Transparency in Coverage (TiC) Update: What You and Your Employers Should Know Now

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In December 2020, the Consolidated Appropriations Act (CAA) was signed into law. Just prior to that—in November 2020—the Transparency in Coverage (TiC) Final Rule was issued. While the goal of these is to make healthcare costs more transparent for plan participants, for employers, the phased manner in which they will be implemented means a lot of dates and responsibilities to stay on top of and potential penalties if these are not met.

According to Marilyn Monahan of Monahan Law Office, whose name you might recognize from Warner Pacific broker webinars, you and your employers should know about these important deadlines: 

July 1, 2022: Plans with a plan year beginning on or after January 1, 2022, were required to post two machine readable files (MRFs) by July 1. These MRFs must disclose in-network provider rates for covered items and services and out-of-network allowed amounts. They must be accessible to the public, free of charge and without conditions. This mandate applies to fully insured and self-funded health plans, but not to grandfathered plans. 

January 1, 2023: In addition, there’s an online self-service tool mandate included in the TiC Final Rule. The first compliance deadline is for plan years beginning on or after January 1, 2023. At that time, a list of the cost for 500 shoppable items and services must be posted. 

January 1, 2024: Beginning January 1, 2024, for plan years beginning on or after that date, the cost for all other items and services must be posted. 
“If you are an employer with a fully insured health plan,” explains Marilyn about the recently passed July deadline, “the carrier could have posted this data for you, but the rules required that you entered into a written agreement with the carrier.” Then, if the employer and the carrier entered into a written agreement, under which the issuer agreed to provide the required information, and the carrier then failed to do so, the carrier, not the employer, then the issuer, remains responsible for any violation of the Final Rule. 
For self-funded plans, it’s similar: An employer could have entered into a written agreement with a third-party vendor to post the information. However, in the case of a self-funded plan, if the third-party then failed to comply, the employer still remains liable for any applicable penalties.
“The biggest challenge has just been getting the word out to ensure that plans and issuers fully complied by the deadline,” shares Marilyn. “There’s so much going on that I think employers are having difficulty keeping up with all the new developments.”

She adds that the most valuable thing brokers can do is continue to inform and educate employers on the mandate, including what they have to do and by when, and supply them with updates on steps carriers and third-party vendors are taking to assist with compliance.

“Particularly for those with employers with self-funded plans,” she says, “they need to make sure their third-party vendors were on top of this because the deadline is upon us.”

For more updates on TiC, visit the Legislative Updates section of the Warner Pacific website.

Frequently Asked Questions on Transparency in Coverage:
The Biden Administration also recently released frequently asked questions and answers around TIC regulations.  

Source: Warner Pacific