H.R. 9117: Clear Healthcare Expense Cost Knowledge Act of 2026

This bill would require more detailed, standardized cost information to be shared between health plans, their service providers, and patients.

What it would change for health plans and their contractors

The bill would add new rules for group health plans, health insurance issuers, third-party administrators, pharmacy benefit managers, network vendors, and similar health plan service providers. It would generally prevent contracts from blocking or delaying the flow of pricing and payment information that a health plan needs to see.

For many private group health plans, and separately for self-funded non-federal governmental plans, service providers would have to send the plan certain information at least quarterly, at no cost. This includes:

• How provider payments are calculated, including pricing schedules and formulas.
• Total rebates, fees, discounts, and other money received or expected to be received.
• Total amounts paid or expected to be paid to subcontractors and others.
• Payment and reconciliation data for arrangements like shared savings, bundled payments, capitation, and value-based care programs.

The bill would also require this information to be shared in specific electronic formats tied to existing HIPAA transaction standards, when applicable.

Privacy and disclosure rules

The bill says that the new disclosures must still follow HIPAA privacy, security, and breach-notification rules. It also limits how plans may re-share the information they receive. In general, the information could only be shared back with the original source, that entity’s business associates, or as otherwise allowed by HIPAA.

If a service provider fails to provide the required information, the bill would treat that as a legal violation. It would also direct federal officials to begin enforcement action within 90 days of learning of a violation.

Penalties

The bill would authorize civil penalties of $100,000 per day for violations by health plan service providers. It also adds related penalty authority under the Public Health Service Act for certain violations involving self-funded governmental plans.

What it would change for patients and explanation-of-benefits notices

The bill would require health plans and issuers to provide more detailed explanation-of-benefits-style notices within 45 days after receiving a claim for payment, starting with plan years beginning on or after January 1, 2026.

These notices would need to be written in clear language and include, for each item or service:

• Whether the provider or facility is in-network.
• A plain-language description of the service.
• Billing codes and modifiers.
• The amount the plan will pay.
• The patient’s cost-sharing amount.
• How much of the deductible or out-of-pocket limit the patient has already used.
• The site where the service was provided.

The bill also updates the rules for emergency-service estimates so that the estimate includes a plain-language description and billing codes.

What it would change for providers and hospitals

The bill would require healthcare providers and facilities that bill patients directly after providing care to send an itemized bill within 30 days after receiving final payment from a third party. That bill would have to include:

• A plain-language description of each item or service.
• Billing codes.
• The price and billed amount for each item, or the binding bundled price if applicable.
• Any payments already made on the patient’s behalf.
• Language-assistance information for people with limited English proficiency.
• Contact information for someone who can answer questions and make corrections.
• Charity care information and how to apply.

The bill would also restrict collection actions in certain situations. In general, providers or facilities could not pursue collections unless they had complied with the itemized-bill requirements. If the amount billed exceeds a prior federal price disclosure or good-faith estimate, the provider would have to document why the extra charges were medically necessary or caused by an unforeseen complication or patient-initiated change. If the provider does not comply, the bill would create a presumption in favor of the patient in billing disputes.

Providers or facilities that fail to comply could face penalties of up to $10,000 per violation.

Implementation

The bill would require the relevant federal agencies to issue regulations through the standard notice-and-comment rulemaking process.

Relevant Companies

• UNH — UnitedHealth Group could be affected through its insurance and benefits-administration businesses, including requirements to provide more detailed claims and payment information.
• CI — Cigna could be affected as a health insurer and through services tied to benefit administration and pharmacy benefits.
• ELV — Elevance Health could be affected through group health plan and administrative service operations.
• HUM — Humana could be affected where it offers health coverage and related plan administration services.
• CVS — CVS Health could be affected through its pharmacy benefit management and claims-administration businesses.
• MC — McKesson may be indirectly affected through healthcare administrative and payment-processing relationships, depending on specific business lines involved.
• CAH — Cardinal Health may be indirectly affected through healthcare services and administration-related business relationships.