HR 9737: Consumer Health Claim Assistance Act

HR 9737 in plain English: This bill would require health plans to provide clearer information to consumers and would impose financial penalties on plans that fail to file required reports or notices, with penalty amounts varying based on plan size.

Stated purpose

This bill aims to create a Benefits Assistance Program within the Department of Labor to help workers and their families better understand and access the health benefits they are entitled to under their employer-sponsored plans, including help with denied claims and appeals.

Key points

• Penalizes health plans $250 per report or notice if the plan had fewer than 100 participants
• Penalizes plans $500 per report or notice if the plan had 100 to 499 participants
• Sets penalties of at least $1,000 per report or notice for larger plans
• Requires disclosure of service providers that received $5,000 or more in compensation from the plan

Arguments supporters make

• Many workers don't know their rights when a health claim is denied, and a dedicated federal program could level the playing field against large insurers and plan administrators.
• Requiring annual reports on claim denials, dollar amounts recovered, and average response times creates accountability and gives Congress real data to improve the system.
• Funding the program through fees on plan filings rather than general taxpayers ties the cost to those who benefit from administering plans.

Arguments opponents make

• New filing fees on employers, especially smaller businesses with fewer than 100 employees, add a financial burden that could discourage offering health benefits at all.
• A new federal bureaucracy may duplicate assistance already provided by existing state insurance consumer assistance offices and ombudsman programs, wasting resources.
• The program's scope and fee levels could expand over time through regulation without additional Congressional approval, giving the Secretary of Labor broad unchecked authority.

Tradeoffs

Providing workers with more support to challenge denied benefits requires new costs placed on employers through filing fees, which may be passed on or affect benefit offerings; expanding federal oversight of health claims could improve consumer outcomes but may overlap with or complicate existing state-level assistance programs.

Current status in Congress: In committee.

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