To amend title XXVII of the Public Health Service Act to establish civil liability for health insurance issuers with high levels of claims denials.
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Summary
This bill amends the Public Health Service Act to establish civil monetary penalties for health insurance issuers with high claims denial rates. Issuers with a claims denial percentage of 25 percent or higher (or a lower threshold set by the Secretary) would face penalties starting at $10 million, plus $2 million for each percentage point above 25 percent. Penalties collected would be distributed pro rata to individuals enrolled in the affected plans. The bill also requires insurers to provide transparent explanations when denying claims based on medical necessity and to report their annual claims denial rates to the Secretary.
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