Align Yourself With The Latest Final Rule: Transparency In Coverage

‘The Departments’, back in November 2020, released a set of new requirements under the Transparency in Coverage rules. As the name suggests, the objective of the rule is to embed increased transparency in the coverage offered by Health Plans.

This Whitepaper covers all of the disclosure requirements and even sheds light on how to align a Health Plan with these latest rules.

Disclosure to Participants, Beneficiaries, or Enrollees

The Departments have mandated issuers to create a platform where enrollees can access cost-sharing estimates on services they would need to avail of in the future.

Disclosure to the Public

Issuers must make public the In-Network Rate File, Allowed Amount File, Prescription Drug File, every month. It must include the details of allowed amounts of all covered items or services from out-of-network providers, negotiated rates of in-network providers, and prescription drugs.

Medical Loss Ratio (MLR)

HHS has updated the formula to allow issuers to include Shared Savings in the MLR numerator. Shared saving is defined as the total amount saved by plans as well as members when members decide to take alternate services based on the low-cost and high-value criteria.

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