This bill requires health care providers, as defined and limited in the bill, to
provide health care consumers with certain charge or payment rate information,
upon request by and at no cost to the consumers; the information must be updated
annually and may not be construed as a legally binding estimate. Under the bill, a
health care provider must, within a reasonable period of time after the request,
provide the consumer with the usual and customary charges, assuming no
complications, for inpatient or outpatient health care services, diagnostic tests, or
procedures provided by the health care provider that the consumer specifies. In
addition, upon request, the health care provider must immediately, on site, provide
the consumer with all of the following information, as a single document:

1. The usual and customary charge, assuming no medical complications, for
each of the 50 health care services, diagnostic tests, or procedures, relevant to the
treatment of particular presenting conditions, that the health care provider most
frequently performs. This information must be classified in the form of
diagnosis-related groups, if provided by a hospital; in the form of presenting
conditions, if provided by a physician; and in a grouping form similar to that for a

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hospital or a physician, if provided by a health care provider that is not a hospital
or a physician.

2. If the health care provider is certified as a provider of Medical Assistance
(MA), the MA payment rates, as specified on the Web site of the Department of
Health and Family Services, for the provider's 50 most frequently performed health
care services, diagnostic tests, or procedures.

3. The average allowable payment from private, third party payers for the
provider's 50 most frequently performed health care services, diagnostic tests, or
procedures.

4. The average of the charges and payment rates for each health care service,
diagnostic test, or procedure specified in 1. to 3., above.

Under the bill, a self-insured health plan of the state or a county, city, village,
town, or school district, or an insurer that provides coverage under a health
insurance policy, including defined network plans and sickness care plans operated
by cooperative associations, must provide to an insured under the health insurance
policy or an enrollee under the self-insured health plan a good faith estimate of the
reimbursement that the insurer or self-insured health plan would expect to pay a
specified provider for a specified health care service. In addition, the insurer or
self-insured health plan must provide to an insured or enrollee a good faith estimate
of the insured's or enrollee's total out-of-pocket cost for the specified service provided
by the specified provider. The information must be provided only if the insured or
enrollee requests it, and it must be provided at no charge to the insured or enrollee.
Any good faith estimate provided is not a legally binding estimate.

The bill also requires health care providers to display prominently statements
informing health care consumers of the consumers' right to request charge or
payment rate information for health care services, diagnostic tests, or procedures
from the health care providers or from their insurers.