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Final Rule on Health Care Transparency Issued

SIMA Financial Group > Benefits  > Final Rule on Health Care Transparency Issued

Final Rule on Health Care Transparency Issued

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:

  • Price and cost-sharing information to participants, beneficiaries and enrollees upon request:
    • A list of 500 shoppable services must be available via the internet for plan years beginning or after Jan. 1, 2023.
    • The remainder of all items and services is required to be available for plan years beginning on or after Jan. 1, 2024.
      • In-network provider-negotiated rates and historical out-of-network allowed amounts on their website:
        • Detailed pricing information must be made public for plan years beginning on or after Jan. 1, 2022.

      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.

      Contact us today to learn more.