Proposed Health Coverage Transparency Rule

A new transparency rule is coming, pushed forward by the current administration. It is focused on your health insurance, and how much information is revealed to you.

With health insurance, you definitely don’t want information hidden, and this goes double for fees or anything that’ll cost you money. For the most part, insurance agents work hard to make sure you’re well-informed to make decisions regarding your policy, but they can only say so much.

people sitting at a table talking about the transparency rule
Changes are coming to teams from insurance companies to hospitals. Everyone will have to be on board.

What the Rule Will Do

If it goes through as proposed, the rule will change the way prices are available, thus creating a better environment for people to comparison-shop for their medical work. Under this rule, both group and individual insurance markets will have to change the administration of their information. This will affect three things:

  1. Give cost-sharing information to enrolled individuals online or in paper form. Online information will be accessed through a tool on company websites.
  2. Disperse both in-network and out-of-network negotiated rates plus allowed amounts. These will be available in two machine-readable files.
  3. Insurers could access “shared savings” by offering lower-cost plans and claiming the credit their enrollee’s saved by choosing the cheaper provider.

Under this rule, the disclosed information will come with seven different items:

  1. Estimated cost-sharing liability An averaged amount for the patient’s payment, not including premiums or otherwise. It will show cost-sharing savings or be eligible for their market plans. 
  2. Accumulated amounts– The amounts already paid (deductibles, out-of-pocket maximums, etc.) 
  3. Negotiated rates– The payments (and how much) made by the insurers, third-parties, or otherwise to in-network providers
  4. Out-of-network allowed amounts– The maximum amount your plan/insurer covers for a specified medical expense if it’s out-of-network
  5. Bundled payment for listed items/services- A list of covered items/services for the cost-sharing estimate. Helps with your payment 
  6. Coverage Prerequisites- A note for enrollees to see what requirements they need to meet before their expenses will be covered. Ex. step therapy
  7. Disclosure notice– Basically anything that needs to be told to the person. Ex. an item not shown in an earlier document, differing final prices, etc.

    man teaching people about new transparency rule
    We’ll have to learn more about our own insurance with this rule. Better visibility means more choice for the policyholder.

The outcome everyone is hoping for is that with visibility comes competition. Hospitals will have to compete with others for their price list, hopefully driving prices down. However, the hospitals fighting this rule believe that insurers will covertly come together to rig the prices. They also aren’t happy about an increase in administrative costs. Unfortunately, we won’t be seeing any changes until 2021 with most hospitals asking for extra time to prepare for the changes. We remain hopeful that this transparency rule will bring positive changes.

If you are looking to get more coverage for your company, EZ.Insure offers solutions. Your agent will answer any questions you have, compare the plans available to you, and even sign you up when you are ready, free of charge. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing, or calling 888-998-2027. EZ.Insure makes the entire process simple, easy, and quick.

About The Author:
Cassandra Love

With over a decade of helpful content experience Cassandra has dedicated her career to making sure people have access to relevant, easy to understand, and valuable information. After realizing a huge knowledge gap Cassandra spent years researching and working with health insurance companies to create accessible guides and articles to walk anyone through every aspect of the insurance process.

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