Benefits Counselor – May 2022

HEALTH PLAN DEVELOPMENTS

New Safe Harbor for Transparency In Coverage Rule's In-Network Machine-Readable File

The Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (the Departments) recently announced a limited enforcement safe harbor for the in-network medical machine-readable file required under the Transparency in Coverage Final Rule (the Rule).

Under the Rule, non-grandfathered group health plans and health insurance issuers offering non-grandfathered coverage in the group and individual markets must disclose, on a public website, information regarding in-network provider rates in a machine-readable file. The Rule also requires plans and issuers to post machine-readable files for (1) out-of-network allowed amounts and billed charges; and (2) negotiated rates and historical net prices for prescription drugs. The Departments are not enforcing the in-network and out-of-network machine-readable file requirements until July 1, 2022,