The Departments of Labor, US Treasury, and Health and Human Services (Departments) will begin enforcing the Transparency in Coverage Final Rules (TiC Final Rules) on July 1, 2022.

The TiC Final Rules, applicable for plan years on or after January 1, 2022, require sponsors and issuers of non-grandfathered group health plans to provide certain cost-sharing information to plan participants upon request, as well as to post on a public website their (1) in-network negotiated rates for covered items and services, (2) billed charges and historical allowed amounts paid to out-of-network (OON) providers, as well as (3) the negotiated rates and historical net prices for prescription drugs, in three separate machine-readable files.

This means that for health plans with January – July 2022 plan years, enforcement will commence beginning July 1, 2022, with respect to items (1) and (2). After July 1, 2022, plans and issuers will need to post the machine-readable files in the month in which the plan year begins, consistent with the applicability provision of the TiC Final Rules.

In addition, with respect to item (3) above, the Departments announced they will delay enforcement of the prescription drug disclosure requirements in the TiC Final Rules, pending further rulemaking. The Departments are currently assessing whether the prescription drug machine-readable file requirement remains appropriate for prescription drugs, as the Consolidated Appropriations Act, 2021, also has prescription drug disclosure and reporting requirements.

Note: Some uncertainty remains with respect to the interpretation of certain provisions of the TiC Rules. For example, current guidance requires that a public website (one outside of the plan sponsor’s firewall) be maintained for housing the machine-readable files, although the files could be maintained by an outside party, such as a third-party administrator (TPA) on its website, as long as the plan sponsor enters into an agreement in writing to do so, and a link to those files is available on the plan sponsor’s public website. Clarification is also needed with respect to whether or not plan sponsors of fully insured plans must provide a link on its public website to the insurer’s website. Consequently, pending the receipt of additional guidance, please consult with legal counsel to address any specific issues in interpreting these and other requirements of the TiC Final Rules.

To comply with the upcoming July 1 deadline, plan sponsors should consider the following next steps.

• Plan sponsors should take an inventory of their benefit plans to determine which plans are subject to the transparency in coverage requirements.
• Plan sponsors of fully insured plans should consult with the respective insurers to confirm that they will be hosting the machine-readable files for items (1) and (2) on their public website, or whether they are delegating that responsibility to the plan sponsor.
• If the insurer retains responsibility for hosting the machine-readable files, plan sponsors should consider posting a link on their public website to these files (maintained on the insurer’s public website) no later than July 1, 2022, unless directed otherwise after consulting with counsel and/or their carriers. Otherwise, the plan sponsor must create a public site for this purpose.
• Plan Sponsors of self-funded plans should work with their TPA to ensure the machine-readable files meet regulatory guidelines and assign responsibility for posting the files onto a public website.
• If the TPA will be posting the machine-readable files onto its public website (or creating a public website on behalf of the plan sponsor), plan sponsors should confirm that the TPA will be sending them a link to this website in time to comply with the July 1, 2022 deadline. If the plan sponsor will be creating its own public website, it must do so, no later than July 1, 2022.
• Plan sponsors of self-funded plans and TPAs should review their service agreements and enter into new contracts or amend existing contracts, if necessary, to reflect any services and costs involved with complying with these additional requirements.
• To the extent that the insurer or TPA, as applicable, retains responsibility for posting the files on a public website, plan sponsors (whether fully insured or self-funded) should have this confirmed in writing.
• To the extent that a plan sponsor has carved-out certain health benefits, determine whether the insurer/TPA for the medical plan, or the carve-out benefit provider, will be establishing and housing the machine-readable files for these benefits, and post a link to that website.

For further information, please see Requirement to Post MRFs.