Health Plan Transparency Requirements Coming in 2022

At the end of August, the Department of Labor, the Department of Health and Human Services and the Treasury delayed enforcing previously created transparency rules for health plans. However, these health plan transparency requirements are now scheduled to go into effect at the beginning of 2022. 

There are multiple layers to the new requirements, and it’s important to understand what they are and be aware of how and when these new requirements will be put into effect. Our employee benefits company wants to keep you informed so you can help your employees be knowledgeable of the changes to their health insurance plans.  

What the New Health Plan Transparency Entails

Beginning in 2022, the new requirements for transparency in coverage will require health insurance groups to provide information about health care costs with in-network provider information, out-of-network provider information and prescription drugs. Transparency requirements aim to help keep your employees better aware of the costs to their health care. Here are a handful of criteria included in the new ruling.

Identification Cards 

An identification card will be issued to all participants and beneficiaries to include information about deductibles or out-of-pocket maximums for in-network and out-of-network care. It must also include a telephone number and a website for consumer assistance. If physical, the cards will have a QR code to access the website. Electronically, there will be a link for additional resources on the website. 

No Surprise Bills

The “No Surprises Act” addresses out-of-network care by a provider or a facility, including emergency situations. This requirement for all group health care options prevents your employees from receiving a surprise medical bill in an emergency situation or in the case of an air ambulance. 

If it is not an emergency, the facility or provider will have to send a detailed notice or an estimate of charges approximately 72 hours prior to receiving out-of-network care. Ensure your employees are aware of their right to know the cost of medical care prior to receiving it and protect them from any surprise payment that is a strain on mental health and causes stress and distraction.  

Prescription Drug Information

In an effort to increase transparency, insurers can no longer write gag clauses into their contracts with pharmaceutical companies. Pharmacies will now be required to share costs in order to help individuals navigate prescription drug costs which can be high out-of-pocket expenses. 

An annual report on certain information regarding prescription drugs is now required. It will contain the top 50 brand prescription drugs paid for by your plan and the total number of claims for each drug. This information will be reported to the secretaries of the U.S. Department of Health and Human Services, the U.S. Department of Labor as well as the Treasury, but it will be available in a public area for your employees to access information on what is included in the group health plan. 

Accurate Provider Information

Effective as of 2022, insurers and plans will have to provide accurate information about in-network providers with verification of information and timely updates to any changes in provider information. Individuals who relied on inaccurate data and received a surprise bill from an out-of-network provider will be granted relief.

If the person visited an out-of-network provider, the bill must reflect the in-network maximum cost of service because the provider information in the database was inaccurate. The payment will be applied towards the enrollee’s deductible. 

If the cost is higher than it would be if the patient was in-network, and the patient paid the bill, the out-of-network provider will reimburse the patient of the excess amount with interest.

Making Sense of Health Plan Rules

These full health plan transparency requirements must be disclosed in three machine-readable files. The information will include rates on in-network providers for all covered items and services, billed charges and covered amounts on out-of-network providers and historical pricing on prescription drugs provided by in-network providers. These free publicly accessed files and requirements were set to be in effect January 1, 2022, and will require monthly updates. 

Educating your employees on these transparency requirements can set them up for success as they navigate the complicated but critical world of healthcare. Cornerstone Insurance Group is always here to answer questions and help you give your employees the best health insurance plan and health care possible. Do you have any questions or concerns? We’re here to help.

We know how difficult it is to navigate new policies related to health insurance and benefits administration, and we want your organization to remain as educated as you can be. Have questions on the new health plan transparency requirements? Contact our employee benefits team today

Topics: HR