---
kind: "section"
citation: "42 U.S.C. § 300gg–115"
title: "42"
title_heading: "The Public Health and Welfare"
number: "300gg–115"
heading: "Protecting patients and improving the accuracy of provider directory information"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/300gg-115"
units:
  - "Chapter 6A — Public Health Service"
  - "Subchapter XXV — Requirements Relating to Health Insurance Coverage"
  - "Part D — Additional Coverage Provisions"
---

# §300gg–115. Protecting patients and improving the accuracy of provider directory information

- (a) **Provider directory information requirements—**
  - (1) **In general—** For plan years beginning on or after January 1, 2022, each [group health plan](/usc/42/300bb–8.md?p=1) and [health insurance issuer](/usc/42/300gg–91.md?p=b-2) offering group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) shall—
    - (A) establish the verification process described in [paragraph (2)](#a-2);
    - (B) establish the response protocol described in [paragraph (3)](#a-3);
    - (C) establish the database described in [paragraph (4)](#a-4); and
    - (D) include in any directory (other than the database described in [subparagraph (C)](#a-1-C)) containing [provider](/usc/42/299b–21.md?p=8) directory information with respect to such plan or such coverage the information described in [paragraph (5)](#a-5).
  - (2) **Verification process—** The verification process described in this paragraph is, with respect to a [group health plan](/usc/42/300bb–8.md?p=1) or a [health insurance issuer](/usc/42/300gg–91.md?p=b-2) offering group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5), a process—
    - (A) under which, not less frequently than once every 90 days, such plan or such issuer (as applicable) verifies and updates the [provider](/usc/42/299b–21.md?p=8) directory information included on the database described in [paragraph (4)](#a-4) of such plan or issuer of each [health care provider](/usc/42/300aa–33.md?p=1) and health care facility included in such database;
    - (B) that establishes a procedure for the removal of such a [provider](/usc/42/299b–21.md?p=8) or facility with respect to which such plan or issuer has been unable to verify such information during a period specified by the plan or issuer; and
    - (C) that provides for the update of such database within 2 business days of such plan or issuer receiving from such a [provider](/usc/42/299b–21.md?p=8) or facility information pursuant to [section 300gg–139 of this title](/usc/42/300gg–139.md).
  - (3) **Response protocol—** The response protocol described in this paragraph is, in the case of an individual enrolled under a [group health plan](/usc/42/300bb–8.md?p=1) or group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) offered by a [health insurance issuer](/usc/42/300gg–91.md?p=b-2) who requests information through a telephone call or electronic, web-based, or Internet-based means on whether a [health care provider](/usc/42/300aa–33.md?p=1) or health care facility has a contractual relationship to furnish items and [services](/usc/42/201.md?p=a) under such plan or such coverage, a protocol under which such plan or such issuer (as applicable), in the case such request is made through a telephone call—
    - (A) responds to such individual as soon as practicable and in no case later than 1 business day after such call is received, through a written electronic or print (as requested by such individual) communication; and
    - (B) retains such communication in such individual’s file for at least 2 years following such response.
  - (4) **Database—** The database described in this paragraph is, with respect to a [group health plan](/usc/42/300bb–8.md?p=1) or [health insurance issuer](/usc/42/300gg–91.md?p=b-2) offering group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5), a database on the public website of such plan or issuer that contains—
    - (A) a list of each [health care provider](/usc/42/300aa–33.md?p=1) and health care facility with which such plan or such issuer has a direct or indirect contractual relationship for furnishing items and [services](/usc/42/201.md?p=a) under such plan or such coverage; and
    - (B) [provider](/usc/42/299b–21.md?p=8) directory information with respect to each such [provider](/usc/42/299b–21.md?p=8) and facility.
  - (5) **Information—** The information described in this paragraph is, with respect to a print directory containing [provider](/usc/42/299b–21.md?p=8) directory information with respect to a [group health plan](/usc/42/300bb–8.md?p=1) or individual or [group health insurance coverage](/usc/42/300gg–91.md?p=b-4) offered by a [health insurance issuer](/usc/42/300gg–91.md?p=b-2), a notification that such information contained in such directory was accurate as of the date of publication of such directory and that an individual enrolled under such plan or such coverage should consult the database described in [paragraph (4)](#a-4) with respect to such plan or such coverage or contact such plan or the issuer of such coverage to obtain the most current [provider](/usc/42/299b–21.md?p=8) directory information with respect to such plan or such coverage.
  - (6) **Definition—** For purposes of this subsection, the term “[provider](/usc/42/299b–21.md?p=8) directory information” includes, with respect to a [group health plan](/usc/42/300bb–8.md?p=1) and a [health insurance issuer](/usc/42/300gg–91.md?p=b-2) offering group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5), the name, address, specialty, telephone number, and digital contact information of each [health care provider](/usc/42/300aa–33.md?p=1) or health care facility with which such plan or such issuer has a contractual relationship for furnishing items and [services](/usc/42/201.md?p=a) under such plan or such coverage.
  - (7) **Rule of construction—** Nothing in this section shall be construed to preempt any provision of [State](/usc/42/201.md?p=f) law relating to [health care provider](/usc/42/300aa–33.md?p=1) directories.
- (b) **Cost-sharing for services provided based on reliance on incorrect provider network information—**
  - (1) **In general—** For plan years beginning on or after January 1, 2022, in the case of an item or [service](/usc/42/201.md?p=a) furnished to a [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee of a [group health plan](/usc/42/300bb–8.md?p=1) or group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) offered by a [health insurance issuer](/usc/42/300gg–91.md?p=b-2) by a nonparticipating [provider](/usc/42/299b–21.md?p=8) or a nonparticipating facility, if such item or [service](/usc/42/201.md?p=a) would otherwise be covered under such plan or coverage if furnished by a participating [provider](/usc/42/299b–21.md?p=8) or participating facility and if either of the criteria described in [paragraph (2)](#b-2) applies with respect to such [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee and item or [service](/usc/42/201.md?p=a), the plan or coverage—
    - (A) shall not impose on such [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee a cost-sharing amount for such item or [service](/usc/42/201.md?p=a) so furnished that is greater than the cost-sharing amount that would apply under such plan or coverage had such item or [service](/usc/42/201.md?p=a) been furnished by a participating [provider](/usc/42/299b–21.md?p=8); and
    - (B) shall apply the deductible or out-of-pocket maximum, if any, that would apply if such [services](/usc/42/201.md?p=a) were furnished by a participating [provider](/usc/42/299b–21.md?p=8) or a participating facility.
  - (2) **Criteria described—** For purposes of [paragraph (1)](#b-1), the criteria described in this paragraph, with respect to an item or [service](/usc/42/201.md?p=a) furnished to a [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee of a [group health plan](/usc/42/300bb–8.md?p=1) or group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) offered by a [health insurance issuer](/usc/42/300gg–91.md?p=b-2) by a nonparticipating [provider](/usc/42/299b–21.md?p=8) or a nonparticipating facility, are the following:
    - (A) The [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee received through a database, [provider](/usc/42/299b–21.md?p=8) directory, or response protocol described in [subsection (a)](#a) information with respect to such item and [service](/usc/42/201.md?p=a) to be furnished and such information provided that the [provider](/usc/42/299b–21.md?p=8) was a participating [provider](/usc/42/299b–21.md?p=8) or facility was a participating facility, with respect to the plan for furnishing such item or [service](/usc/42/201.md?p=a).
    - (B) The information was not provided, in accordance with [subsection (a)](#a), to the [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee and the [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee requested through the response protocol described in [subsection (a)(3)](#a-3) of the plan or coverage information on whether the [provider](/usc/42/299b–21.md?p=8) was a participating [provider](/usc/42/299b–21.md?p=8) or facility was a participating facility with respect to the plan for furnishing such item or [service](/usc/42/201.md?p=a) and was informed through such protocol that the [provider](/usc/42/299b–21.md?p=8) was such a participating [provider](/usc/42/299b–21.md?p=8) or facility was such a participating facility.
- (c) **Disclosure on patient protections against balance billing—** For plan years beginning on or after January 1, 2022, each [group health plan](/usc/42/300bb–8.md?p=1) and [health insurance issuer](/usc/42/300gg–91.md?p=b-2) offering group or [individual health insurance coverage](/usc/42/300gg–91.md?p=b-5) shall make publicly available, post on a public website of such plan or issuer, and include on each explanation of benefits for an item or [service](/usc/42/201.md?p=a) with respect to which the requirements under [section 300gg–111 of this title](/usc/42/300gg–111.md) applies—
  - (1) information in plain language on—
    - (A) the requirements and prohibitions applied under sections [300gg–131](/usc/42/300gg–131.md) and [300gg–132](/usc/42/300gg–132.md) of this title (relating to prohibitions on balance billing in certain circumstances);
    - (B) if provided for under applicable [State](/usc/42/201.md?p=f) law, any other requirements on [providers](/usc/42/299b–21.md?p=8) and facilities regarding the amounts such [providers](/usc/42/299b–21.md?p=8) and facilities may, with respect to an item or [service](/usc/42/201.md?p=a), charge a [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee of such plan or coverage with respect to which such a [provider](/usc/42/299b–21.md?p=8) or facility does not have a contractual relationship for furnishing such item or [service](/usc/42/201.md?p=a) under the plan or coverage after receiving payment from the plan or coverage for such item or [service](/usc/42/201.md?p=a) and any applicable cost sharing payment from such [participant](/usc/42/300gg–91.md?p=d-11), [beneficiary](/usc/42/300gg–91.md?p=d-2), or enrollee; and
    - (C) the requirements applied under [section 300gg–111 of this title](/usc/42/300gg–111.md); and
  - (2) information on contacting appropriate [State](/usc/42/201.md?p=f) and Federal [agencies](/usc/42/8262.md?p=1) in the case that an individual believes that such a [provider](/usc/42/299b–21.md?p=8) or facility has violated any requirement described in [paragraph (1)](#c-1) with respect to such individual.

## Source credit

(July 1, 1944, ch. 373, title XXVII, § 2799A–5, as added Pub. L. 116–260, div. BB, title I, § 116(a), Dec. 27, 2020, 134 Stat. 2878.)