Sponsors (3)
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 gives employers and fiduciaries better, machine-readable access to claims and pricing to reduce waste and fraud, at the cost of higher compliance burdens, greater privacy risks, potential exposure of proprietary terms, and the likelihood that vendors will raise prices or limit offerings—especially for smaller plans.
Plan sponsors and fiduciaries (employers and plan administrators) gain timely, machine-readable access to claims, encounter, pricing, and audit data so they can better monitor plan spending, audit payments, and pursue cost savings.
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 (ASC X12N 837/835, NCPDP) and requiring no-cost machine-readable files reduces administrative friction and can lower administrative costs for plans and employers.
Network service providers and vendors will face broader disclosure and audit obligations and potential large penalties, likely raising their compliance costs that are then passed on to employers and beneficiaries and/or reduce vendor participation.
Requiring disclosure of detailed pricing, proprietary formulas, and extra-contractual terms risks exposing trade secrets and may reduce vendors' incentives to develop innovative payment models or negotiate flexibly.
Mandating that plans receive and store extensive claims and encounter data increases the volume of sensitive information plans hold, raising privacy and breach risks and adding administrative burden despite HIPAA protections.
Based on analysis of 2 sections of legislative text.
Defines "network service provider" under ERISA and requires group health plan service contracts to give fiduciaries access to claims and encounter data while expanding certain prohibited-transaction exemptions.
Adds a new federal definition of “network service provider” within ERISA and changes ERISA’s prohibited-transaction exemption rules for group health plan service contracts. The bill requires that contracts between group health plans and service providers include provisions giving the plan’s responsible fiduciary (and its designated agent) access to claims and encounter data and adjusts which plan–service-provider transactions are exempt from ERISA’s prohibited-transaction rules. The change expands the kinds of entities treated as service providers (including insurers, PBMs, TPAs, provider networks, intermediaries, and others) and alters the statutory list of exempted transactions, creating new legal conditions that affect plan sponsors, fiduciaries, providers, and third-party administrators that enter into or renew contracts with group health plans.