Agencies Propose Health Insurance Price-Transparency Rules

The Departments of Labor (DOL) and Health and Human Services (HHS), together with the Internal Revenue Service (IRS), have proposed rules that would require employer-sponsored health plans to provide enrollees with out-of-pocket expense estimates.

health-care-spending-to-rise-5.5%-annuallyThe rules work in tandem to achieve what the DOL describes as requiring “group health plans and health insurance issuers in the individual and group markets to disclose cost-sharing information upon request, to a participant, beneficiary, or enrollee (or his or her authorized representative), including an estimate of such individual’s cost-sharing liability for covered items or services furnished by a particular provider.”

The information would need to be posted on a website and, if requested, made available through non-Internet means. The online data would need to be machine-readable, “allowing the public to have access to health insurance coverage information that can be used to understand health care pricing and potentially dampen the rise in health care spending.”

These proposed rules also include proposals to require plans and issuers to disclose in-network provider negotiated rates, and historical out-of-network allowed amounts.

The agencies will be accepting public commentary through 5 p.m. on Jan. 14, 2020.

NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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