Beginning in 2024, group health plans and carriers will be required to include all covered items and services in their self-service internet-based price comparison tool, as required under the Transparency in Coverage (TIC) Final Rules.
As background, plans must provide participants and beneficiaries with out-of-pocket cost estimates via a user-friendly online self-service tool (and by paper upon request). The intent of this requirement is to provide individuals with real-time cost-sharing information to support making informed health care decisions. Implemented in two phases, the first phase of the price comparison tool required the first 500 items and services (as defined by the DOL) to be published in the tool effective for plan years beginning on or after January 1, 2023, and the second phase will require all other services covered by the plan to be included in the tool effective for plan years beginning on or after January 1, 2024.
Practically speaking, most employers are relying on their carriers and/or third-party administrators (TPAs) to comply with this requirement. That said, employers should consider the following action based on their plan’s funding type:
- Fully Insured: Confirm that your carrier is providing the required disclosures to now include all covered items and services as part of the self-service online tool. If not done already, it is recommended that fully insured employers have a written agreement with their carriers to provide the required disclosures. If there is a written agreement in place, the carrier (not the employer) will be held liable for any failure.
- Self-insured/Level Funded: Confirm that your TPA/ASO is providing the required disclosures to now include all covered items and services as part of the self-service online tool. If not done already, employers should consider entering into a written agreement with their ASO/TPAs to provide the required disclosures. Note, however, that self-insured/level funded employers will be held liable for any failure, even if there is a contract agreement in place with their ASO or TPA.
- TIC Public Disclosure FAQs
- Final Rule on Transparency in Coverage
- Sequoia Foreword: Round Up of the New Transparency Rules: The No Surprises Act, Health Plan Transparency, and Mental Health Parity
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