In accordance with the government’s Transparency in Coverage Rules, the Departments of Labor, Health and Human Services and Treasury require Health Plans disclose on a public website Machine-readable files.
These files provide pricing data for covered items and services based on in-network negotiated payment rates and historical out-of-network allowed amounts.
Health plan price transparency is designed to help consumers know the cost of a covered item or service before receiving care.
Beginning July 1, 2022, most group health plans, and issuers of group or individual health insurance will begin posting pricing information for covered items and services.
This pricing information can be used by third parties, such as researchers and app developers to help consumers better understand the costs associated with their health care.
More requirements will go into effect starting on January 1, 2023, and January 1, 2024, which will provide additional access to pricing information and enhance consumers’ ability to shop for the health care that best meet their needs.