Summary

On October 5, 2026, federal agencies issued a final rule updating Transparency in Coverage (TiC) requirements for employer-sponsored health plans. Key changes include restructuring machine-readable files (MRFs) by provider network and market type, adding phone-based price comparison tools, introducing quarterly MRF updates with attestations, and releasing new contextual files (utilization, taxonomy, and text). Employer plan sponsors should verify vendor readiness, confirm contractual attestation responsibilities, and monitor phased compliance deadlines from January 2027 through 2028.

On October 5, 2026, the U.S. Departments of Labor, Health and Human Services, and the Treasury (“Departments”) issued a final rule updating the Transparency in Coverage (TiC) requirements, revising healthcare price transparency requirements for non-grandfathered group health plans and health insurance issuers (i.e., carriers). The final rule substantially restructures the machine-readable file framework (MRF); requires telephone access to personalized cost sharing information upon request; and aligns certain Transparency in Coverage requirements with overlapping No Surprises Act (NSA) obligations.

In addition to issuing the final rule, the Departments and Centers for Medicare & Medicaid Services (CMS) also released these supporting resources:

Per the Department of Labor (DOL), the new rules standardize how pricing information is published, cut down on unnecessary or irrelevant data, organize information in a more logical way, and make data easier to locate. While TiC compliance largely is handled by carriers, third-party administrators (TPAs), pharmacy benefit managers (PBMs) and other vendors, employer plan sponsors should be aware of these changes and any related employer action, discussed below.

Background

The TiC regulations require non-grandfathered group health plans to publicly disclose detailed pricing information, including through an internet-based self-service tool and in paper form upon request (among other requirements).

Specifically, plans must post three separate machine-readable files on a public website containing information on: (1) in-network rates for covered items and services, (2) out-of-network allowed amounts and billed charges for covered items and services, and (3) negotiated rates and historical net prices for covered prescription drugs (on hold while awaiting technical guidance from the Departments). Plans must also provide participants and beneficiaries with out-of-pocket cost estimates through a user-friendly online self-service tool, with paper copies available upon request. The NSA expanded this requirement to include price-comparison information provided by phone.

Since TiC guidance was first issued, implementation has been subject to delayed enforcement timelines, evolving agency guidance, and efforts to coordinate the TiC requirements with overlapping requirements under the NSA obligations. See our prior updates: Updated Enforcement Guidance for Transparency in Coverage Machine Readable Files and Transparency in Coverage Price Comparison Tool Requirements Expanded For 2024.

TiC Amendments

These latest amendments aim to reduce file size, improve data usability, add context, and better align TiC reporting with NSA requirements. Highlights of the TiC Final Rule 2026 include (not an exhaustive list):

  • In-Network Rate Files: These files must be organized by provider network, rather than by plan, and must include the network name and identifier. In addition, plans and insurers must exclude from the In-Network Rate MRFs any negotiated rate/provider combinations for items or services the provider is unlikely to perform because they fall outside the provider’s specialty, e.g., rates for a podiatrist performing heart surgery.
  • Out-of-Network Allowed Amount Files: These files must be organized by health insurance market type (e.g., large group, small group, and self-insured) rather than by individual plan and expand the amount of out-of-network data disclosed publicly. For self-insured plans, administrators may combine allowed amounts across multiple plans, including plans sponsored by different employers, into one file.
  • New Contextual File Requirements:
    • Utilization File: Published each year, this file shows which covered services had paid claims and which in-network providers delivered them.
    • Taxonomy File: Shows the approach used – i.e., how the plan or issuer maps billing codes to provider specialties to determine which provider-rate combinations should be excluded from the In-network Rate MRF.
    • Text File: A .txt file containing links to the MRFs and contact information for file-related issues or inquiries to help improve access.
  • Update Frequency: MRFs must be updated quarterly instead of monthly. The prescription drug file, once applicable, must still be updated monthly.
  • Website Posting Requirements: Plans and insurers may use a third party to host and post MRFs. However, plans with their own public website must include a link to any MRFs hosted by a service provider.
  • New Attestation Requirements: Each MRF must include an attestation that, to the best of the plan’s or insurer’s knowledge, the information is true, accurate, complete, and submitted in accordance with applicable requirements. Each file must also identify the senior official responsible for overseeing the submission. If a third-party posts files on a plan’s or insurer’s behalf, the parties may enter into a written agreement allowing the third party to make the attestation. As most plans rely on their carrier or TPA to develop MRFs, plan sponsors should seek contractual commitments requiring carriers and/or TPAs to make the required attestations on the plan’s behalf.
  • Price Comparison Tool Requirements: Plans and insurers must provide the same price comparison information available through the online tool upon request by phone or paper method.

The final rule is effective 12/7/2026, with phased implementation:

  • Price comparison tool requirements are effective for plan years beginning on or after 1/1/2027.
  • Changes to in-network and out-of-network files take effect 3/6/2027. The first updated quarterly MRFs for those files must be disclosed by 4/1/2027, and the attestation requirement applies to those files.
  • New contextual file requirements apply as of 9/6/2027, with the initial disclosure required on 10/1/2027 for the Text and Taxonomy Files and 7/1/2028 for the Utilization files.
  • Guidance regarding the pharmacy MRF is expected to be released in May 2027 with plans and issuers expected to publish Rx MRFs beginning December 2027.

Employer Takeaways

Although carriers, TPAs, PBMs and other service providers will implement many of these operational changes, employers retain an ongoing fiduciary duty to prudently select and monitor these third parties. As such, employer plan sponsors should verify vendor readiness before the phased compliance deadlines begin and should consider the following based on plan funding type:

  • Fully Insured Plans: Insurance carriers typically manage file creation, posting, and compliance directly. That said, employers should secure written confirmation that their carrier will manage file creation, posting, and compliance directly, confirm website link requirements and verify that phone-based cost-sharing disclosures work using the phone number provided on ID cards.
  • Self-Funded and Level Funded Plans: TPAs, PBMs, and network vendors often handle the required operational work, including building the MRFs. However, the employer remains ultimately responsible for compliance. Employers who sponsor self-insured and level funded plans should review TPA, carrier, and PBM contracts to confirm who is responsible for producing, posting, maintaining, and attesting to the required disclosures and clearly assign compliance responsibility.
  • Plan sponsors should also require service providers to provide periodic confirmations, reporting, and updates, including notice of any related inquiries or participant complaints.

Additional Resources

The information and materials on this blog are provided for informational purposes only and are not intended to constitute legal or tax advice. Information provided in this blog may not reflect the most current legal developments and may vary by jurisdiction. The content on this blog is for general informational purposes only and does not apply to any particular facts or circumstances. The use of this blog does not in any way establish an attorney-client relationship, nor should any such relationship be implied, and the contents do not constitute legal or tax advice. If you require legal or tax advice, please consult with a licensed attorney or tax professional in your jurisdiction. The contributing authors expressly disclaim all liability to any persons or entities with respect to any action or inaction based on the contents of this blog.

Diane Cross

Diane Cross

Compliance Director

Diane is a Compliance Director for Sequoia, where she works with our clients to optimize and streamline benefits compliance. In her free time, Diane enjoys spending time with her family, live music, and cycling.