Health plans would answer care requests within 30 days

Health plans and insurers would send written decisions on care requests, while they and care providers would compensate patients for their own billing errors. These rules cover group health plans, insurers offering group or individual coverage, their enrolled patients, and care providers who bill those patients. Decisions must reach the patient and provider through a secure portal within 30 days of the request. If a denial leads to a doctor-to-doctor review, the reviewing doctor must share the treating doctor's specialty. Compensation applies when a billing error charges a patient more than they owe; the amount depends on the excess charge and when it is refunded. These rules would take effect January 1, 2029.

Health plans and insurers would limit coverage changes during a policy term and provide coverage details with insurance contracts. The rules cover group health plans and insurers offering group or individual coverage. A prescription drug could not move to a more restrictive coverage tier during the policy term. Each contract copy given to someone must list covered care, billing codes for covered procedures, and the charge for each procedure. These rules would take effect January 1, 2029.

Health plans and insurers would set minimum payments for covered care from providers outside their networks. The rules cover group health plans and insurers offering group or individual coverage. For covered care given to an enrolled person, a provider outside the network must receive at least what a participating provider would receive. Plans and insurers could not stop participating providers from treating people outside the plan. These rules would take effect January 1, 2029.

Certain health plans would meet a federal coverage rule if they covered primary care visits and delayed most other benefits. This rule covers plans outside the bronze, silver, gold, and platinum coverage levels. The plan must cover at least three primary care visits. Most other benefits would wait until the patient has paid costs equal to the annual spending limit; care covered by a separate federal requirement is excepted. The rule would apply to plans and coverage beginning in calendar year 2027.

Designated savings accounts would generally avoid federal income tax on the account and on withdrawals. The rules cover individuals who hold the proposed savings accounts. A trust in the United States must hold the account for one person's benefit. Ordinary deposits must be cash. Transfers between these accounts must occur within 60 days to qualify for the rollover exception. The $10,000 yearly deposit limit covers all such accounts for one person and rises with inflation after 2026. Account income from certain excess deposits remains taxable. The tax rules would apply to tax years beginning after December 31, 2024.