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Quick Facts Recently passed legislation and related regulatory guidance will require insurers and group health plans to provide new information detailing provider reimbursement rates. Beginning in 2022, insurers and health plans must publicly post three reimbursement rate data files. Beginning in 2023, at the request of a participant, plans and insurers must disclose in advance an estimate of the participant’s expected cost-sharing for covered items or services. Most employers who sponsor a group health plan generally do not have access to provider reimbursement rates and will need to rely on their insurance carrier or TPA to provide the …

… are delayed, with some requirements delayed indefinitely until further guidance is provided. However, there are a few requirements that will go into effect in 2022 as originally indicated. Group Health Plan Application & Responsibility The transparency in coverage rules apply to most group health plans, but not grandfathered health plans, excepted benefits (including limited scope dental or vision benefits), or health reimbursement arrangements (HRAs). The CAA requirements apply similarly, but there is no exception for grandfathered health plans. For fully insured plans, the requirements will be handled by the carrier. For self-funded plans, the requirements will generally be handled by …