(a) CLEAR ACCOUNTING FOR COSTS.—A health insurance issuer offering group or individual health insurance coverage shall, with respect to each plan year, submit to the Secretary a report concerning the percentage of total premium revenue that such coverage expends—
”(1) on reimbursement for clinical services provided to enrollees under such coverage; (2) for activities that improve health care quality; and (3) on all other non-claims costs, including an explanation of the nature of such costs, and excluding State taxes and licensing or regulatory fees.
The Secretary shall make reports received under this section available to the public on the Internet website of the Department of Health and Human Services.
(b) ENSURING THAT CONSUMERS RECEIVE VALUE FOR THEIR PREMIUM PAYMENTS.—
”(1) REQUIREMENT TO PROVIDE VALUE FOR PREMIUM PAYMENTS.—
(c) STANDARD HOSPITAL CHARGES
Please note – This is not the entire provision, please read the entire provision at:
This provision provides for greater transparency and accountability. It holds the health insurance issuer responsible for explaining the percentage of premiums collected from the insured on various activities such as improving health care quality. The health insurance issuer is required to submit a report, each [plan] year to the HHS Secretary. This section also requires hospitals in the United States to make the their list of standard charges for items and services available to the public (includes diagnosis-related groups established under section 1886(d)(4) of the Social Security Act).
What does this mean for the bleeding disorders community?
Individuals and families spend a great deal on premiums. It is a very costly expense for many individuals and families. This provision allows the community to gain insight as to how health insurance companies are utilizing their “premium” dollars. The reports will be made available to the public on the internet website of the Department of Health and Human Services (HHS). This provision will also allow the public to see hospital standard charges.