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Transparency in Coverage

On October 29th, the release of the Transparency in Coverage (TiC) rule delivered and finalized methods to enable consumers to know and understand the cost of health care, and their corresponding out-of-pocket costs, before they receive services. The Transparency in Coverage Final Rule was set forth by the U.S. Department of the Treasury, the U.S. Department of Labor, and the U.S. Department of Health and Human Services (the Departments) in response to President Trump’s previous Executive Order to improve quality, choice and competition in the health care market. This rule specifically targets improvement of consumer information in the health care decision-making process, giving consumers the tools needed to access pricing information through their health plans.

The machine-readable file requirements of the TiC Final Rules are applicable for plan years (in the individual market, policy years) beginning on or after January 1, 2022.

Machine-Readable Files (MRFs)

Plans and issuers must publicly disclose cost-related information using machine-readable files (MRFs), updated monthly, that include: 1) payment rates for in-network providers; 2) historical pricing information showing allowed amounts and charges for covered items and services from out-of-network (OON) providers; and 3) information on prescription drug pricing. Plans must also make the information available on an internet website. Plans cannot charge a fee, require individuals to create a user account, or mandate that participants provide personally identifiable information to access the pricing information. This information must also be provided to participants on paper upon request.

Access the Files