Industry News

On November 15, 2019, the Departments of Health and Human Services (HHS), Labor (DOL), and the Treasury have issued a new Transparency in Coverage Proposed Rule.  The rule imposes transparency requirements for group health plans and health insurers in the individual and group markets.  Under the proposed regulations, employer-sponsored group health plans and health insurers would be required to disclose extensive amounts of plan cost-sharing information (on request) to participants, beneficiaries, and enrollees (or their authorized representatives).  According to the HHS, the proposed rule is intended to empower patients, increase competition and potentially help to lower health care costs. 

If the rule is finalized, the health plans and insurance issuers would be required to provide accurate estimates of out-of-pocket costs that must be paid by individuals to meet their deductible, copay or coinsurance requirements.  Specifically, they would be required to:

• Provide real-time cost-sharing information to participants through an online tool.  This information would include an estimate of the participant’s cost-sharing liability for all covered items and services that would allow consumers to compare costs between providers before receiving care.
• Disclose negotiated rates for in-network and out-of-network providers.

Comments are due by January 14, 2020.

The proposed rule is available here.