Sponsor
Robert F. Onder
Representative · R-MO
Representative · R-MO
The bill increases plan transparency, oversight, and enforcement—helping detect fraud and control costs—but raises compliance, privacy, and market‑participation risks that could raise costs or reduce options for employers and beneficiaries.
Plan sponsors and fiduciaries gain timely access to claims, encounter, pricing, and audit data, enabling better oversight of plan costs and provider payments.
Requiring HIPAA‑consistent disclosures, explicit attestations, and civil penalties increases transparency and accountability of issuers and service providers and creates enforcement teeth to deter unlawful gag clauses.
Plans can detect and correct erroneous or fraudulent payments faster because contracts cannot block requests for action on suspicious claims.
Broader disclosure and new access/audit requirements increase administrative and compliance costs for network service providers and vendors, which may be passed on to employers and beneficiaries as higher premiums or fees.
Requiring plans to receive and store extensive claims and encounter data increases the risk and consequences of privacy breaches and raises administrative burden for plans, even with HIPAA protections.
Large civil penalties and expanded compliance exposure could produce disproportionate liability for vendors, prompting higher contract prices, reduced vendor participation, and avoidance of smaller plans or employers.
Based on analysis of 2 sections of legislative text.
Adds a ‘‘network service provider’’ ERISA definition and requires service contracts to give plan fiduciaries access to claims/encounter data as a condition for certain exempt transactions.
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
Creates a new statutory definition of “network service provider” for ERISA group health plans and changes ERISA’s prohibited-transaction exemption language to add conditions for allowable service contracts. The bill requires certain service contracts between group health plans and service providers to give the plan’s responsible fiduciary (and a designated agent) access to claims and encounter data and other information needed to evaluate plan performance and spending. Overall, it expands the universe of entities covered as plan service providers and conditions exemptions for transactions on transparency and data access requirements.