Effective for plan years beginning on or after January 1, 2023, the Transparency in Coverage Final Rule (TiC) requires most group health plans and carriers to make personalized out-of-pocket cost information available to participants through an internet-based self-service tool or in paper format (upon request). The self-service tool is designed to provide participants with real-time, accurate estimates of their cost-sharing liability for healthcare items and services from different providers prior to receiving care.
The TiC provided phased-in effective dates for the internet self-service tool requirement. An initial list of 500 “shoppable” items and services must be made available through the tool for plan years beginning on or after January 1, 2023. For plan years beginning on or after January 1, 2024, all items and services, including prescription drugs and durable medical equipment, must be made available.
Employers should consult with their carriers or third-party administrators (TPAs) to ensure timely implementation of the self-service tool. Fully insured plans can contract with their carrier to assume liability for the requirement. Self-insured plans can contract with TPAs or other vendors but remain responsible for satisfying the requirements.
For further information regarding the TiC and self-service tool requirements, please see the FAQ and the Transparency in Coverage Final Rule.
PPI Benefit Solutions does not provide legal or tax advice. Compliance, regulatory and related content is for general informational purposes and is not guaranteed to be accurate or complete. You should consult an attorney or tax professional regarding the application or potential implications of laws, regulations or policies to your specific circumstances.
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