‘‘SEC. 2718.
BRINGING DOWN THE COST OF HEALTH CARE COVERAGE.
‘‘(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. — A health insurance issuer
offering group or individual health insurance coverage shall, with respect to
each plan year, provide an annual rebate to each enrollee
under such coverage, on a pro rata basis, in an amount that is equal to the
amount by which premium revenue expended by the issuer on activities described
in subsection (a)(3) exceeds—
‘‘(A) with
respect to a health insurance issuer offering coverage in the group market, 20
percent, or such lower percentage as a State may by regulation determine; or
‘‘(B) with
respect to a health insurance issuer offering coverage in the individual
market, 25 percent, or such lower percentage as a State may by regulation
determine, except that such percentage shall be adjusted to the extent the
Secretary determines that the application of such percentage with a State may
destabilize the existing individual market in such State.
‘‘(2)
CONSIDERATION IN SETTING PERCENTAGES.—In determining the percentages under
paragraph (1), a State shall seek to ensure adequate participation by health
insurance issuers, competition in the health insurance market in the State, and
value for consumers so that premiums are used for clinical services and quality
improvements.
‘‘(3) TERMINATION.—The
provisions of this subsection shall have no force or effect after December 31,
2013.
‘‘(c)
STANDARD HOSPITAL CHARGES.—Each hospital
Well, for a while there I thought that they might have done something for the consumer. BUT what is that termination clause all about? What, they will no longer need to provide an annual rebate for excess profits?
