CHECK Act of 2026
- Sponsor
- Rep. Langworthy, Nicholas A. [R-NY-23]
- Committees
- Education and Workforce Committee (primary)
- Last action
- Jun 3, 2026
Bottom line
This bill aims to empower consumers and health plans with more transparent and detailed healthcare cost information, potentially reducing surprise billing and improving oversight of service providers through new disclosure mandates and penalties.
What it actually does
This bill mandates increased transparency in healthcare pricing and billing by requiring health plan service providers to disclose detailed financial and contractual information to group health plans, and by requiring health plans and providers to issue comprehensive, itemized explanations of benefits and bills to patients. It also imposes significant penalties for non-compliance with these new disclosure and billing requirements. The legislation amends the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act (PHSA), and the Internal Revenue Code (IRC) to implement these changes.
Proponents argue
Supporters argue that the bill will increase transparency in the opaque healthcare system, allowing employers and individuals to better understand and manage healthcare costs. This increased visibility will foster competition, drive down prices, and protect consumers from unexpected medical bills by providing clear, itemized statements and holding providers accountable to good faith estimates.
Opponents contend
Opponents might argue that the extensive disclosure requirements could impose significant administrative burdens and compliance costs on health plan service providers and healthcare facilities, potentially leading to increased operational expenses that could be passed on to consumers or result in reduced services. Concerns could also be raised about the practicality of providing such granular data quarterly and the potential for proprietary information to be inadvertently disclosed.
The bill is moderately complex, requiring careful reading to understand the interplay of amendments to existing laws and the detailed disclosure requirements. The estimated reading time is reasonable for its scope.
Section 2(a) of H.R. 9117, amending Subpart B of part 7 of subtitle B of ERISA by adding Section 727.
Mandates Disclosure of Healthcare Cost Information to ERISA Group Health Plans
This provision prohibits agreements between ERISA group health plans and health plan service providers (such as third-party administrators, pharmacy benefit managers, or provider networks) that limit or delay the disclosure of specific financial information. Service providers must quarterly provide detailed contractual methodologies, fee schedules, rebates, discounts, and payment data related to claims and administrative services to the group health plan at no cost.
Supporters argue
Supporters argue this provision is crucial for employers to understand the true costs of their health plans, identify inefficiencies, and negotiate better rates, ultimately benefiting employees through more affordable healthcare. It addresses information asymmetry in the healthcare market.
Critics contend
Critics may argue that these extensive disclosure requirements are overly burdensome, could expose proprietary business practices, and might lead to increased administrative costs for service providers, which could then be passed on to health plans and consumers.
Tradeoffs
Balances the need for transparency and plan oversight against the administrative burden and potential disclosure of proprietary business information for health plan service providers.
Section 2(a)(2) of H.R. 9117, amending Section 502(a) of ERISA.
Establishes Civil Penalties for ERISA Disclosure Violations
This provision adds a new paragraph to ERISA Section 502(a), allowing the Secretary of Labor to assess a civil penalty of $100,000 per day for each violation by any person of the new Section 727 (Oversight of Administrative Service Providers).
Section 2(b) of H.R. 9117, amending Part D of title XXVII of the Public Health Service Act by adding Section 2799A-12.
Extends Disclosure Requirements to Self-Funded, Non-Federal Governmental Health Plans
This provision mirrors the ERISA amendments, applying similar quarterly disclosure requirements to health plan service providers for self-funded, non-Federal governmental health plans. It prohibits agreements that limit or delay disclosure of detailed financial and contractual information, including pricing, rebates, and alternative compensation arrangements.
Section 2(b)(2) of H.R. 9117, amending Section 2723(b) of the Public Health Service Act.
Establishes Civil Penalties for PHSA Disclosure Violations
This provision authorizes the Secretary of Health and Human Services to assess a penalty of $100,000 per day for each violation by a health plan service provider of the new Section 2799A-12, which applies to self-funded, non-Federal governmental plans.
Section 3(a) of H.R. 9117, amending Section 2799A-1 of the Public Health Service Act.
Mandates Detailed Post-Service Explanation of Benefits for Patients
This provision requires group health plans and health insurance issuers to provide participants, beneficiaries, or enrollees with a detailed, itemized Explanation of Benefits (EOB) within 45 days of receiving a payment request. The EOB must include plain language descriptions, billing codes, amounts paid by the plan, patient cost-sharing, progress towards deductibles/out-of-pocket maximums, and the site of service. It also updates the 'good faith estimate' requirements to include plain language descriptions and billing codes.
Section 3(b) & 3(c) of H.R. 9117, amending Section 9816 of the Internal Revenue Code of 1986 and Section 716 of the Employee Retirement Income Security Act of 1974.
Harmonizes EOB Requirements Across Federal Statutes
These sections make conforming amendments to the Internal Revenue Code and ERISA, respectively, to align with the new Explanation of Benefits requirements introduced in the Public Health Service Act. This ensures that the detailed EOB mandates apply consistently across the federal regulatory framework for health plans.
Section 4 of H.R. 9117, amending Part E of title XXVII of the Public Health Service Act by adding Section 2799B-10.
Mandates Itemized Bills from Healthcare Providers to Patients
This provision requires healthcare providers and facilities to provide a written, itemized bill to individuals within 30 days of receiving final payment from a third party. The bill must include plain language descriptions, billing codes, prices, billed amounts, payments received, language assistance information, contact for bill discussion, and charity care policies. It also prohibits collection actions if the provider hasn't complied or if the billed amount exceeds a good faith estimate (unless medically necessary due to unforeseen complications or patient-initiated changes, with the burden of proof on the provider). Penalties of up to $10,000 per instance of non-compliance are established.
Mandates that health plan service providers must provide information consistent with HIPAA privacy, security, and breach notification regulations, and restrict its use and disclosure accordingly. Group health plans must also comply with specific HIPAA regulations regarding disclosure.
Section 2(a)(1) adding ERISA Sec. 727(b)(2) and Section 2(b)(1) adding PHSA Sec. 2799A-12(b)(2).
Why it matters:Standard legislative practice to ensure new data sharing mandates align with existing privacy frameworks without re-stating all the rules.
Case for: Ensures that while transparency is increased, patient privacy and data security are maintained according to established federal standards, preventing unintended privacy breaches.
Case against: Critics might argue that relying on existing complex HIPAA regulations for new data flows could still lead to compliance challenges or ambiguities in application, potentially hindering the smooth exchange of information.
Estimated impact: Ensures that the vast amount of sensitive healthcare data being shared under the new transparency rules remains protected, impacting all entities handling this data.
Specifies that all claims data must be in ASC X12N 837 (institutional, professional, dental) or NCPDP (prescription drug) format, and all claim payment/remittance advice must be in ASC X12N 835 format, unmodified and at no cost to the plan.
Section 2(a)(1) adding ERISA Sec. 727(b)(4) and Section 2(b)(1) adding PHSA Sec. 2799A-12(b)(4).
Why it matters:Standard legislative practice to ensure interoperability and standardization of data exchange in a technical domain.
Case for: Ensures that the disclosed data is provided in a standardized, machine-readable format, making it usable for analysis, verification, and integration into existing systems, maximizing the utility of the transparency mandates.
Case against: Some providers or service providers might face challenges or costs in converting their existing data systems to strictly adhere to these specific formats, especially if their current systems are not fully compliant or if they handle a mix of electronic and paper claims.
Estimated impact: Facilitates efficient data processing and analysis for health plans, potentially increasing initial IT costs for some service providers.
States that the burden of proof rests with the provider if a billed amount exceeds a good faith estimate, and absent documentation for medical necessity due to unforeseen complications or patient-initiated changes, the good faith estimate shall be binding.
Section 4, adding PHSA Sec. 2799B-10(a)(2)(B).
Why it matters:Could be seen as a technical enforcement detail rather than a primary requirement, but it has significant implications for providers and patients.
Case for: This provision strongly protects patients from surprise bills by making good faith estimates legally binding unless specific, documented exceptions apply, shifting the burden of proof to providers to justify discrepancies.
Case against: Providers might argue that this creates an overly rigid system that doesn't adequately account for the unpredictable nature of medical care, potentially leading to situations where they are unable to recover legitimate costs for necessary services that deviate from an initial estimate.
Estimated impact: Significantly strengthens patient protections against surprise billing, potentially increasing financial risk for providers who fail to accurately estimate or document changes.