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Health Plans Need to Disclose Pricing Says DOL Final Rule

Health Plans Need to Disclose Pricing Says DOL Final Rule

Nov. 20, 2020
The DOL issued a final rule that discusses new requirements for employer-sponsored group health plans

The DOL issued a final rule that discusses new requirements for employer-sponsored group health plans. It includes a provision that these health plans provide plan enrollees with estimates of their out-of-pocket expenses for services from different health care providers.

Under the Transparency in Coverage, final rule—issued by the Departments of Labor (DOL), Treasury, and Health and Human Services (HHS) on Nov. 12—self-insured group health plans and insurance companies need to ensure that this information is so employees can compare costs prior to receiving care.

The Transparency in Coverage rule requires plans and insurers to disclose in-network rates negotiated with health care providers, payments made to out-of-network providers, and prices for prescription drugs. 

"We want every American to be able to work with their doctor to decide on the health care that makes sense for them, and those conversations can't take place in a shadowy system where prices are hidden," said HHS Secretary Alex Azar n a statement. "With more than 70% of the most costly health care services being shoppable, Americans will have vastly more control over their care." 

The rule will begin to take effect in January 2022 and will fully effective in 2024.

During the phase-in period:

  • Rates for all covered items and services negotiated with in-network providers, historical payment amounts made to out-of-network providers, and in-network negotiated rates and historic net prices for all covered prescription drugs are required to be made public for plan years that begin Jan. 1, 2022.
  • Cost-sharing information for over 500 "shoppable services" must be made available to enrollees for plan years beginning Jan. 1, 2023.
  • Cost-sharing information must be disclosed for all services for plan years beginning Jan. 1, 2024.
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EHS Today Staff

EHS Today's editorial staff includes:

Dave Blanchard, Editor-in-Chief: During his career Dave has led the editorial management of many of Endeavor Business Media's best-known brands, including IndustryWeekEHS Today, Material Handling & LogisticsLogistics Today, Supply Chain Technology News, and Business Finance. In addition, he serves as senior content director of the annual Safety Leadership Conference. With over 30 years of B2B media experience, Dave literally wrote the book on supply chain management, Supply Chain Management Best Practices (John Wiley & Sons, 2021), which has been translated into several languages and is currently in its third edition. He is a frequent speaker and moderator at major trade shows and conferences, and has won numerous awards for writing and editing. He is a voting member of the jury of the Logistics Hall of Fame, and is a graduate of Northern Illinois University.

Adrienne Selko, Senior Editor: In addition to her roles with EHS Today and the Safety Leadership Conference, Adrienne is also a senior editor at IndustryWeek and has written about many topics, with her current focus on workforce development strategies. She is also a senior editor at Material Handling & Logistics. Previously she was in corporate communications at a medical manufacturing company as well as a large regional bank. She is the author of Do I Have to Wear Garlic Around My Neck?, which made the Cleveland Plain Dealer's best sellers list.

Nicole Stempak, Managing Editor:  Nicole Stempak is managing editor of EHS Today and conference content manager of the Safety Leadership Conference.

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