap-
plicable) furnished by a health care provider to an en-
rollee of such plan or coverage, the following: 
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00031
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS
‘‘(D) The amount the enrollee has already 
accumulated with respect to any deductible or 
out of pocket maximum under the plan or cov-
erage (broken down, in the case separate 
deductibles or maximums apply to separate en-
rollees in the plan or coverage, by such separate 
deductibles or maximums, in addition to any cu-
mulative deductible or maximum). 
‘‘(E) Any shared savings or other benefit 
available to the enrollee with respect to such item 
or service. 
‘‘(F) In the case such plan or coverage im-
poses any frequency or volume limitations with 
respect to such item or service (excluding medical 
necessity determinations), the amount that such 
enrollee has accrued towards such limitation 
with respect to such item or service. 
‘‘(G) Any prior authorization, concurrent 
review, step therapy, fail first, or similar re-
quirements applicable to coverage of such item or 
service under such plan or group or individual 
health insurance coverage. 
‘‘(3) SELF-SERVICE
TOOL.—For purposes of 
paragraph (1), a self-service tool established by a 
group health plan or health insurance issuer offering 
VerDate Sep 11 2014 
01:59 Dec 27, 2024
Jkt 059200
PO 00000
Frm 00033
Fmt 6652
Sfmt 6203
E:\BILLS\H4507.RH
H4507
ssavage on LAPJG3WLY3PROD with BILLS