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HR 9397

Premium Transparency Act

119th Congress Introduced by Nathaniel Moran and 1 co-sponsor

Requires public disclosure of insurer overhead, administrative, and claim-payment data to improve transparency and comparability of health plans.

Introduced in House
0
WeVote Research Nonpartisan
Bill Summary · HR 9397

Summary of HR 9397 — Premium Transparency Act (115th Congress? 119th, Session 2)

Note: This summary describes the bill as introduced on June 23, 2026, by Representatives August Pfluger and Nathaniel Moran. It proposes new transparency requirements related to health insurance overhead costs, claim payments, and standardized information for consumers.

Purpose and intent

  • Establish health insurer accountability by mandating public disclosure of overhead costs and claim payments.
  • Require guidance from the Secretary of Health and Human Services (HHS) on how to provide certain insurance information in a standardized format.
  • Improve comparability of qualified health plans offered through Exchanges by ensuring consistent presentation of pricing and plan data.

Key provisions

1) Public disclosure of overhead costs and claim payments (Public Health Service Act, section 2718(a))

  • Applies to health insurance issuers offering group or individual coverage (including grandfathered plans).
  • For plan years beginning on or after January 1, 2027:
    • issuers must submit to the Secretary and publish on its public website:
    • (i) The percentage of total premium revenue spent on each category specified in the bill (overhead costs, administrative costs, etc., as defined by the act and its subparagraphs).
    • (ii) An explanation described in prior paragraph (presumably a summary of cost categories and impact).
    • (iii) The percentage of total premium revenue not expended and retained by the issuer (retained earnings).
    • Publication: Data will be presented at the coverage level and may also be aggregated across coverage offered within the same insurance market, as determined appropriate by the Secretary.

2) Medicare Advantage financial transparency (Social Security Act, section 1857(e))

  • Beginning with plan years starting on or after January 1, 2027:
    • MA organizations must submit to the Secretary and publish on their public website:
    • (i) The total revenue collected under each MA plan (using the applicable CMS/regulatory revenue definition).
    • (ii) The amount and percentage of revenue expended on incurred claims.
    • (iii) The amount and percentage of revenue expended on non-claims costs (e.g., administrative costs).
    • (iv) The difference between the Medicare Advantage Organization’s Medical Loss Ratio (MLR) numerator and denominator, expressed as an amount.
    • (v) The amount described in (iv) as a percentage of revenue.
    • Publication: Data must be reported at the MA plan level and may be aggregated across plans by the organization as determined appropriate by the Secretary.

3) Comparability of qualified health plans on Exchanges (Section 1311(d)(4)(C) of the ACA)

  • Amends the website requirements for plan comparison information.
  • Starting with plan years beginning on or after January 1, 2029:
    • If a QHP was offered through a given Exchange for a prior plan year, the website must include, as part of plan comparison information, the most recent information submitted for that plan by the issuer under section 2718(a)(2) of the Public Health Service Act.
    • This enhances the ability of consumers to compare current and prior-year plan data.

4) Guidance on providing standardized insurance information (Section 4)

  • Not later than January 1, 2028, the Secretary must issue guidance to:
    • Group health plans, health insurance issuers, and MA organizations about providing information on benefits and coverage in a standardized, plain-English format.
    • The guidance must cover:
    • (1) Monthly premium.
    • (2) Annual deductible.
    • (3) Maximum out-of-pocket limits.
    • (4) Type of provider network.
    • (5) Plan or coverage share of total allowed costs.
    • (6) Standard cost-sharing for in-network care across various services (primary care, specialist, urgent care, ER, imaging, inpatient, outpatient, labs, drugs).
    • (7) Additional features (referral policies, wellness programs, disease management, eligibility for Health Savings Accounts, preventive care coverage).
    • (8) Other aspects as the Secretary may specify.
  • The Secretary must consult the Labor and Treasury Secretaries in developing this guidance.
  • The section clarifies it does not require plans to offer any specific features, but does require standardized information where available.
  • Definitions are provided for Medicare Advantage terms and private insurance terms to ensure consistent applicability.

Who would be affected

  • Health insurance issuers offering group or individual coverage (including grandfathered plans).
  • Medicare Advantage organizations offering MA plans.
  • Consumers enrolled in or considering plans on the ACA Exchanges (standardized comparisons).
  • The Secretary of Health and Human Services, in collaboration with the Secretaries of Labor and the Treasury, tasked with implementing and enforcing the provisions.
  • Plan sponsors and administrators responsible for plan disclosures and website publishing.

Procedural and timeline aspects

  • Effective date for publishing overhead costs and claim payment information:
    • Plan year starting January 1, 2027, or later.
  • For MA plans, similar effective timeline: plan years starting January 1, 2027, or later.
  • Guidance on standardized information:
    • Secretary must issue guidance by January 1, 2028.
  • Exchange comparability enhancement:
    • Requirement applies to plan years beginning January 1, 2029, for inclusion of prior-year information in plan comparisons.
  • Administrative details:
    • Data must be published on public issuer websites and submitted to the HHS Secretary.
    • Publication may occur at the coverage level or aggregated as determined appropriate by the Secretary.

Potential impact

  • Increased transparency of insurer overhead and claim-payment data for consumers and policymakers.
  • Improved ability to compare real costs, plan efficiency, and net revenue retention across individual and group plans, as well as MA plans.
  • Potential pressure on insurers to control overhead and non-claims costs due to public disclosure.
  • Greater consistency in how information is presented, aiding consumer decision-making, with standardized, plain-English guidance starting 2028.
  • Data publication could influence plan design, pricing strategies, and competitive dynamics in both the individual and small-group markets, and among MA plans.

If you’d like, I can tailor this summary to a specific audience (e.g., policymakers, health plan executives, consumer advocates) or provide a side-by-side comparison with current law provisions.

Compiled from official sources — confirm details with the bill’s official record.

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