Transparency Rules: 5 Considerations for Employers

We recently blogged about the new transparency rule that will require most group health plans and insurers to disclose price and cost-sharing information. The Transparency in Coverage rule has a phased in implementation that starts in 2022.

Employers do not typically have the data needed to comply with these rules so they will need to work closely with insurers, third-party administrators and point solutions to comply. Employer plan sponsors should begin by considering the following:

  • Ability and willingness of insurers, third-party administrators and point solutions to provide the required information.
  • How to incorporate quality metrics, although not required under the rule
  • Impacts to plan costs and cost projections.
  • Communication planning and response to increased member inquiries. Participants need to understand that the provided cost-sharing liability numbers are estimates only and that their actual charges may be different due to the actual services at the point of service, their provider decisions and unforeseen circumstances that arise in the course of treatment.
  • Identify opportunities to utilize the newly available data to educate participants and drive value-based utilization.   

 Look for a more detailed analysis of the final regulations later this month on our Law & Policy page.

Sheryl Stime
by Sheryl Stime

Principal, Mercer

Carol Malenka
by Carol Malenka

Principal, Mercer

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