Insurance Company to Disclosed Negotiated Rates



T.D. 9929; Code Sec. 9815

The Department of Treasury and Health and Human Services (HHS) (collectively the "Departments") have finalized the latest insurance price transparency rules. These rules require group health plans and insurance issuers ("insurance companies") to disclose cost-sharing information upon request by participant, beneficiary, or enrollee. The insurance companies must disclose the information online or, if requested, in paper form. These rules allow participants to understand health care pricing and aim to dampen the rise in health care spending.


Cost-sharing information includes:

  • estimates of the individual’s cost-sharing liability for covered items or services furnished by a particular provider,

  • in-network provider negotiated rates,

  • historical out-of-network allowed amounts, and

  • drug pricing information through three machine-readable files posted on an internet website.

Although the participants would much appreciate a fast implementation of these rules, the Departments have allowed the implementation to be phased in.

  • The requirements to publish the machine-readable files will become effective for plan years (or in the individual market, for policy years) beginning on or after January 1, 2022.

  • Plans and issuers will be required to provide pricing information for a minimum of 500 items and services identified by the Departments beginning with plan years (or in the individual market, policy years) on or after January 1, 2023.

  • Plans and issuers will be required to provide the pricing information through the internet-based self-service tool for all items and services by plan years (or in the individual market, policy years) beginning on or after January 1, 2024.

These materials have been prepared by Le Tax Law, PLLC for informational purposes only. They are not intended to be and should not be considered legal advice.


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