Transparency in Coverage Rule

For the last 3 decades, healthcare pricing data has not been available for the public to use in making informed healthcare procurement decisions. Under the new transparency rule, employers and their members, will benefit from reduced healthcare costs, better quality, and consistency of care at multiple levels in the healthcare system.

Employer sponsored group health plans, insurance issuers and Hospitals will be required to disclose certain information. Are you required to be compliant?

1. Costs for items and Services

   • In-network rates for all covered items and services between the plan or issuer and in-network providers

   • Allowed amounts for, and billed charges from, out-of-network providers.

2. Internet-based price comparison tool (also available by phone, or in paper form, upon request) allowing an individual to receive an estimate of their cost-sharing responsibility for a specific item or service from a specific provider or providers, for 50 items and services.

3. Internet-based price comparison tool (or disclosure on paper, upon request) allowing an individual to receive an estimate of their cost-sharing responsibility for a specific item or service from a specific provider or providers, for all items and services.

   
   

Hospital and Payer Transparency Benefits for Advisors and Employers

Bridge the Data Gap

New Hospital and Payer Transparency legislation passed in 2021 and recently made pricing, cost, and payer data available for the first time; however, due to the sheer size of the data set and lack of standardization, it is impossible for employers and advisors to take advantage of this transformative information. Our strategic partner’s solution integrates hospital, payer, CMS and employer claims. Advisors and Employers can procure health benefits based on comparision by service, hospital, carrier, by value or based on utilization.