Are You Ready? Transparency in Coverage Compliance Deadline Approaching

Important reminder about a new requirement for group health plans and health insurance issuers: for plan years beginning on or after Jan. 1, 2023, plans and issuers were required to make price comparison information available for 500 shoppable items, services, and drugs. Starting in 2024, all covered items, services, and drugs must be included in the internet-based price comparison tool that is made available to participants, beneficiaries, and enrollees.

Starting in 2024, all covered items, services, and drugs must be included in the internet-based price comparison tool that is made available to participants, beneficiaries, and enrollees.

This requirement comes from final rules regarding transparency in coverage that were issued by the U.S. Departments of Labor, Health and Human Services, and the Treasury (Departments) in November 2020.

The purpose of this tool is to provide consumers with real-time estimates of their cost-sharing liability from different providers for covered items and services, including prescription drugs. This information can help consumers shop and compare prices before receiving care.

By providing employees with access to this price comparison tool, employers can help them save money on their healthcare costs. This can be a valuable benefit for employees, especially those who are struggling to afford healthcare.

Action steps for employers:

Most employers rely on their issuers or third-party administrators (TPAs) to develop and maintain the price comparison tool and provide related disclosures on paper or over the phone upon request.

To help ensure compliance, employers should consider the following steps:

• Fully insured health plans: An employer with a fully insured health plan is not required to provide the price comparison tool if the issuer agrees in writing to provide the tool. Employers with fully insured health plans should confirm that their issuer is providing the cost comparison tool and this responsibility is addressed in a written agreement.
• Self-insured health plans: Employers with self-insured plans (including level funded plans) may contract with another party, such as a third party administrator, to provide the required tool. Employers with self-insured health plans should reach out to their TPAs (or other service providers) to confirm that they are providing this tool and that this responsibility is addressed in a written agreement. In addition, employers should monitor their service provider’s compliance with this requirement. Unlike fully insured plans, the legal responsibility for this tool stays with a self-insured plan even if its service provider agrees to provide the price comparison tool on its behalf.

More information on this tool is available through the Centers for Medicare and Medicaid Services.

Time is running out! Employers should take steps to ensure that their organization is in compliance with this requirement by the end of the year.

Time is running out! Employers should take steps to ensure that their organization is in compliance with this requirement by the end of the year.

Have questions? Need assistance making sure you are in compliance by the deadline date of January 1st, 2024? Morrison Insurance Services is here to help you every step of the way.

• Visit our website to learn more about our group health insurance and employee benefits services: https://misbenefits.com
• Call us at 760-438-9311 to schedule a consultation with one of our experts.

Morrison Insurance Services, Inc. | License Number OD87966

2710 Gateway Road Carlsbad, CA 92009

Phone: 760-438-9311 | Website: https://misbenefits.com