Price Transparency Rules for Health Plans: Key Issues for Plan Sponsors, Service Providers, and Insurers

Strafford

This CLE course will guide employee benefits attorneys, plan sponsors, and plan administrators and service providers through new price transparency rules for health plans. The panel will discuss key provisions of the final rule; the rule's impact on plan sponsors, insurers, and service providers; requirements and new mandates; administrative and operational challenges; and best practices to promote compliance.

Description

In 2020, the Departments of Health and Human Services, Treasury, and Labor jointly issued a "Transparency in Coverage" final rule. The rule imposes significant transparency requirements and mandates on group health plans and insurers in the individual and small group markets.

Under the final rule, affected plans and insurers must disclose cost-sharing estimates, negotiated rates for in-network providers, out-of-network allowed amounts and charges. The rules are subject to enforcement under the ACA, requiring strict operational procedures to promote compliance and help avoid state and DOL enforcement actions.

The final rule does not change existing privacy and security requirements under HIPAA or other applicable state and federal laws. Employee benefits attorneys, plan sponsors, and insurers must implement procedures aligned with the mandates under the final rule while maintaining compliance with other applicable state and federal laws.

Listen as our panel discusses key provisions of the final transparency in coverage rule, requirements and mandates, administrative and operational challenges, and best practices and next steps for plan sponsors, insurers, and service providers.

Outline

1. Key provisions of the price transparency rules
2. Application of disclosure requirements to health plans
3. Disclosure of cost-sharing information
4. Disclosure of negotiated in-network and out-of-network rates
5. Shared savings in the medical loss ratio
6. Best practices and next steps for plan sponsors, insurers, and service providers

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