Price Comparison Tool Required for 2023 Plan Years

     Effective for plan years beginning on or after Jan. 1, 2023, group health plans and health insurance issuers must make an internet-based price comparison tool available to participants, beneficiaries, and enrollees. This requirement comes from final rules regarding transparency in coverage (TiC Final Rules) that were issued by the Departments of Labor, Health and Human Services, and the Treasury (Departments) in November 2020.

According to the Departments, this tool will provide consumers with real-time estimates of their cost-sharing liability from different providers for covered items and services, including prescription drugs, so they can shop and compare prices before receiving care.

The TiC Final Rules require health plans and issuers to provide this information in paper form upon request. In addition, plans and issuers should be prepared to provide this comparison information over the telephone to comply with a transparency requirement added by the Consolidated Appropriations Act, 2021 (CAA).

Action Steps

     Most employers will rely on their health insurance issuers or third-party administrators (TPAs) to develop and maintain the price comparison tool and provide related disclosures on paper or over the phone upon request.

Employers with fully insured health plans should confirm that their health insurance issuer will comply with the price comparison tool requirements, beginning with 2023 plan years, and ensure this compliance responsibility is reflected in a written agreement. Similarly, employers with self-insured plans should reach out to their TPAs (or other service providers) to confirm they will be in compliance by the deadline and update agreements, as necessary, to reflect this responsibility.

Highlights

The TiC Final Rules’ requirement to provide a price comparison tool applies to group health plans (including self-insured and level-funded plans) and health insurance issuers. However, the requirement does NOT apply to:

  • Plans with grandfathered status;
  • Excepted benefits (such as limited-scope vision and dental benefits); and
  • Account-based plans, such as FSAs, HRAs and HSAs.

Important Dates

Plan Years Beginning in 2023

The price comparison tool must provide cost-sharing information for 500 items and services.

Plan Years Beginning in 2024

The price comparison tool must provide cost-sharing information for all covered items and services.

Download the full PDF here – Price Comparison Tool Required for 2023 Plan Years

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