Transparency in Coverage Rule (TCR)

On October 29, 2020, the Departments of Treasury, Health and Human Services and Labor (Departments) released the Transparency in Coverage Final Rule and accompanying fact sheet, which outlines requirements for most employer-based group health plans and insurers to disclose price and cost-sharing information to consumers up front.

Currently, plans like GeoBlue must make available to the public two machine-readable files of pricing information: 1) the in-network negotiated rates with their providers; 2) the historical payments to out-of-network providers and their billed charges. These files must follow a standardized format and be regularly updated (monthly). As additional TCR requirements come into effect, web-based cost-comparison tools for consumers will be available beginning in 2023.

For an overview and status of key provisions, click here.