Transparency in Coverage

Transparency in Coverage: The July 1, 2022 deadline is here. In 2020, the Federal Government finalized two rules, both intended to make health care pricing more accessible and understandable for consumers. The “Transparency in Coverage” Rule requires health insurers and group health plans, including self-funded clients, to provide cost-sharing data to consumers via:

• Machine-readable files: Machine-readable files must be published for plan years beginning on or after July 1, 2022 and provide pricing data for covered items and services (in-network negotiated payment rates, historical out-of-network allowed amounts, and prescription* drug rates (currently this ruling is being delayed) and historical costs). Information in these files must be updated monthly. The Web site is: Transparency in Coverage (uhc.com)
• Consumer price transparency tool: This online tool for members will include personalized, real-time, cost-share estimates for covered services and items, including Rx with paper versions available upon request. The tool will be available for plan years beginning on or after Jan 1, 2023 for 500 designated services and plan years beginning on or after Jan 1, 2024 for all services.