Compliance FYI: Feds Issue Price Transparency Rule

On October 29, 2020, the Department of Health and Human Services (HHS), Department of Labor (DOL), and Department of the Treasury issued a final rule on price transparency. Specifically, the rule addresses the disclosure of pricing and cost sharing information by health insurance companies and self-insured plans with the goal of enabling consumers with private sector insurance to access real-time price information before pursuing treatment.

The specific price transparency requirements along with implementation dates are outlined below for non-grandfathered group health plans and health insurance issuers in the individual and group markets.

Effective January 1, 2022 plans shall provide members with: 

  • Standardized, regularly updated data files containing:
    • negotiated rates between the plan/issuer and in-network providers pricing and cost comparison data;
    • historical payments to, and billed charges from, out of network providers
    • in-network negotiated rate and historical net prices for all prescription drugs by plan or issuer at the pharmacy location level

Effective January 1, 2023, plans shall provide members with:

  • Cost sharing information for 500 specified items and services

Effective January 1, 2024, plans shall provide members with:

  • Cost-sharing information for all items and services

This requirement applies to non-grandfathered fully insured and self-funded group health plans. Health insurance carriers (fully insured) and third-party administrators (self-funded) will be required to work in conjunction with plan sponsors (employers) to provide this information and plan sponsors may contract with other parties to provide the required information. Further details will be provided in additional guidance.

This final rule provides the outline of requirements for health insurance carriers, third-party administrators and employers. We will continue to monitor releases from the federal agencies as they provide further guidance and details in regards to logistics and requirements.
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The information above is a summary of laws and regulations regarding provisions relating to employee benefit plan compliance. The information should not be construed as legal or tax advice. In all cases, employers should be advised to consult with tier accountant or legal counsel for assistance.

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