CHECK Act of 2026
Sponsored By: Representative Langworthy, Nicholas A. [R-NY-23]
Introduced
Summary
This bill requires more transparent health-plan financial data and clearer patient cost estimates. It forces administrative service providers and plans to disclose detailed payment, rebate, pricing, and alternative‑payment data and creates a unified plain‑language explanation of benefits and good‑faith cost estimates.
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- Families and patients: Plans and issuers must provide a plain‑language explanation of benefits within 45 days that lists what the plan will pay, the enrollee's cost‑sharing, applicable billing codes, the site of service, and how much counts toward deductibles and out‑of‑pocket limits.
- Employers and group plans: Plans must receive detailed disclosures at no cost, at least quarterly, including pricing formulas, rebate totals, and data on alternative payment arrangements. ERISA plans get these rules for plan years beginning two years after enactment and self‑funded non‑Federal government plans start one year after enactment.
- Administrative service providers and third‑party vendors: Contracts may not hide or delay required disclosures and redisclosure is limited by HIPAA rules. Violations can trigger civil penalties of $100,000 per day and enforcement under the ERISA and PHSA provisions, with the Secretary required to issue rules to implement the changes.
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 3 benefits, 0 costs, 0 mixed.
Quarterly plan pricing data and penalties
If enacted, health plan service providers would have to give group plans and issuers detailed pricing and payment data at least every quarter and at no cost. The data would include how providers are paid, rebate and fee totals (including escrow or variance accounts), and reconciliation for alternative payment models. Claims and payment files would use standard HIPAA electronic formats (ASC X12N 837, NCPDP, ASC X12N 835) and stay subject to HIPAA privacy rules. The Secretary could fine a provider $100,000 for each day it breaks these disclosure rules, and must begin enforcement within about 90 days of learning of a failure.
Itemized medical bills and collections protections
If enacted, any provider who asks an individual for payment would have to give a written, itemized bill. The bill must be provided within 30 days after the provider receives a final third-party payment and must list each item or service, billing codes (including modifiers), prices or a total bundled price, payments made, language help info, who to contact about the bill, and charity care rules and applications. Providers could not try to collect unless they followed these rules, and they could not collect more than earlier disclosed price estimates unless they document unforeseen complications or patient-initiated changes. The Secretary could fine a provider up to $10,000 for each failure, and a failure to comply would create a presumption that charges exceeded the good faith estimate.
Faster patient cost notices and estimates
If enacted, for plan years beginning on or after January 1, 2026, group and individual plans would have to send a clear notice within 45 days after a payment request. The notice must say if the provider is in-network and list each item or service in plain language with billing codes and modifiers. It must show how much the plan will pay, what you would owe, and your deductible and out-of-pocket totals as of the notice date. Also, emergency good-faith estimates would have to show the amount the plan is responsible for and include billing codes and plain descriptions.
Sponsors & CoSponsors
Sponsor
Langworthy, Nicholas A. [R-NY-23]
NY • R
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
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