Transparency in Coverage Rules: Action Required for Self-Insured Health Plans
By Vita on May 24, 2022
Implemented in Phases
The first phase of compliance requires the posting of three Machine-Readable Files (MRF) that disclose the cost of healthcare services. These are files that can be imported and read by computer systems. The three files disclose the following data:- In-Network Rate (negotiated rates with contracted providers)
- Out-of-Network Allowed Rates (billed charges and allowed amounts)
- In-Network Prescription Drug File
These files must be updated monthly and must be accessible without login credentials or fees to access the files. The In-Network and Out-of-Network files must be posted and accessible by July 1, 2022. The prescription drug file has been delayed until further notice. It should be noted that the format of these files is not something that is decipherable at the consumer level.
The second phase will include the rollout of an online cost estimator tool which will provide consumers with cost share estimates for all covered services. The first round of the consumer level disclosure requirement is effective January 1, 2023 and reflects a list of 500 designated services. The final phase will require costs for all services to be disclosed. This last phase is effective January 1, 2024.
Fully Insured Plans: No Action Required
For those employer groups with fully insured plans, it is the responsibility of the insurance carrier to comply with the MRF requirements. Vita is in the process of confirming that all insurance carriers will be in compliance with this requirement.Self-Insured Plans: Action Required for July 1, 2022
Employers that offer self-insured health plans must take action to comply with these requirements. The specific requirement is to post somewhere on their public website a link to the MRF. Employers will be able to determine where, on their website, this file is posted as long as it is publicly facing and does not require login credentials. The requirements state that anyone in the United States should be able to locate this link.Employers should start working with IT resources now to ensure compliance by the July 1 deadline.
Next Steps
Vita clients with self-insured plans will receive an email with additional instructions based on the specifics of the health plans in place and recommendations on verbiage to assist in the process.Vita will continue to monitor the developments of the cost estimator tool and post further updates as information is solidified.
- April 2025 (1)
- March 2025 (4)
- February 2025 (1)
- January 2025 (2)
- December 2024 (4)
- November 2024 (1)
- October 2024 (5)
- September 2024 (1)
- May 2024 (3)
- March 2024 (4)
- February 2024 (1)
- January 2024 (4)
- December 2023 (1)
- November 2023 (7)
- October 2023 (3)
- September 2023 (5)
- June 2023 (2)
- May 2023 (5)
- April 2023 (5)
- February 2023 (7)
- January 2023 (2)
- November 2022 (1)
- October 2022 (2)
- September 2022 (2)
- August 2022 (4)
- June 2022 (1)
- May 2022 (2)
- January 2022 (1)
- December 2021 (1)
- November 2021 (2)
- August 2021 (1)
- May 2021 (2)
- April 2021 (1)
- March 2021 (3)
- December 2020 (1)
- November 2020 (1)
- October 2020 (1)
- September 2020 (1)
- June 2020 (1)
- March 2020 (3)
Subscribe by email
Share this
Previous story
← Implementing a Medical Travel BenefitYou May Also Like
These Related Stories
The Latest on Rx Data Collection (RxDC)

The Latest on Rx Data Collection (RxDC)
March 5, 2024
4
min read
Upcoming Rx Data Collection (RxDC)

Upcoming Rx Data Collection (RxDC)
March 6, 2025
4
min read
New Reporting Requirements for Rx Spending

New Reporting Requirements for Rx Spending
August 3, 2022
3
min read