Transparency in Coverage

Requirements and updates

Transparency in coverage final rule — public access requirement

On October 29, 2020, the Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury jointly released the final Transparency in Coverage final rule, which implements the section 1311(e)(3) of the AffordableCare Act. The rule requires that group health plans and issuers offering coverage in the group and individual markets post in-network and out-of-network rates they negotiate with providers that must be in a machine-readable format. Issuers and grouphealth plans must also develop online price transparency tools to give consumers and other stakeholders cost-sharing information. The rule excludes grandfathered plans, Medicare, personal funding accounts, vision-only, and dental-only plans.

Please be aware the Consolidated Appropriations Act has transparency requirements that are similar to the Transparency in Coverage rule. The information below is specific to the Transparency in Coverage rule only.