This legislation, titled the Clear Healthcare Expense Cost Knowledge Act of 2026, seeks to significantly enhance transparency across the healthcare billing and payment ecosystem. It introduces new requirements for various entities involved in healthcare administration and delivery, aiming to provide clearer cost information to both health plans and individual patients. The bill amends existing laws, including the Employee Retirement Income Security Act (ERISA), the Public Health Service Act (PHSA), and the Internal Revenue Code (IRC), to achieve these objectives. A key provision mandates that health plan service providers , such as third-party administrators and pharmacy benefit managers, must quarterly disclose detailed financial and contractual information to group health plans and health insurance issuers. This includes contractual methodologies for reimbursement, total rebates and fees received, and payment data for alternative compensation arrangements, all provided at no cost. Agreements that limit or delay such disclosures are prohibited and deemed void, with non-compliance incurring a civil penalty of $100,000 per day. Furthermore, the bill strengthens patient-facing transparency by requiring health plans and insurers to provide a comprehensive Explanation of Benefits (EOB) within 45 days of receiving a payment request. These EOBs must be clear, understandable, and itemized, detailing each service, its billing codes, the amount the plan is responsible for, the patient's cost-sharing, and their progress towards deductibles and out-of-pocket maximums. This builds upon existing good faith estimate requirements, ensuring patients receive detailed cost breakdowns. Finally, the legislation imposes new requirements on healthcare providers and facilities regarding itemized bills. They must provide a written, itemized bill to individuals within 30 days of receiving final payment from a third party, detailing each service, its billing codes, price, and any payments already made. These bills must also include information on language assistance, a contact for bill inquiries, and charity care policies. The bill prohibits collection actions if these itemized bill requirements are not met or if charges exceed federal price transparency regulations or good faith estimates without documented justification, with penalties up to $10,000 per instance for non-compliance.