Final Rule Issued for Health Care Transparency

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The Department of Labor, Health and Human Services, and the Treasury Department issued the final ruling regarding the transparency in health care coverage for group health plans and health insurers in both the individual and group markets. These changes affect non-grandfathered coverage including self-insured and insured group health plan sponsors.

The final rule will require plans and issuers to disclose personalized price and cost-sharing information to consumers.

• Personalized cost-sharing information must be available online in a self-service tool. An initial list of 500 shoppable services will be required for plan years beginning on or after January 1, 2023. The remainder of all services and items will be required for plan years beginning on or after January 1, 2024.
• Issuers and plans must also disclose online their in-network negotiated rates, billed charges, and allowed amounts for paid out-of-network providers, and the negotiated rate and historical net price for prescription drugs. This is for plans beginning on or after January 1, 2022.

Issuers who share savings with consumers resulting from consumers shopping for lower-cost, higher-value services can take credit for the “shared savings” payments in their medical loss ratio calculations.

Download the bulletin for more details.