New Transparency in Coverage Rule for 2022

The Transparency in Coverage Rule will come into effect on July 1, 2022. The rule was passed by the US Department of Health & Human Services, the Department of Labor, and the Department of Treasury in 2020. The rule outlines that all health insurers and group health plans must provide two separate machine-readable files: one for in-network providers and one for out-of-network benefits. In-network benefits must state negotiated rates for all covered items and services between the plan/insurer and in-network providers, while the out-of-network benefits must state the allowed amount paid to, and billed charges from, out-of-network providers for all covered services within a 90-day period. It’s important that all businesses understand the implications of this rule to ensure compliance.

So, what does this mean for your business?

As benefits become increasingly more expensive for businesses and employees, the need for transparency in pricing has become apparent. This new rule impacts not only your business but also your employees. Providing your employees with up-to-date information on where to access pricing information should be a high priority. As a business owner, it is essential to understand your responsibility to comply with changes in regulations.

How To Prepare for Transparency in Coverage Compliance:

If your company is self-insured, which includes level funding arrangements, you have work to do, and the deadline is fast approaching! 

  1. Contact your benefits advisor and your plan administrator to understand how they will ensure your plan meets these requirements by July 1st. 
  2. Work with your advisor and administrator to develop a resource sheet for your employees to reference when looking for pricing and plan information.

If your medical benefits are fully insured, your health plan insurer is responsible for compliance. Compliance information should be available on your health plan insurer’s website. You should also consider going over this information with your employees to ensure full understanding.

Have questions or concerns regarding compliance and the Transparency in Coverage Rule? Our Benefits Advisors are here to help you understand your benefits plan, keep up to date on regulations and make the compliance process as seamless as possible. Reach out to one of our Benefits Advisors at (973) 658 -7227 today!

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Eric Thieringer President
Eric Thieringer is president of Eli Advisors, an HR, payroll and employee benefits firm focused on serving small to mid-size organizations. Eli's services and support address the frustrating gaps that challenge employers and their employees. By solving these problems, Eli Advisors creates financially sustainable programs and services that help organizations attract, retain, and engage the talent needed to succeed.