Health Affairs November 17, 2019
On November 15, 2019, the Departments of Health and Human Services (HHS), Treasury, and Labor released a new “transparency in coverage” proposed rule. The rule imposes new transparency requirements on group health plans and health insurers in the individual and group markets. HHS also released an accompanying fact sheet and press release.
If the rule is finalized, plans and insurers would have to disclose cost-sharing estimates at the request of an enrollee and publicly release negotiated rates for in-network providers and historical out-of-network allowed amounts. HHS would also amend its medical loss ratio (MLR) methodology to allow insurers to claim credit for “shared savings payments” made to an enrollee who selects a lower-cost provider. The proposed rule solicits comment on...
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