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Group health plans and issuers will need to provide an internet-based price comparison tool available to participants, beneficiaries, and enrollees. The tool will provide consumers with real time estimates of their cost-sharing liability for covered items and services, including prescription drugs, so they can shop and compare prices before receiving care. This information must also be available in paper form or over the phone upon request.
For plan years beginning in 2023, price comparison tools must provide cost-sharing information for 500 items and services. For plan years beginning in 2024, price comparison tools must provide cost-sharing information for all covered items and services.
This requirement is part of the final rules regarding transparency in coverage (TiC Final Rules) that were issued by the Departments of Labor, Health and Human Services, and the Treasury in November 2020. The requirement does not apply to plans with grandfathered status, excepted benefits (such as limited-scope vision and dental benefits), and account-based plans like Flexible Spending Accounts, Health Reimbursement Arrangements, and Health Savings Accounts.
Most employers will rely on their health insurance carrier or third-party administrators (TPAs) to develop and maintain the price comparison tool and handle any phone or paper copy requests.
Employers with fully insured health plans should confirm that their carrier will comply with these rules beginning with 2023 plan years and ensure this compliance responsibility is reflected in a written agreement. Self-insured employers should reach out to their TPAs to confirm compliance by the deadline and update agreements as necessary.
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National Insurance Services is not a law firm and no opinion, suggestion, or recommendation of the firm or its employees shall constitute legal advice. Readers are advised to consult with their own attorney for a determination of their legal rights, responsibilities and liabilities, including the interpretation of any statute or regulation, or its application to the readers’ business activities.
