The Departments of Health and Human Services, Labor, and Treasury (“the Departments”) have issued the final rule on health care coverage transparency, imposing important new requirements on non-grandfathered health plans and self-insured plans to disclose health care cost and cost-sharing information.
Group Health Plan Transparency Requirements
For plan years beginning on or after January 1, 2022, plans must make the following information available to the public via a machine-readable file and update it every month:
- In-network negotiated rates between the plan and its providers for covered services and items;
- Out-of-network allowable charges and billed amounts for the most recent 90-day period; and
- Negotiated rates for In-network prescription drugs and historical net prices for all prescription drugs covered by the plan at the pharmacy location level.
- In-network and out-of-network negotiated rates for all covered health care services and items, including prescription drugs;
- Estimated cost-sharing amount for the insured;
- How much the insured has paid to date toward the plan’s deductible or out-of-pocket maximum;
- If the service or item requested is part of a bundled payment, a list of items or services included in the bundle for which cost-sharing information is available; and
- A notice if there are any requirements prior to obtaining coverage.
