Sponsors (2)
Official title: To amend the Employee Retirement Income Security Act of 1974 to ensure plan fiduciaries have access to de-identified information relating to health claims, and for other purposes.
Introduced June 9, 2026 by Robert F. Onder · Last progress June 9, 2026
The bill increases transparency and oversight of health plan costs and claims (helping plan sponsors detect fraud and reduce administrative friction) at the expense of higher compliance burdens, risks to proprietary business practices, potential privacy exposure, and the possibility that penalties and costs get passed on to employers and consumers.
Plan sponsors and fiduciaries (employers and responsible plan officials) gain timely access to claims, encounter, pricing, and audit data so they can better oversee plan costs and provider payments.
Group health plans can detect and correct erroneous or fraudulent payments faster because contracts cannot block requests for action on suspicious claims.
Standardizing electronic claim formats and requiring machine-readable files at no cost reduces administrative friction and can lower administrative costs for plans and employers.
Network service providers and vendors will face broader disclosure and compliance obligations, raising administrative costs that are likely passed through to employers and beneficiaries as higher premiums or fees.
Requiring disclosure of detailed pricing, proprietary formulas, and extra-contractual terms may expose trade secrets and reduce vendors' incentives to develop or negotiate innovative payment models.
Large civil penalties (up to $10,000/day) create risk of disproportionate financial exposure for vendors over access or technical-compliance disputes, which could increase contract prices or discourage vendor participation.
Based on analysis of 2 sections of legislative text.
Defines “network service provider” under ERISA and conditions certain prohibited-transaction exemptions on providing plan fiduciaries access to claims and encounter data.
Creates a new ERISA definition for “network service provider” and changes ERISA’s prohibited-transaction exemption rules to require that contracts with group health plan service providers give plan fiduciaries (and their agents) access to plan claims and encounter data and related information. The change expands which entities are covered as service providers and adds conditions to the list of transactions exempted from ERISA’s prohibited-transaction rules, making data access and transparency a statutory requirement for many plan service contracts. The amendment affects group health plans, plan fiduciaries, insurers, PBMs, TPAs, provider networks and intermediary vendors by imposing new data-access obligations and altering the statutory safe-harbor exemptions that govern plan-service-provider relationships. That creates compliance, operational, and potential privacy consequences while strengthening fiduciary oversight of plan spending and contracts.