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Upcoming Transparency in Coverage (TiC) Compliance Requirement: Price Comparison Tool

Among the many changes required by the ACA’s Transparency in Coverage (TiC) Final Rules is the requirement that group health plans and carriers make price comparison information available to participants and beneficiaries through an internet-based self-service tool and in paper form, upon request.

Under the TiC Final Rules, group health plans and health insurers are required to disclose:

  • A preliminary set of 500 items and services for plan years beginning on or after January 1, 2023.
  • The entire list of items and services for plan years beginning on or after January 1, 2024.

The Consolidated Appropriations Act, 2021 (CAA-21) contained a similar price comparison tool requirement. The CAA-21 requires group health plans and health insurers to:

  • Offer price comparison guidance by telephone.
  • Provide a “price comparison tool” on their website that allows enrolled participants to compare the portion of cost-sharing that they would be responsible for under the plan for particular services for the plan year.

The CAA-21’s price comparison tool requirement applies for plan years beginning on or after January 1, 2022.

On August 20, 2021, the Department of Labor (DOL), U.S Department of Health & Human Services (HHS), and the Treasury (the Departments) issued guidance on how the TiC Final Rules and CAA-21 requirements for the self-service price comparison tools interact.

The price comparison methods required by the CAA-21 are largely duplicative of the internet-based self-service tool of the TiC Final Rules. With that in mind, the Departments will issue proposed regulations regarding whether compliance with the internet-based self-service tool rules under the TiC Final Rules can also satisfy the requirements under the CAA-21. The Departments’ proposed regulations may require that the same pricing information that is available through the online tool or in paper form must also be provided over the telephone upon request as required by the CAA-21.

The guidance also stated that the Departments would defer enforcement of the CAA-21 price comparison tool before plan years beginning on or after January 1, 2023, to align with the enforcement date for the TiC Final Rules.

Following similar transparency disclosure requirements, the TiC Final Rules contain a special rule to avoid unnecessary duplication. For a fully insured group, the plan may comply if it:

  • Requires the health insurer that offers the coverage to provide the required transparency information.
  • Enters into a written agreement with the insurer that governs disclosure of the required transparency information.

If the fully insured group has entered into a written agreement with their carrier and the carrier fails to comply, then the carrier, not the plan, is deemed to have violated the compliance requirements.

For self-funded groups, the plan may also enter into a written agreement with another party (e.g., TPA, PBM) for the third party to provide the required information. However, unlike fully insured plans, the plan can still be held liable for violating the compliance requirements if the third party fails to provide the required information.

Employers with fully insured group health plans should contact their carriers to ensure compliance. Employers should also work with their carriers to prepare communications informing employees about the tools.

Employers with self-funded group health plans should begin working with their TPAs or PBMs to understand what role they will take in helping to comply with the new rule.

If you have any questions, contact your OneDigital consultant.

Learn more about recent legislation and announcements impacting employer-sponsored benefits. View the recently published Health and Welfare 2023 Benefit Plan Limits.