Tag: Price Transparency

  • Transparency in Coverage

    May 25, 2022

    Tags: ,

    Health plan price trans­paren­cy helps con­sumers know the cost of a cov­ered item or ser­vice before receiv­ing care. Begin­ning July 1, 2022, most group health plans and issuers of group or indi­vid­ual health insur­ance will begin post­ing pric­ing infor­ma­tion for cov­ered items and ser­vices. This pric­ing infor­ma­tion can be used by third par­ties, such as researchers and app devel­op­ers to help con­sumers bet­ter under­stand the costs asso­ci­at­ed with their health care. More require­ments will go into effect start­ing on Jan­u­ary 1, 2023, and Jan­u­ary 1, 2024 which will pro­vide addi­tion­al access to pric­ing infor­ma­tion and enhance con­sumers’ abil­i­ty to shop for the health care that best meet their needs.

    Mak­ing pric­ing infor­ma­tion avail­able to the public

    In three stages, most group health plans and issuers of group or indi­vid­ual health insur­ance are required to dis­close pric­ing information.

    1.    Machine-Read­able Files con­tain­ing the fol­low­ing sets of costs for items and services

    • In-Net­work Rate File: rates for all cov­ered items and ser­vices between the plan or issuer and in-net­work providers.
    • Allowed Amount File: allowed amounts for, and billed charges from, out-of-net­work providers.

    2.    Inter­net-based price com­par­i­son tool (or dis­clo­sure on paper, upon request) allow­ing an indi­vid­ual to receive an esti­mate of their cost-shar­ing respon­si­bil­i­ty for a spe­cif­ic item or ser­vice from a spe­cif­ic provider or providers, for 500 items and services.

    3.    Inter­net-based price com­par­i­son tool (or dis­clo­sure on paper, upon request) allow­ing an indi­vid­ual to receive an esti­mate of their cost-shar­ing respon­si­bil­i­ty for a spe­cif­ic item or ser­vice from a spe­cif­ic provider or providers, for all items and services.

    Stay tuned for more! Phase 2 and Phase 3 go into effect in 2023 and 2024.

    By plan or pol­i­cy years begin­ning on or after Jan­u­ary 1, 2023, most group health plans and issuers of group or indi­vid­ual health insur­ance cov­er­age are required to dis­close per­son­al­ized pric­ing infor­ma­tion for all cov­ered items and ser­vice to their par­tic­i­pants, ben­e­fi­cia­ries, and enrollees through an online con­sumer tool, or in paper form, upon request. Cost esti­mates must be pro­vid­ed in real-time based on cost-shar­ing infor­ma­tion that is accu­rate at the time of the request.

    Read More »

  • Transparency in Coverage

    May 25, 2022

    Tags: ,

    Health plan price trans­paren­cy helps con­sumers know the cost of a cov­ered item or ser­vice before receiv­ing care. Begin­ning July 1, 2022, most group health plans and issuers of group or indi­vid­ual health insur­ance will begin post­ing pric­ing infor­ma­tion for cov­ered items and ser­vices. This pric­ing infor­ma­tion can be used by third par­ties, such as researchers and app devel­op­ers to help con­sumers bet­ter under­stand the costs asso­ci­at­ed with their health care. More require­ments will go into effect start­ing on Jan­u­ary 1, 2023, and Jan­u­ary 1, 2024 which will pro­vide addi­tion­al access to pric­ing infor­ma­tion and enhance con­sumers’ abil­i­ty to shop for the health care that best meet their needs.

    Mak­ing pric­ing infor­ma­tion avail­able to the public

    In three stages, most group health plans and issuers of group or indi­vid­ual health insur­ance are required to dis­close pric­ing information.

    1.    Machine-Read­able Files con­tain­ing the fol­low­ing sets of costs for items and services

    • In-Net­work Rate File: rates for all cov­ered items and ser­vices between the plan or issuer and in-net­work providers.
    • Allowed Amount File: allowed amounts for, and billed charges from, out-of-net­work providers.

    2.    Inter­net-based price com­par­i­son tool (or dis­clo­sure on paper, upon request) allow­ing an indi­vid­ual to receive an esti­mate of their cost-shar­ing respon­si­bil­i­ty for a spe­cif­ic item or ser­vice from a spe­cif­ic provider or providers, for 500 items and services.

    3.    Inter­net-based price com­par­i­son tool (or dis­clo­sure on paper, upon request) allow­ing an indi­vid­ual to receive an esti­mate of their cost-shar­ing respon­si­bil­i­ty for a spe­cif­ic item or ser­vice from a spe­cif­ic provider or providers, for all items and services.

    Stay tuned for more! Phase 2 and Phase 3 go into effect in 2023 and 2024.

    By plan or pol­i­cy years begin­ning on or after Jan­u­ary 1, 2023, most group health plans and issuers of group or indi­vid­ual health insur­ance cov­er­age are required to dis­close per­son­al­ized pric­ing infor­ma­tion for all cov­ered items and ser­vice to their par­tic­i­pants, ben­e­fi­cia­ries, and enrollees through an online con­sumer tool, or in paper form, upon request. Cost esti­mates must be pro­vid­ed in real-time based on cost-shar­ing infor­ma­tion that is accu­rate at the time of the request.

    Read More »

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