On October 5, 2026, the Departments of Health and Human Services, Labor, and the Treasury finalized updates to the federal Transparency in Coverage (TiC) regulations. The new regulations reflect a significant overhaul of the current TiC file framework and compliance requirements. TiC rules apply to group health plans and are intended to make health care pricing easier to find, compare, and trust.
The changes take effect for plan years beginning on or after January 1, 2027, with operational requirements phased in through July 1, 2028.
For employers, the key point is that group health plans remain responsible for compliance even when a carrier, third-party administrator (TPA), or other vendor performs the technical work.
What Were the Prior Requirements?
The prior rules required public, machine-readable files containing negotiated in-network rates and out-of-network allowed amounts and historical billed charges. The required pricing files were often enormous, highly technical, and difficult for employers, participants, and even data specialists to locate and use. Inconsistent formats, duplicate or irrelevant data, unclear provider and network information, and questionable or incomplete rate reporting also created data-integrity concerns and made meaningful comparisons difficult.
Some of the data elements reflected provider-to-service pairings that ranged from implausible to comical. For example, listing a podiatrist’s negotiated rate for delivering a baby or an ophthalmologist’s rate for performing a knee replacement. These are humorous illustrations of the mismatches the new rule is designed to screen out.
In short, the many data challenges made the disclosures more of a cumbersome compliance exercise than the practical tool for evaluating health care costs that was envisioned.
What Changed?
The earlier rules required plans and issuers to post large, public, machine-readable files containing in-network negotiated rates and historical out-of-network payment information.
The new rules do the following:
Special Note #1. The phone cost sharing information requirement is effective January 1, 2027. Employers should confirm that participants calling the phone number on the back of their health plan ID card will be provided with the required cost sharing information.
Special Note #2. Compliance with the TiC cost-sharing disclosure requirements also satisfies the price comparison tool requirements under the No Surprises Act. This eliminates the need for a separate tool.
The practical impact for employers depends on the plan funding arrangement.
1. Non-Grandfathered Plans (Most Plans Today)
Fully Insured Plans. The insurance carrier generally handles compliance (file creation and file posting). However, employers should confirm file posting responsibility, verify public link procedures, and maintain a written agreement that transfers these contractual responsibilities to the carrier.
Self-Funded Plans. Typically, employers contract out the compliance responsibilities (file creation, attestation, and sometimes file posting). However, employers remain legally responsible for compliance, even when a TPA, PBM, network vendor, or other partner is contracted to perform the operational work. ASO agreements should be updated to reflect this transfer of TiC compliance obligations. This includes any carve-out vendors that may need to report separately for a segment of the group health plan coverage.
Level-Funded Plans. Level-funded plans are self-insured plans, so employers retain responsibility for the compliance. Often level funded carriers provide additional levels of compliance support, but the ultimate responsibility rolls up to the employer, just as under a classic self-funded plan. Employers should confirm compliance elements that the vendor will be handling.
2. Grandfathered Plans
Grandfathered plans are exempt from the TiC rules, however, they are still covered by the price-comparison requirement and should prepare to comply with the new phone disclosure requirements.
1. Confirm Carrier/Vendor Responsibility. Identify carriers/vendors who will produce, host, update, and validate each required transparency file. Confirm carrier/vendor responsibility for operating the online and telephone cost-estimator services.
2. Update Agreements. Vendor service agreements should be updated to address updated TiC responsibilities, data access, error correction, attestation, and compliance evidence.
3. Verify Access. Confirm where required links and contact information will be hosted. Will it be on the employer’s benefits site, a vendor site, or both? Links should be public, functional, and easy to locate.
4. Verify Cost Tools. Test the cost-comparison process and confirm that employees can obtain personalized information by phone in addition to online and paper estimates.
5. Confirm ID Card Phone Number. Confirm the plan ID card phone number can deliver cost-sharing estimates by January 1, 2027.
6. Update Communications. Confirm that participant communications regarding access to cost and estimate data are updated.
7. Monitor Data Quality. Ask vendors how they validate rates, provider network information, and out-of-network claims data. Retain certifications, reports, screenshots, correspondence, and remediation records. Employers may also use standardized data to compare network pricing, evaluate vendors, and document prudent oversight of their ERISA plan.
Timing
The final rule is effective December 7, 2026, with requirements being phased in over two years. Changes to the in-network and out-of-network files begin in 2027, and other requirements continue into 2028.
Next Steps
A practical first step is to create a compliance inventory: identify each plan and funding arrangement; list the carrier, TPA, network, and pharmacy vendors; assign responsibility for every disclosure and consumer tool; confirm the applicable dates; test public links and telephone access; and review evidence of compliance at least quarterly. Employers should coordinate with benefits counsel or another qualified advisor when responsibilities are unclear or contracts need updating. By clarifying vendor roles and documenting oversight now, employers will be better positioned for implementation and better able to use the new information to manage plan costs and support employees.