Transparency in Coverage

Price Transparency Guide

Transparency in Coverage Rule:

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 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.

Machine-Readable File Requirement:

The Machine Readable File requirements were designed by the Departments with the goal of placing downward pressure on health care costs through the disclosure of rate information and with the understanding that broad rate data available through the use of the MRF files would create additional transparency and opportunity for researchers and third-party developers to use the data to create even more benefits to consumers, including those consumers not currently enrolled in a particular plan or coverage.

Note: The below files are very large and expand to as large as 100GB files.