Text of Agency ACA FAQs, Part 65: Transparency in Coverage (PDF)
"How should plans and issuers comply with the cost-sharing disclosure requirements of the TiC Final Rules with regard to items and services with extremely low utilization when a cost estimate is based on claims data rather than prospective rates? ... To ensure that consumers
receive accurate cost- sharing information, the Departments are likely to exercise their discretion, on a case-by-case basis, not to bring enforcement actions against plans and issuers that fail to include in their self- service tool (or in paper form, upon request) or fail to provide over the phone cost-sharing information for items and services for which a cost estimate for such items and services would need to be based on past claims data
and for which there have been fewer than 20 different claims in total over the past three years." MORE >>
U.S. Department of Health and Human Services [HHS]; U.S. Department of Labor [DOL]; and U.S. Treasury Department
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BenefitsLink® Health & Welfare Plans Newsletter, ISSN no. 1536-9595.
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