Bill would force insurers to share claims data with employers

What does this do?

HR 9228 would require contracts between health plans and insurers, third-party administrators, and pharmacy benefit managers to guarantee employers broad access to claims data, pricing formulas, fee schedules, and audit rights, generally within 15 days of a request. It bans "gag clauses" blocking employer audits, voids conflicting contract terms, and requires annual certification that plans have this data access.

Who does it affect?

The bill affects employers and unions that sponsor group health plans, plus insurance companies, pharmacy benefit managers, and other claims administrators facing new transparency rules. Workers and families covered by these plans could be indirectly affected.

Why does it matter?

Supporters say the change would help employers detect overcharges or billing errors, but it also imposes new compliance burdens and legal exposure on service providers and plan sponsors.

What does it cost, and who pays?

• DOL fines up to $10,000 per day
• providers can't be reimbursed for fines