KMK Law Management Rights Blog

The Transparency in Coverage Proposed Rule aims to give individuals greater access to health care pricing information. The proposals essentially require most group health plans, including self-insured plans, to disclose price and cost-sharing information to participants and beneficiaries. More specifically, not only do these rules require disclosure of cost-sharing estimates, plans would also be required to disclose negotiated rates for in-network providers and allowed amounts paid for out-of-network (OON) providers. Out-of-pocket cost information would be provided through an internet-based self-service tool and in paper format. In-network negotiated rates and allowed amounts for OON providers would be made available through standardized machine-readable files. Industry groups have already voiced disagreement with pricing transparency rules, citing proprietary concerns and consumer confusion, and further pushback is expected from stakeholders given the proposed rule will entail additional costs and administrative burdens. Comments are still being accepted on the proposed rule, and we do not expect an effective date before January 1, 2022. We will keep you updated on significant changes as the rules are finalized.