The Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments) issued a final rule that imposes new transparency requirements on group health plans and health insurers in the individual and group markets.
Specifically, the final rule requires plans and issuers to disclose:
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Price and cost-sharing information to participants, beneficiaries and enrollees upon request:
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A list of 500 shoppable services must be available via the internet for plan years beginning or after Jan. 1, 2023.
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The remainder of all items and services is required to be available for plan years beginning on or after Jan. 1, 2024.
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In-network provider-negotiated rates and historical out-of-network allowed amounts on their website:
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Detailed pricing information must be made public for plan years beginning on or after Jan. 1, 2022.
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The final rule also allows issuers that share savings with consumers—resulting from consumers shopping for lower-cost, higher-value services—to take credit for those “shared savings” payments in their medical loss ratio calculations.
