Health Plan Transparency in Coverage

In December 2020, the Consolidated Appropriations Act (CAA) was signed into law. At the same time, the Transparency in Coverage (TIC) rule was enacted. Even though the CAA and TIC will be implemented in a phased manner over a number of years, the ultimate goal of these rules is to make healthcare costs more transparent for plan participants.

Health plan price transparency helps consumers know the cost of a covered item or service before receiving care. Beginning July 1, 2022, most group health plans and issuers of group or individual health insurance will begin posting pricing information for covered items and services.

This pricing information can be used by third parties, such as researchers and app developers, to help consumers better understand the costs associated with their healthcare. More requirements will go into effect starting on January 1, 2023, and January 1, 2024, which will provide additional access to pricing information and enhance consumers' ability to shop for the healthcare that best meet their needs.

In three stages, most group health plans and issuers of group or individual health insurance are required to disclose pricing information.

1. Machine-Readable Files containing the following sets of costs for items and services
2. Internet-based price comparison tool (or disclosure on paper, upon request) allowing an individual to receive an estimate of their cost-sharing responsibility for a specific item or service from a specific provider or providers, for 500 items and services.
3. Internet-based price comparison tool (or disclosure on paper, upon request) allowing an individual to receive an estimate of their cost-sharing responsibility for a specific item or service from a specific provider or providers, for all items and services.

Source: https://www.cms.gov/healthplan-price-transparency/plans-and-issuers(Opens in a new window)

Reference: DOL FAQ

To meet regulatory requirements, our carrier partners have provided guidance on the provision.