Bill Summary
The "Health Share Transparency Act of 2025" aims to enhance transparency and accountability for health care sharing ministries (HCSMs), which provide members with a way to share medical costs. This legislation amends the Public Health Service Act to establish specific disclosure requirements for HCSMs.
Key provisions include:
1. **Annual Reporting**: HCSMs must submit detailed financial and operational information annually to relevant federal agencies, including data on financial reserves, enrollment numbers, claims processed, and denial rates.
2. **Member Disclosure**: HCSMs are required to inform both prospective and current members about essential details such as claims reimbursement processes, financial responsibilities, and any limitations on coverage. This information must be clearly articulated, available in multiple languages, and provided before enrollment.
3. **Entity Contracting Requirements**: Entities enrolling individuals in HCSMs must inform potential members about available health care options, including any tax credits or benefits under federal health programs, and clarify that HCSMs do not provide guaranteed health insurance coverage.
4. **Enforcement Mechanisms**: If an HCSM fails to comply with these regulations, the Secretary of Health and Human Services can impose civil penalties.
5. **Consumer Complaint Reporting**: The Federal Trade Commission (FTC) will publish biannual reports on consumer complaints related to HCSMs, detailing the nature of these complaints and the organizations involved.
Overall, the Act seeks to protect consumers by ensuring they have access to clear and comprehensive information about HCSMs, thereby promoting informed decision-making regarding their health care options.
Possible Impacts
The **Health Share Transparency Act of 2025** could affect people in several significant ways:
1. **Increased Transparency for Enrollees**: By requiring health care sharing ministries to disclose detailed financial information, including the amount of money collected from enrollees, claims paid, and the average out-of-pocket expenses, individuals considering enrollment will have access to crucial information. This transparency can help potential members make informed decisions about whether to join a health care sharing ministry, ultimately impacting their financial planning and health care choices.
2. **Consumer Protection and Awareness**: The legislation mandates that health care sharing ministries provide clear information about the lack of guarantee for reimbursement of claims, as well as conditions under which certain items or services may not be reimbursable. This requirement aims to protect consumers from misunderstandings about the nature of health care sharing ministries compared to traditional insurance. As a result, individuals will be better equipped to understand the limitations of their coverage and avoid unexpected costs.
3. **Enhanced Regulatory Oversight**: The Act empowers the Secretary of Health and Human Services to impose penalties on health care sharing ministries that fail to meet disclosure requirements. This regulatory oversight may lead to improved practices within these ministries, promoting accountability and ethical behavior. For enrollees, this could translate into a more reliable and trustworthy experience, potentially reducing the incidence of complaints and disputes regarding coverage and reimbursement.
These examples show how the legislation aims to improve transparency, protect consumers, and ensure accountability in health care sharing ministries.
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3103 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 3103
To amend title XXVII of the Public Health Service Act to establish
requirements for the disclosure of certain information relating to
health care sharing ministries, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 30, 2025
Mr. Huffman (for himself, Mr. Raskin, Mr. Casten, Ms. Norton, Ms.
Tlaib, Mr. Pocan, Mr. Moulton, Mr. Cohen, and Mr. Frost) introduced the
following bill; which was referred to the Committee on Energy and
Commerce
_______________________________________________________________________
A BILL
To amend title XXVII of the Public Health Service Act to establish
requirements for the disclosure of certain information relating to
health care sharing ministries, and for other purposes.
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 ``Health Share Transparency Act of
2025''.
SEC. 2. ESTABLISHING REQUIREMENTS FOR THE DISCLOSURE OF CERTAIN
INFORMATION RELATING TO HEALTH CARE SHARING MINISTRIES.
(a) In General.--Title XXVII of the Public Health Service Act (42
U.S.C. 300gg et seq.) is amended by adding at the end the following new
part:
``PART F--HEALTH CARE SHARING MINISTRIES
``SEC. 2799C-1. DISCLOSURE OF INFORMATION.
``(a) In General.--A health care sharing ministry (as defined in
section 5000A(d)(2)(B)(ii) of the Internal Revenue Code of 1986)--
``(1) shall, not less frequently than annually, submit to
the Secretary, the Commissioner of Internal Revenue, and the
Director of the Bureau of Consumer Financial Protection the
information described in subsection (b);
``(2) shall disclose to each individual seeking to enroll
in the ministry, and each individual so enrolled, the
information described in paragraph (1) of subsection (c) in the
manner specified in paragraph (2) of such subsection; and
``(3) may not enter into a contract with an entity for
purposes of enrolling an individual in such ministry, or
otherwise provide remuneration to such an entity in exchange
for enrolling an individual in such ministry, unless such
entity meets the requirements described in subsection (d).
``(b) Disclosure of Financial and Appeals Information.--
``(1) In general.--For purposes of subsection (a)(1), the
information described in this subsection is, with respect to a
health care sharing ministry, the following:
``(A) The amount of financial reserves held by such
ministry.
``(B) The ratio of the amount of money collected
from enrollees for purposes of reimbursing enrollees
for medical claims that is expended by such ministry on
costs described in paragraphs (1) and (2) of section
2718(a) to the total amount of money so collected for
the preceding year.
``(C) The number of individuals enrolled in such
ministry.
``(D) The total amount paid by individuals enrolled
in such ministry for coverage under such ministry over
the preceding year.
``(E) The total amount paid by such ministry for
items and services for which benefits were available
under such ministry over the preceding year.
``(F) The average out-of-pocket expenses incurred
by individuals enrolled under such ministry for items
and services for which benefits are available under
such ministry over the preceding year.
``(G) A list of each State and county in which
individuals who reside in such State or county may
enroll in such ministry.
``(H) The percentage of claims made under such
ministry during the preceding year which were denied.
``(I) Contact information for the operator (or a
representative of the operator) of such ministry.
``(J) A specification of each health care provider
with which such ministry has in effect a contractual
relationship for furnishing items and services under
such ministry.
``(K) The average amount of time such ministry took
to reimburse a claim once submitted to such ministry
during the preceding year.
``(2) Publication.--The Secretary shall publish the
information submitted under subsection (a)(1) on a public
website.
``(c) Disclosure of Information to Prospective and Current
Enrollees.--
``(1) In general.--For purposes of subsection (a)(2), the
information described in this paragraph is, with respect to a
health care sharing ministry, the following:
``(A) How an enrollee may file a complaint or
appeal a coverage determination, including a disclaimer
that appeals may not be available to any entity other
than such ministry.
``(B) Whether an enrollee must use arbitration in
appealing a coverage determination or has other legal
recourse.
``(C) An explanation that, unlike a group health
plan or health insurance coverage, there is no
guarantee that an enrollee will be reimbursed for any
portion of claims submitted to such ministry, as well
as a specification of whether any lifetime caps on
health care sharing per enrollee are imposed under such
ministry.
``(D) The information described in subsection
(b)(1)(F).
``(E) The average amount paid per enrollee to such
ministry for membership under such ministry over the
preceding year.
``(F) With respect to claims made during the
preceding year for items and services for which
benefits were available under such ministry, the total
amount paid by such ministry for such claims compared
and the total amount for which individuals enrolled
under such ministry were responsible in cost sharing.
``(G) A list of all items and services for which
reimbursement is not available under such ministry, as
well as, with respect to each item or service for which
such reimbursement is so available, a specification of
any conditions that would render such item or service
nonreimbursable.
``(H) A list of any other requirements imposed on
claims submitted for health care sharing under such
ministry.
``(2) Manner of disclosure.--For purposes of subsection
(a)(2), information described in paragraph (1) shall be--
``(A) disclosed in a prominent manner;
``(B) made available in multiple langauges;
``(C) provided immediately before enrollment of any
individual in a health care sharing ministry; and
``(D) be written in at least 14 point font (or, if
such enrollment is being made over the phone, be read
out loud).
``(d) Entity Requirements.--For purposes of subsection (a)(3), the
requirements described in this subsection are, with respect to an
entity with a contract in effect with a health care sharing ministry
for purposes of enrolling an individual in such ministry (or otherwise
receiving remuneration from such ministry in exchange for enrolling an
individual in such ministry), that such entity provides to such
individual--
``(1) an explanation of any tax credit that may be
available to such individual under section 36B of the Internal
Revenue Code of 1986 to purchase a qualified health plan (as
defined in section 1301(a) of the Patient Protection and
Affordable Care Act) through an Exchange established pursuant
to such Act;
``(2) if such individual qualifies to enroll under a State
plan (or waiver of such plan) under title XIX of the Social
Security Act, or if such individual is entitled to benefits
under part A or eligible to enroll under part B of title XVIII
of such Act, an explanation of such qualification, entitlement,
or eligibility;
``(3) an explanation of the types of benefits required to
be provided under such plans and other protections applicable
under such plans (such as limitations on cost sharing) compared
to the benefits provided, and cost-sharing requirements
imposed, under such ministry; and
``(4) an explanation that such ministry is not a group
health plan or health insurance coverage and that benefits
provided under such ministry are not guaranteed.
``(e) Enforcement.--In the case that the Secretary determines that
a health care sharing ministry has failed to meet a requirement of this
section, the Secretary may impose a civil monetary penalty on such
ministry in an amount not to exceed $100 for each day for each
individual with respect to which such a failure occurs. The provisions
of subparagraphs (C) through (G) of paragraph (2) of section 2723 shall
apply to a civil monetary penalty imposed under this subsection in the
same manner as such provisions apply to a civil monetary penalty
imposed under such section.
``(f) Definitions.--For purposes of this section, the Secretary may
specify the meaning of any term used in relation to a health care
sharing ministry and clarify the applicability of such term to such a
ministry.''.
(b) Disclosures by Federal Trade Commission Regarding Consumer
Complaints.--
(1) In general.--Not later than January 1 and July 1 of
each year, the Federal Trade Commission shall publicly disclose
on the Internet website of the Commission, and transmit to the
Secretary of Health and Human Services and the Commissioner of
Internal Revenue--
(A) the number of consumer complaints regarding
health care sharing ministries (as defined in section
5000A(d)(2)(B)(ii) of the Internal Revenue Code of
1986) received by the Commission during the period
covered by the disclosure;
(B) the general categories (as determined by the
Commission) of the complaints described in subparagraph
(A); and
(C) with respect to each complaint described in
subparagraph (A)--
(i) the name of the health care sharing
ministry against which the complaint was made;
and
(ii) such details as the Commission
considers appropriate regarding the ownership,
operation, and executive leadership of such
ministry.
(2) Timing of initial disclosure.--Paragraph (1) shall
apply beginning on the January 1 or July 1 that first occurs
after the date that is 90 days after the date of the enactment
of this Act.
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