§1185m — Title 29 Labor | U.S. Code

§1185m Increasing transparency by removing gag clauses on price and quality information

Title 29 › Chapter CHAPTER 18— - EMPLOYEE RETIREMENT INCOME SECURITY PROGRAM › Subchapter SUBCHAPTER I— - PROTECTION OF EMPLOYEE BENEFIT RIGHTS › Subtitle Subtitle B— - Regulatory Provisions › Part part 7— - group health plan requirements › Subpart Subpart B— - Other Requirements › § 1185m

Last updated Apr 6, 2026|Official source

Summary

Health plans and insurers must not sign contracts that stop them from sharing provider-specific cost or quality information with referring doctors, the plan sponsor, people covered by the plan, or people who could join the plan. They also must not be blocked from electronically getting de-identified claims and encounter data for each person in the plan when requested, following privacy rules like HIPAA, GINA, and the ADA. That data can include per-claim financial details (for example, the allowed amount), provider name and role, service codes, and other claim elements. Plans may share this information with a business associate as defined in 45 C.F.R. 160.103 (or its successor) if privacy rules are followed. Providers or networks may still set reasonable limits on making the information public. Each plan or issuer must annually send the Secretary a statement saying it follows these rules. Nothing here weakens existing state or federal privacy protections or limits data access allowed under HIPAA, GINA, or the ADA.

Title 29, §1185m

Labor — Source: USLM XML via OLRC

(a)(1)A group health plan (or an issuer of health insurance coverage offered in connection with such a plan) may not enter into an agreement with a health care provider, network or association of providers, third-party administrator, or other service provider offering access to a network of providers that would directly or indirectly restrict a group health plan or health insurance issuer offering such coverage from—

(A)providing provider-specific cost or quality of care information or data, through a consumer engagement tool or any other means, to referring providers, the plan sponsor, participants or beneficiaries, or individuals eligible to become participants or beneficiaries of the plan or coverage;

(B)electronically accessing de-identified claims and encounter information or data for each participant or beneficiary in the plan or coverage, upon request and consistent with the privacy regulations promulgated pursuant to section 264(c) of the Health Insurance Portability and Accountability Act of 1996, the amendments made by the Genetic Information Nondiscrimination Act of 2008, and the Americans with Disabilities Act of 1990 [42 U.S.C. 12101 et seq.], including, on a per claim basis—

(i)financial information, such as the allowed amount, or any other claim-related financial obligations included in the provider contract;

(ii)provider information, including name and clinical designation;

(iii)service codes; or

(iv)any other data element included in claim or encounter transactions; or

(C)sharing information or data described in subparagraph (A) or (B), or directing that such data be shared, with a business associate as defined in section 160.103 of title 45, Code of Federal Regulations (or successor regulations), consistent with the privacy regulations promulgated pursuant to section 264(c) of the Health Insurance Portability and Accountability Act of 1996, the amendments made by the Genetic Information Nondiscrimination Act of 2008, and the Americans with Disabilities Act of 1990 [42 U.S.C. 12101 et seq.].

(2)Nothing in paragraph (1)(A) prevents a health care provider, network or association of providers, or other service provider from placing reasonable restrictions on the public disclosure of the information described in such paragraph (1).

(3)A group health plan (or health insurance coverage offered in connection with such a plan) shall annually submit to the Secretary an attestation that such plan or issuer of such coverage is in compliance with the requirements of this subsection.

(4)Nothing in this section shall be construed to modify or eliminate existing privacy protections and standards under State and Federal law. Nothing in this subsection shall be construed to otherwise limit access by a group health plan, plan sponsor, or health insurance issuer to data as permitted under the privacy regulations promulgated pursuant to section 264(c) of the Health Insurance Portability and Accountability Act of 1996, the amendments made by the Genetic Information Nondiscrimination Act of 2008, and the Americans with Disabilities Act of 1990 [42 U.S.C. 12101 et seq.].

Notes & Related Subsidiaries

Editorial Notes

References in Text

section 264(c) of the Health Insurance Portability and Accountability Act of 1996, referred to in subsec. (a)(1)(B), (C), (4), is section 264 of Pub. L. 104–191, which is set out as a note under section 1320d–2 of Title 42, The Public Health and Welfare. The Genetic Information Nondiscrimination Act of 2008, referred to in subsec. (a)(1)(B), (C), (4), is Pub. L. 110–233, May 21, 2008, 122 Stat. 881. For complete classification of this Act to the Code, see

Short Title

note set out under section 2000ff of Title 42, The Public Health and Welfare, and Tables. The Americans with Disabilities Act of 1990, referred to in subsec. (a)(1)(B), (C), (4), is Pub. L. 101–336, July 26, 1990, 104 Stat. 327, which is classified principally to chapter 126 (§ 12101 et seq.) of Title 42, The Public Health and Welfare. For complete classification of this Act to the Code, see

Short Title

note set out under section 12101 of Title 42 and Tables.

§1185m Increasing transparency by removing gag clauses on price and quality information

Summary

Title 29, §1185m

Notes & Related Subsidiaries

Editorial Notes

References in Text

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