124 STAT. 137 PUBLIC LAW 111–148—MAR. 23, 2010 respect to each plan year, submit to the Secretary a report con- cerning 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 avail- able 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 PAY- MENTS.—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 indi- vidual market in such State. ‘‘(2) CONSIDERATION IN SETTING PERCENTAGES.—In deter- mining 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 operating within the United States shall for each year establish (and update) and make public (in accordance with guidelines developed by the Secretary) a list of the hospital’s standard charges for items and services provided by the hospital, including for diagnosis-related groups established under section 1886(d)(4) of the Social Security Act. ‘‘(d) DEFINITIONS.—The Secretary, in consultation with the National Association of Insurance Commissions, shall establish uni- form definitions for the activities reported under subsection (a). ‘‘SEC. 2719. APPEALS PROCESS. ‘‘A group health plan and a health insurance issuer offering group or individual health insurance coverage shall implement an effective appeals process for appeals of coverage determinations and claims, under which the plan or issuer shall, at a minimum— ‘‘(1) have in effect an internal claims appeal process; 42 USC 300gg–19. Public information. Web posting.
