Transparency in Coverage Final Rule Released

On October 29, 2020, the Department of Health and Human Services (HHS) released the Transparency in Coverage Final Rule. The final rule sets requirements for 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. Plans and issuers are required to make this information available on a website and, if requested, in paper. The final rules also require plans and issuers to disclose in-network provider negotiated rates, historical out-of-network allowed amounts, and drug pricing information.

HHS issued a separate transparency final rule for hospitals on November 15, 2019.


For more information visit the McDermottPlus Payment Innovation Resource Center or contact Sheila Madhani at 202-204-1459/ or Mara McDermott at 202-204-1462/