Overview

• The Federal Government finalized the Transparency in Coverage rule November 12, 2020. The rule is intended to make health care pricing more visible and understandable by requiring health plans and plan sponsors,
  including self-funded customers in individual and group markets to disclose extensive, detailed price and cost-sharing information.

The two primary components of TiC:

• Machine-readable files (MRF): Required detailed pricing data for all covered items and services via three machine-readable files — in-network negotiated rates, out-of-network allowed amounts and pharmacy
  rates — updated monthly. These files must be published in a publicly accessible website by July 1, 2022.
• Consumer Price Transparency Tool: An online tool with personalized, real-time, cost-share estimates for all covered services and items, including pharmacy. The tool, which must be available on the internet, is
  effective January 1, 2023, for 500 designated services and January 1, 2024, for all services. Paper-version estimates must also be available upon request.

Transparency in Coverage Timeline

• The Transparency in Coverage rule will be implemented in phases, over the course of three years, beginning in 2022.

• Phase 1 [July 1, 2022] – Create public “Machine-readable files” (MRFs)
• Phase 2 [January 1, 2023] – Offer an internet-based, advanced “Cost estimator tool” (500 pre-determined items and services)
• Phase 3 [January 1, 2024] – Expand the internet-based advanced cost estimator tool (cost-estimates for all covered items, services and prescription drugs)