I 
111TH CONGRESS 
1ST SESSION H. R. 3681 
To provide for minimum loss ratios for health insurance coverage. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 30, 2009 
Mr. ELLISON (for himself and Mr. TIERNEY) introduced the following bill; 
which was referred to the Committee on Energy and Commerce 
A BILL 
To provide for minimum loss ratios for health insurance 
coverage. 
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 ‘‘Fairness in Health 
Insurance Act of 2009’’. 
SEC. 2. REQUIREMENT OF MINIMUM LOSS RATIO OF 90 
PERCENT FOR HEALTH INSURANCE COV-
ERAGE. 
(a) IN GENERAL.—A health insurance issuer shall 
not offer health insurance coverage unless the issuer dem-
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onstrates that such coverage has a medical loss ratio of 
at least 90 percent. 
(b) MEDICAL LOSS RATIO.— 
(1) IN
GENERAL.—In this section, the term 
‘‘medical loss ratio’’ has the meaning given such 
term by the Secretary of Health and Human Serv-
ices. The Secretary shall establish a uniform defini-
tion of medical loss ratio and methodology for deter-
mining how to calculate the medical loss ratio. Such 
methodology shall take into account the cir-
cumstances of different plans and activities related 
to health services such as chronic disease manage-
ment and quality assurance. 
(2) REPORT.—Not later than December 31, 
2010, the Secretary of Health and Human Services 
shall publish a report that describes the definition 
developed under paragraph (1) and the elements 
with respect to such definition. 
(c) TRANSPARENCY.— 
(1) SUBMISSION OF DATA.—Beginning in plan 
year 2011, a health insurance issuer shall provide 
the Secretary of Health and Human Services with 
data to enable the Secretary to determine whether 
the issuer is in compliance with subsection (a) with 
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respect to health insurance coverage offered by such 
issuer. 
(2) DEVELOPMENT OF ELEMENTS AND DEFINI-
TIONS.—Not later than December 31, 2010, the 
Secretary of Health and Human Services shall de-
velop, publish in a report, and implement the stand-
ardized data elements and definitions to be used by 
health insurance issuers in the reporting of data 
necessary for the calculation of the medical loss ratio 
under paragraph (1). 
(d) REBATES.—Each health insurance issuer that of-
fers health insurance coverage shall provide that for any 
plan year in which the coverage has a medical loss ratio 
below 90 percent, the issuer shall provide, in a manner 
specified by the Secretary, for rebates to enrollees of pay-
ments sufficient with respect to such loss ratio. 
(e) ENFORCEMENT.—The Secretary shall promulgate 
regulations for enforcing the provisions of this section and 
may provide for appropriate penalties. 
(f) DEFINITION.—In this section, the terms ‘‘health 
insurance coverage’’ and ‘‘health insurance issuer’’ shall 
have the meanings given such terms in section 2791 of 
the Public Health Service Act (42 U.S.C. 300gg–91). 
Æ 
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