Consumer Health Claim Assistance Act

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9737 Introduced in House (IH)]

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119th CONGRESS
  2d Session
                                H. R. 9737

 To amend the Employment Retirement Income Security Act to establish a
    Benefits Assistance Program to improve access to benefits under
        employee welfare benefit plans, and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             July 16, 2026

Mr. DeSaulnier introduced the following bill; which was referred to the
                  Committee on Education and Workforce

_______________________________________________________________________

                                 A BILL

 To amend the Employment Retirement Income Security Act to establish a
    Benefits Assistance Program to improve access to benefits under
        employee welfare benefit plans, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Consumer Health Claim Assistance
Act''.

SEC. 2. BENEFITS ASSISTANCE PROGRAM.

    Part 5 of subtitle B of title I of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1131 et seq.) is amended by adding at
the end the following new section:

``SEC. 524. BENEFITS ASSISTANCE PROGRAM.

    ``(a) Establishment.--Not later than January 1, 2027, the Secretary
shall establish, within the Employee Benefits Security Administration
of the Department of Labor, a Benefits Assistance Program (in this
section, referred to as the `Program') to improve access to benefits
under employee welfare benefit plans.
    ``(b) Duties.--The Program shall--
            ``(1) establish a process for the receipt of inquiries or
        complaints from participants and beneficiaries, and health care
        providers (on behalf of participants and beneficiaries),
        relating to--
                    ``(A) adverse benefit determinations (as defined
                under section 2560.503-1(m)(4) of title 29, Code of
                Federal Regulations, as in effect on the date of
                enactment of the Consumer Health Claim Assistance Act);
                and
                    ``(B) alleged violations of--
                            ``(i) plan terms; and
                            ``(ii) any provision of this title;
            ``(2) assist participants and beneficiaries in
        understanding their rights to benefits under their plan and the
        availability of internal appeals and external review (as such
        terms are defined under sections 2590.715-2719(a)(2) of title
        29, Code of Federal Regulations, as in effect on the date of
        enactment of the Consumer Health Claim Assistance Act);
            ``(3) directly assist participants and beneficiaries in
        filing appeals for denied benefits and navigating such appeals
        or reviews;
            ``(4) make referrals to appropriate entities regarding any
        inquiries or complaints relating to adverse benefit
        determinations by a plan that may violate this title or any
        other law;
            ``(5) provide additional training, technical assistance,
        and support to Department staff, including benefits advisors,
        to address adverse benefit determinations or any violations of
        this title; and
            ``(6) if the inquiry or complaint was received as a result
        of a referral from a State office of health insurance consumer
        assistance, health insurance ombudsman, or other program that
        carries out the duties described in section 2793(c) of the
        Public Health Service Act (42 U.S.C. 300gg-93(c)), inform such
        office or program of the result of such inquiry or complaint.
    ``(c) Annual Report.--The Secretary of Labor shall, on an annual
basis, submit to the Committee on Education and Workforce of the House
of Representatives and the Committee on Health, Education, Labor, and
Pensions of the Senate a report, with respect to the Program, on the
following:
            ``(1) The number of inquiries and complaints received
        (disaggregated by type of plan, size of plan, and type of
        assistance provided).
            ``(2) The number of participants and beneficiaries who
        received assistance (disaggregated by type of plan, size of
        plan, and type of service provided).
            ``(3) The dollar amounts of claims for benefits for which
        assistance was provided (disaggregated by type of plan, size of
        plan, and type of service provided).
            ``(4) The total dollar amount expended to operate the
        Program and the number of full-time equivalents assigned by the
        Secretary to operate the Program.
            ``(5) The number of referrals to appropriate entities and,
        when available, the disposition of such enforcement actions.
            ``(6) The number and type of any non-monetary recoveries by
        participants and beneficiaries who received assistance.
            ``(7) The average amount of time it takes to provide
        assistance.
            ``(8) Recommendations regarding any additional authority or
        resources needed to improve the Program, including
        recommendations on necessary increases in filing fees under
        section 104(d).
            ``(9) Any other data determined appropriate by the
        Secretary.''.

SEC. 3. PLAN FILING FEES.

    (a) Fees on Filings.--Section 104 of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1024) is amended by redesignating
subsections (d) and (e) as subsections (e) and (f), respectively, and
by inserting after subsection (c) the following new subsection:
    ``(d) Fees on Filings With Secretary of Labor.--
            ``(1) In general.--The administrator of any employee
        welfare benefit plan which is a single-employer plan shall pay
        to the Secretary a filing fee in the amount determined under
        paragraph (2) at the time of filing an annual report or a
        notice under subsection (a)(1)(A).
            ``(2) Amount of fee.--
                    ``(A) Annual reports.--Subject to subparagraph (B),
                the amount of the fee under paragraph (1) with respect
                to each report or notice shall be--
                            ``(i) $250 if the plan had fewer than 100
                        participants as of the close of the plan year
                        preceding the plan year in which such report or
                        notice is filed;
                            ``(ii) $500 if the plan had 100 or more but
                        fewer than 500 participants as of the close of
                        such plan year; and
                            ``(iii) not less than $1,000 in the case of
                        any other plan.
                    ``(B) Regulatory.--The Secretary may by regulation
                require a fee that is higher than is otherwise required
                under this paragraph. If the Secretary requires a
                higher fee, the Secretary shall establish a fee scale
                that increases the fee charged to a plan as the number
                of participants in a plan increases.
            ``(3) Prohibition on use of plan assets.--Payment of a
        filing fee under this subsection may not be made using any
        funds that are assets of the plan.
            ``(4) Use and availability of funds.--
                    ``(A) In general.--The Secretary of Labor shall
                expend the amounts received under this subsection for
                each fiscal year for enforcement of title I of the
                Employee Retirement Income Security Act of 1974 and to
                support operations of the Benefits Assistance Program
                described in section 524. Such funds shall be available
                without fiscal year limitation.
                    ``(B) Limitation.--At least 50 percent of the
                amounts described in subparagraph (A) shall be used to
                support operations of the Program.''.
    (b) Effective Date.--Section 104(d) of the Employee Retirement
Income Security Act of 1974, as added by this section, shall apply to
reports, descriptions, notices, and attestations filed after January 1,
2027.

SEC. 4. MINIMUM NOTICE.

    (a) Minimum Notice.--Section 104(a) of the Employee Retirement
Income Security Act (29 U.S.C. 1024(a)) is amended--
            (1) in paragraph (1), by inserting after ``plan year'' the
        following: ``(or, if applicable, file with the Secretary a
        notice as described in paragraph (3)(B) for a plan year)''; and
            (2) in paragraph (3)--
                    (A) by striking ``The Secretary'' and inserting
                ``(A) Subject to subparagraph (B), the Secretary''; and
                    (B) by adding at the end the following:
            ``(B) In the case of any employee welfare benefit plan
        which is a single-employer plan that is not required to file an
        annual report for any year, the administrator of the plan shall
        file with the Secretary a notice containing the following
        information in relation to such plan for such year:
                    ``(i) The name of the employer maintaining such
                plan.
                    ``(ii) The number of employees covered by such
                plan.
                    ``(iii) The aggregate amount of benefits provided
                by such plan.
                    ``(iv) The method of funding of such plan (whether
                such plan is unfunded, insured, or a combination) and,
                if applicable, the name of any issuers contracted to
                provide health insurance coverage in connection with
                such plan.
                    ``(v) The name of any service providers that
                rendered services to the plan and received $5,000 or
                more in compensation, directly or indirectly, from the
                plan.''.
    (b) Effective Dates.--The amendments made by this section shall
apply with respect to plan years ending after January 1, 2027.
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