Dear client,
The Transparency In Coverage act requires most non-grandfathered group health plans or health insurance issuers in the individual and group markets to make available to the public (consumers, researchers, and third-party developers) three separate machine-readable files that include detailed pricing information. These files follow the Centers for Medicare & Medicaid Services (CMS) defined layout and are in the CMS-approved format (JSON) and are not meant for a consumer-friendly search of rates, benefits or cost sharing. The files must be updated monthly. The files must include
- negotiated rates for all covered items and services between the plan or issuer and in-network providers;
- historical payments to, and billed charges, from out-of-network providers; and
- (DELAYED PENDING ADDITIONAL RULEMAKING) in-network negotiated rates and historical net prices for all covered prescription drugs by plan or issuer at the pharmacy location level.
Files must be made public by July 1, 2022, for plan years that begin on or after January 1, 2022. (For example, plan years from January through July, must comply by July 1. August 1 plan years must have files posted by August 1.
Issuers (carriers) vary in their interpretation of how plan sponsors meet this requirement.
UHC advises Level-funded employers to post this link to their website (Please note, the website may not be active until after July 1st)
To access the machine-readable files created and published by UnitedHealthcare, please click here.
Self-Insured
To access the machine-readable files created and published by UnitedHealthcare, please click here.
