Ensuring health insurer accountability through publishing of overhead costs and claim payments

(a) In general Section 2718(a) of the Public Health Service Act (42 U.S.C. 300gg–18(a)) is amended— (1) by redesignating paragraphs (1) through (3) as subparagraphs (A) through (C), and adjusting the margins accordingly; (2) by striking A health insurance issuer and inserting the following: (1) In general A health insurance issuer; and (3) by adding at the end the following new paragraph: (2) Overhead costs and claim payment information (A) In general A health insurance issuer offering group or individual health insurance coverage (including a grandfathered health plan) shall, with respect to each plan year beginning on or after January 1, 2027, submit to the Secretary (and, in the case such coverage was offered through an Exchange established under subtitle D of title I of the Patient Protection and Affordable Care Act, to such Exchange) and publish on the public website of such issuer the following information in a consumer-friendly format specified by the Secretary: (i) the percentage of total premium revenue expended for each category described in subparagraphs (A) through (C) of paragraph (1); (ii) the explanation described in paragraph (1)(C); and (iii) the percentage of total premium revenue not expended and retained by such issuer. (B) Manner of publication Information submitted and published by a health insurance issuer under subparagraph (A) shall be so submitted and published at the coverage level and shall in addition, if determined appropriate by the Secretary, be so submitted and published in the aggregate in such manner as specified by the Secretary (such as across all such coverage offered by such issuer that are offered within the same insurance market (as specified in subclause (I), (II), (III), or (IV) of section 2799A–1(a)(3)(E)(iv))).. (b) Medicare Advantage Section 1857(e) of the Social Security Act (42 U.S.C. 1395w–27(e)) is amended by adding at the end the following new paragraph: (7) Overhead costs and claim payment information (A) In general Beginning with plan years beginning on or after January 1, 2027, a contract under this section with an MA organization shall require the organization, with respect to each MA plan offered by such organization during such plan year, to submit to the Secretary and publish on the public website of such organization the following information in a consumer-friendly format specified by the Secretary: (i) The amount of total revenue (as determined under section 422.2420(c) of title 42, Code of Federal Regulations (or a successor regulation)) collected under such plan. (ii) The amount and percentage of such revenue expended on incurred claims (as determined in accordance with paragraphs (2) through (4) of section 422.2420(b) of title 42, Code of Federal Regulations (or a successor regulation)). (iii) The amount and percentage of such revenue expended on non-claims costs (as defined in section 422.2401 of title 42, Code of Federal Regulations (or a successor regulation)). (iv) The amount of the difference between the MLR numerator (as determined under paragraph (b) of section 422.2420 of title 42, Code of Federal Regulations (or a successor regulation)) and the MLR denominator (as determined under paragraph (c) of such section (or a successor regulation)). (v) The amount described in clause (iv), expressed as a percentage of such revenue. (B) Manner of publication Information submitted and published by an MA organization under subparagraph (A) shall be so submitted and published at the MA plan level and shall in addition, if determined appropriate by the Secretary, be so submitted and published in the aggregate in such manner as specified by the Secretary (such as across all MA plans offered by such organization)..