ABA and the transparency in
Coverage Final Rule – An Overview
Working with ABA, you know we’ve always been about delivering more than
just benefits. We constantly strive to provide you with all the information you
need to make informed decisions for your client companies.
As such, we want to bring you up to speed on the transparency in Coverage Final Rule that goes into effect on July 1, 2022 for group health plans network insurance carriers. The act has been set forth by the U.S. Department of the Treasury, the U.S. Department of Labor and the U.S. Department of Health and Human Services (The «Tri-Agencies»).
What is the act?
The Transparency in Coverage Final Rule Act requires group health plans and health insurance issuers to make information available to the public so consumers can better understand healthcare, pricing and the cost for healthcare services. Consumers must be empowered to shop and compare cost and make price-conscious decisions.
Here is what must be included:
A third required MRF disclosing negotiated rates and historical net prices for covered prescription drugs is currently delayed, but is on the horizon.
Please note: These files must be available free of charge, without having to establish a user account password, credentials or submit personal information.
Below you’ll find a link to each of our provider’s network MRF:
What is a machine-readable file (MRF)?
Machine-readable data is described as «data in a format that can be easily processed by a computer without human intervention while ensuring no semantic meaning is lost.» (Please note, “Machine Readable” is not synonymous with digitally accessible.)
Machine-readable data is classified in two groups:
Required content elements for all MFR’s
ABA will publish machine-readable files to its website monthly
Please also note:
For your reference, here is a pdf of the Final Act
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