The federal Transparency in Coverage rules require health plan sponsors to provide pricing disclosures via separate sets of machine-readable files (MRFs) posted on a public website (enforcement begins July 1, 2022). The intent of this aspect of the federal transparency rules is to make public the financial arrangements in place between health plans and providers. These MRFs are not for participant use, but rather the files are designed to be read by a computer system and are intended to be available for researchers and policy makers to have access to health plan costs nationally on an aggregate basis. The health plans (i.e., carriers and third-party administrators) have the information needed to compile the data and create these MRFs, and we have confirmed they will produce and provide access to these files and they will update the MRFs at least monthly.
Effective July 1, 2022, the MRFs must include:
While the health plans need to provide access to the data files, the rules appear to make it a plan sponsor’s responsibility to publicly post access to the MRFs.
For self-insured plan sponsors, Conner Strong & Buckelew has created two solutions to assist in complying with these new rules:
Since the rules and requirements are new, we expect there may be more federal guidance in the future. We will keep you abreast of continued developments. Your Conner Strong & Buckelew account team will work with you to discuss your organization’s specific set-up requirements.
Please contact your Conner Strong & Buckelew account representative toll-free at 1-877-861-3220 with any questions. For a complete list of Legislative Updates issued by Conner Strong & Buckelew, visit our online Resource Center.