Transparency in Coverage Rule
In compliance with The Transparency in Coverage Rule, issued in 2020, effective beginning July 1, 2022, health plans and health insurance issuers must publish two separate Machine-Readable Files (MRFs) containing In-Network and Out-Of-Network details. We are pleased to provide the following information to participants.
The final rule released by the Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury delivers on Improving Price and Quality Transparency in American Healthcare.
The rule requires most group health plans, and health insurance issuers to disclose price and cost-sharing information to participants, beneficiaries, and enrollees. Pricing to include negotiated rates, billed charges and allowed amounts paid for out-of-network providers, and the negotiated rate and historical net price for prescription drugs. The files will contain the following details:
- In-Network: Negotiated rates for all covered items and services between the plan or issuer and in-network providers
- Out-of-Network: Allowed amount paid to, and billed charges from, out-of-network providers for all covered services within a 90-day period
The link provided below leads to the MRFs that are made available in response to the federal Transparency in Coverage Rule. The MRFs are formatted to allow participants, researchers, regulators, and application developers to easily access and analyze data.