What does Preamble of Premium Transparency Act do?

This bill, formally titled 'To amend title XXVII of the Public Health Service Act and title XVIII of the Social Security Act to ensure health insurer accountability through publishing of overhead costs and claim payments, and to direct the Secretary of Health and Human Services to issue guidance on the provision of certain insurance information,' aims to ensure health insurer accountability. The bill proposes amendments to title XXVII of the Public Health Service Act and title XVIII of the Social Security Act. It intends to achieve accountability through the publishing of health insurers' overhead costs and claim payments. The Secretary of Health and Human Services would be directed to issue guidance on the provision of certain insurance information.

What does SHORT TITLE. of Premium Transparency Act do?

This bill is formally titled the Premium Transparency Act.

What does ENSURING HEALTH INSURER ACCOUNTABILITY THROUGH PUBLISHING OF of Premium Transparency Act do?

This section amends the Public Health Service Act and the Social Security Act to require health insurance issuers and Medicare Advantage (MA) organizations to publish financial information. Health insurance issuers offering group or individual health insurance coverage must publish, starting January 1, 2027, information including the percentage of premium revenue spent on various categories, an explanation, and revenue retained by the issuer. MA organizations must submit and publish, beginning with plan years starting January 1, 2027, information including total revenue, incurred claims, non-claims costs, and the difference between the MLR numerator and denominator. The information must be published in a consumer-friendly format specified by the Secretary and at the coverage/plan level, with potential for aggregated publication as determined by the Secretary.

What does PROMOTING COMPARABILITY OF QUALIFIED HEALTH PLANS OFFERED of Premium Transparency Act do?

This section amends Section 1311(d)(4)(C) of the Patient Protection and Affordable Care Act. The amendment modifies language related to websites used for qualified health plan enrollment. It requires Exchanges to include comparative information for enrollments beginning on or after January 1, 2029. If a qualified health plan was offered through an Exchange in a previous plan year, the Exchange must include the most recent information submitted by the health insurance issuer under section 2718(a)(2) of the Public Health Service Act.

What does GUIDANCE ON PROVISION OF CERTAIN INSURANCE INFORMATION IN of Premium Transparency Act do?

This section requires the Secretary of Health and Human Services to issue guidance by January 1, 2028, regarding the provision of insurance information in a standardized, plain English format. The guidance applies to group health plans, health insurance issuers, and Medicare Advantage organizations. The guidance must cover aspects like monthly premiums, deductibles, out-of-pocket expenses, provider networks, cost-sharing amounts, and additional features such as specialist referral policies and wellness programs. The Secretary must consult with the Secretaries of Labor and the Treasury when developing this guidance. This section does not require plans to offer any specific features listed in the guidance. Definitions are provided for terms like 'Medicare Advantage organization,' 'group health plan,' and 'Secretary'.

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Premium Transparency Act

Last updated: 6/25/2026 · Introduced: 6/23/2026

Author: August Pfluger (R-TX)

TL;DR (AI)

Health insurance issuers and Medicare Advantage organizations will be required to publicly disclose financial information, including premium revenue allocation and incurred claims, starting in 2027.
Health Exchanges must display comparative information about qualified health plans, including previously submitted financial data, beginning in 2029.
The Secretary of Health and Human Services must provide guidance by 2028 on presenting insurance information in a standardized, easy-to-understand format for consumers.

119th Congressin committeeOfficial page

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Other Sections

Includes provisions on preamble, short title., and 3 more.

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