Health Plan Price Transparency - Compliance Reminders for Employers

Employer-sponsored group health plans must comply with a variety of relatively new reporting and disclosure requirements related to health care transparency. These requirements are intended to reduce health care costs by making meaningful price information more accessible to consumers. They broadly apply to group health plans (including fully insured plans, self-insured plans and level funded plans) and health insurance issuers.  

In general, most employers rely on their issuers, third-party administrators (TPAs) and other service providers to satisfy many key transparency requirements for their health plans, including the obligations to provide detailed pricing information in machine-readable files (MRFs) and submit reports on prescription drug and health care spending (RxDC reporting). Despite this reliance, employers still have important compliance obligations under federal transparency laws.

Significantly, President Donald Trump has directed the Departments of Labor, Health and Human Services, and the Treasury (Departments) to prioritize health care price transparency during his second term. Employers should watch for new guidance from the federal government implementing additional health care transparency requirements in response to this directive.

Key Requirements

Key reporting and disclosure requirements under federal transparency laws include:

• RxDC reporting;
• Gag clause attestations;
• MRFs with detailed pricing information;
• Self-service cost comparison tool;
• Balance billing notice; and
• Advanced explanation of benefits (EOB) (implementation delayed)

Reporting Deadlines

Health plans and issuers are subject to the following annual transparency reporting deadlines:

• RxDC reporting: Due each year by June 1, covering data from the prior year; and
• Gag clause attestations: Due each year by Dec. 31, covering the period since the last attestation.

Download this Compliance advisor to learn more about the below action items, and next compliance steps:

1. File RxDC report by June 1 of each year
2. Submit gag clause attestation by Dec. 31 of each year
3. Post MRFs and make monthly updates
4. Provide a self-service price comparison tool
5. Post balance billing notice
6. Provide advanced EOBs (delayed)

Contact us today for additional compliance resources.