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Fact Sheet | Payment Reimbursement and Managed Care

Health Plan Price Transparency Requirements Final Rule Summary

Fact Sheet | Payment Reimbursement and Managed Care

Health Plan Price Transparency Requirements Final Rule Summary

On November 12, 2020, the Internal Revenue Service of the Department of the Treasury, the Department of Labor, and the Department of Health and Human Services (hereinafter referred to as “the Departments”) will publish in the Federal Register final rules requiring group health plans and health insurance issuers in the individual and group markets: 1) to disclose, upon request, cost-sharing liability including in-network provider negotiated rates, and out-of-network allowed amounts to a participant, beneficiary or enrollee (hereinafter referred to as an “enrollee”) through an internet self-service tool and in paper form; 2) to publicly disclose in-network provider negotiated rates, historical out-of-network allowed amounts, and drug pricing information in machine readable data files; and 3) to permit insurers to claim credit towards their medical loss ratios (MLR) for “shared savings” when an enrollee selects a lower- cost, higher-value provider.

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