[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3681 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 3681

   To provide for minimum loss ratios for health insurance coverage.


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                    IN THE HOUSE OF REPRESENTATIVES

                           September 30, 2009

  Mr. Ellison (for himself and Mr. Tierney) introduced the following 
    bill; which was referred to the Committee on Energy and Commerce

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                                 A BILL


 
   To provide for minimum loss ratios for health insurance coverage.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Fairness in Health Insurance Act of 
2009''.

SEC. 2. REQUIREMENT OF MINIMUM LOSS RATIO OF 90 PERCENT FOR HEALTH 
              INSURANCE COVERAGE.

    (a) In General.--A health insurance issuer shall not offer health 
insurance coverage unless the issuer demonstrates that such coverage 
has a medical loss ratio of at least 90 percent.
    (b) Medical Loss Ratio.--
            (1) In general.--In this section, the term ``medical loss 
        ratio'' has the meaning given such term by the Secretary of 
        Health and Human Services. The Secretary shall establish a 
        uniform definition of medical loss ratio and methodology for 
        determining how to calculate the medical loss ratio. Such 
        methodology shall take into account the circumstances of 
        different plans and activities related to health services such 
        as chronic disease management and quality assurance.
            (2) Report.--Not later than December 31, 2010, the 
        Secretary of Health and Human Services shall publish a report 
        that describes the definition developed under paragraph (1) and 
        the elements with respect to such definition.
    (c) Transparency.--
            (1) Submission of data.--Beginning in plan year 2011, a 
        health insurance issuer shall provide the Secretary of Health 
        and Human Services with data to enable the Secretary to 
        determine whether the issuer is in compliance with subsection 
        (a) with respect to health insurance coverage offered by such 
        issuer.
            (2) Development of elements and definitions.--Not later 
        than December 31, 2010, the Secretary of Health and Human 
        Services shall develop, publish in a report, and implement the 
        standardized data elements and definitions to be used by health 
        insurance issuers in the reporting of data necessary for the 
        calculation of the medical loss ratio under paragraph (1).
    (d) Rebates.--Each health insurance issuer that offers health 
insurance coverage shall provide that for any plan year in which the 
coverage has a medical loss ratio below 90 percent, the issuer shall 
provide, in a manner specified by the Secretary, for rebates to 
enrollees of payments sufficient with respect to such loss ratio.
    (e) Enforcement.--The Secretary shall promulgate regulations for 
enforcing the provisions of this section and may provide for 
appropriate penalties.
    (f) Definition.--In this section, the terms ``health insurance 
coverage'' and ``health insurance issuer'' shall have the meanings 
given such terms in section 2791 of the Public Health Service Act (42 
U.S.C. 300gg-91).
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