Health Plan Transparency
Health plan price transparency helps consumers know the cost of a covered item or service before receiving care. Beginning July 1, 2022, HealthFirst TPA, Inc. started publishing machine-readable files contraining the following sets of costs for items and services:
- In-Network Rate File: rates for all covered items and services between your plan and in-network providers.
- Allowed Amount File: allowed amounts for, and billed charges from, out-of-network providers.
To access the machine readable files for your plan, please go to your employer's website to access the link to your plan.
Phase 2 and Phase 3 go into effect in 2023 and 2024.
For more information about the Health Plan Transparency, please vist Consumers | CMS
Background
The Departments of the Treasury, Labor, and Health and Human Services (the Departments) have issued the Transparency in Coverage final rules (85 FR 72158) on November 12, 2020. The final rules require non-grandfathered group health plans and health insurance issuers in the individual and group markets (plans and issuers) to disclose certain pricing information. Under the final rules a plan or issuer must disclose in-network negotiated rates, and billed and out-of-network allowed through two machine-readable files posted on an internet website.
Plans and issuers are required to make these files public for plan or policy years beginning on or after July 1, 2022.
