Health Plan Transparency Reporting

On October 29, 2020, the Transparency in Coverage Rule was released by the Departments of Health and Human Services (HHS), Labor, and Treasury based on an executive order by the President to improve price and quality transparency in American healthcare in an effort to put patients first. This rule is a historic step toward putting health care price information in the hands of consumers and other stakeholders to ensure consumers are empowered with the critical information they need to make informed health care decisions.  The requirements in the Transparency in Coverage Rule will also reduce the secrecy behind health care pricing with the goal of bringing greater competition to the private health care industry.  

Beginning July 1, 2022, group health plans and issuers of health insurance are mandated to make available machine-readable files that include in-network negotiated payment rates and historical out-of-network charges for covered items and services, including prescription drug pricing. The files must be posted on an internet website that is publicly available and accessible to any person free of charge. No conditions can be imposed on the access to the files, such as establishment of a user account, password, or other credentials or submission of personally identifiable information to access the file. The files must be updated on a monthly basis and also clearly indicate the date on which they were most recently updated.

The health plan price transparency rule can help employees know the cost of a covered item or service before receiving care and help define the value of those services. This pricing information can also be used by third parties, such as researchers, app developers, etc. to help consumers better understand the costs associated with their health care. 

Click the link below to access machine-readable files posted by the City of Roanoke (files will be posted July 1, 2022):