In 2020, the Federal Government released its Transparency in Coverage Rule, which requires health insurers and self-funded plans to provide data on in- and out-of-network standard rates for their commercial and self-funded lines of business.
There are two major components to this rule:
- Machine-readable files, effective July 1, 2022: health plans publish “machine-readable” files of their pricing data for covered in-network items and services and allowed amounts for, and billed charges from, out-of-network providers.
- Internet-based price comparison tool, effective January 1, 2023: health plans provide internet-based price comparison tools to allow an individual to receive an estimate of their cost-sharing responsibility for 500 shoppable services. As of January 1, 2024, health plans provide their price comparison tools for all items and services.
Files will be updated on a regular basis.