Transparency in Coverage
The Departments of the Treasury, Labor, and Health and Human Services (the Departments) have issued the Transparency in Coverage final rules (85 FR 72158) on November 12, 2020. The final rules require non-grandfathered group health plans and health insurance issuers in the individual and group markets (plans and issuers) to disclose certain pricing information. Under the final rules a plan or issuer must disclose in-network negotiated rates and billed and out-of-network allowed through two machine-readable files(MRF) posted on an internet website.
Plans and issuers are required to make these files public for plan policy years beginning with 2022. This material is for information only. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Please note the link is not for members, that is why it needs to be posted on a public website and not an internal website.
The point of the release of these cost data files has nothing to do with communication to employees or plan participants, but instead, in the name of health cost transparency, this rule requires insurance companies and self-insured plans to publicize what they pay providers for medical services and make that available to the public. One of the primary goals with this requirement is that the information can then be gathered broadly, and data analytics run to provide more transparency across the industry.