42 U.S.C. § 300gg–93 — Health insurance consumer information

(a) In general: The Secretary must award grants to states so they, or the Exchanges operating in those states, can set up, expand, or support (1) offices of health insurance consumer assistance, or (2) health insurance ombudsman programs. (b) Eligibility (1) In general: To be eligible for a grant, a state must designate an independent office of health insurance consumer assistance, or an ombudsman, that — directly or with state insurance regulators and consumer assistance organizations — receives and responds to questions and complaints about health insurance coverage, covering both federal requirements and state law. (2) Criteria: A state receiving a grant must follow criteria the Secretary sets for carrying out grant activities. (c) Duties: The office or ombudsman must (1) help people file complaints and appeals, including internal plan or insurer appeals, and give information about the external appeal process; (2) collect, track, and count the problems and questions consumers raise; (3) teach consumers their rights and duties under group health plans and health insurance coverage; (4) help consumers enroll in a group health plan or coverage, by giving them information, referrals, and assistance; and (5) help resolve problems people have getting premium tax credits under section 36B of title 26. (d) Data collection: To keep a grant, the office or ombudsman program must collect and report data to the Secretary on the types of problems and questions consumers raise. The Secretary must use that data to find where more enforcement action is needed, and must share it with state insurance regulators, the Secretary of Labor, and the Secretary of the Treasury for use in their own enforcement work. (e) Funding (1) Initial funding: $30,000,000 is appropriated, out of funds in the Treasury not otherwise appropriated, for the first fiscal year this section applies, and it stays available without a fiscal-year time limit. (2) Authorization for subsequent years: For each fiscal year after that first year, Congress authorizes whatever amount is necessary to carry out this section.