Health Plan Price Transparency - Transparency in Coverage

Health plan price transparency helps consumers know the cost of a covered item or service before receiving care. The user will be able to view the Files associated with an employer’s name. Users will visit to access their table of contents (TOC) file. Once a user clicks on the TOC file with their employer name, they will see the File(s) associated with the health plan(s). 

The Transparency in Coverage Rule, issued in 2020 by the U.S. Department of Health & Human Services, U.S. Department of Labor and U.S. Department of the Treasury and enforced beginning 7/1/22, health plans (which includes clients who sponsor employee benefit plans) and health insurance issuers must publish two separate Machine Readable Files: 

  • 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