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.