Transparency in Coverage Rule
On November 12, 2020, the Departments of Health and Human Services, Labor and the Treasury finalized the Transparency in Coverage Rule that requires health insurers and group health plans to create a member-facing price comparison tool and post publicly available machine-readable files.
The machine-readable files include negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.
Please see below for additional details, timing, and applicable links.
Document Links In This Article
Publicly Available Machine-Readable Files – https://www.cigna.com/legal/compliance/machine-readable-files
Consumer Price Transparency Tool
- Beginning with plan years on or after January 1, 2023, insurers and plans are required to create online consumer tools that include personalized information regarding members’ cost-sharing responsibilities for covered items and services, including prescription drugs.
- Implementation will be phased; starting January 1, 2023, the tool must include estimates for 500 “shoppable” services. All covered items and services must be included by January 1, 2024.
- The cost estimator tool can be found on www.myCigna.com.
Publicly Available Machine-Readable Files
- Effective July 1, 2022, insurers and plans will be required to make available to the public machine-readable files disclosing detailed information on the costs of covered items and services including prescription drug pricing.
- Cigna has complied with this requirement and these files are available by following this link: https://www.cigna.com/legal/compliance/machine-readable-files
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