Guidance on provision of certain insurance information in standardized, plain English format

(a) In general Not later than January 1, 2028, the Secretary shall issue guidance to group health plans, health insurance issuers offering group or individual health insurance coverage, and Medicare Advantage organizations offering an MA plan on providing information on the benefits and coverage available under the applicable plan or coverage, consistent with the relevant requirements under section 2715 of the Public Health Service Act (42 U.S.C. 300gg–15), section 1851(d) of the Social Security Act (42 U.S.C. 1395w–21(d)), and section 1852(c) of such Act (42 U.S.C. 1395w–22(c)). Such guidance shall include standards for providing information in a standardized, plain English format with respect to the following aspects of the plan or coverage (to the extent applicable): (1) Any monthly premium. (2) Any annual deductible. (3) Any maximum limitations on out-of-pocket expenses. (4) The type of provider network used by the plan or coverage. (5) The plan or coverage share of the total allowed costs of benefits provided under the plan or coverage. (6) The standard cost-sharing amounts for in-network care, including for the following types of care: (A) Primary care. (B) Specialist care. (C) Urgent care. (D) Emergency department care. (E) Imaging. (F) Inpatient hospital care. (G) Outpatient facility care. (H) Laboratory services. (I) Preferred brand name drugs. (J) Generic drugs. (7) Additional features of the plan or coverage, including the following: (A) Specialist referral policies. (B) The availability of wellness programs. (C) The availability of disease management programs. (D) Whether an individual enrolled in such plan or coverage is an eligible individual for purposes of section 223 of the Internal Revenue Code of 1986 (relating to health savings accounts). (E) Coverage of preventive care services. (8) Such other aspects of the plan or coverage as the Secretary may specify. (b) Consultation In developing the guidance under subsection (a), the Secretary shall consult with the Secretary of Labor and the Secretary of the Treasury. (c) Rule of construction Nothing in this section shall be construed as requiring a group health plan, a health insurance issuer offering group or individual health insurance coverage, or a Medicare Advantage organization offering an MA plan to offer any of the plan features described in subsection (a). (d) Definitions In this section: (1) Medicare Advantage terms The terms Medicare Advantage organization and MA plan have the meanings given each such term for purposes of part C of title XVIII of the Social Security Act (42 U.S.C. 1395w–21 et seq.). (2) Private health insurance terms The terms group health plan, health insurance coverage, health insurance issuer, group health insurance coverage, and individual health insurance coverage have the meanings given each such term in section 2791 of the Public Health Service Act (42 U.S.C. 300gg–91). (3) Secretary The term Secretary means the Secretary of Health and Human Services.