UnitedHealthcare provides support for Transparency in Coverage
Federal Government releases rules and guidelines in an effort to make health care pricing more visible, transparent and understandable.
- All States
- Fully Insured and Self-Funded
- Reform and Regulatory
The Federal Government finalized the Transparency in Coverage rules in October 2020, intending to make health care pricing more visible and understandable. The rule requires health plans and plan sponsors in individual and group markets, including self-funded customers, to disclose cost-sharing data to stakeholders through two primary components:
- Machine-Readable Files: Detailed pricing data for all covered items and services via three machine-readable files — in-network negotiated rates, out-of-network allowed amounts and Rx rates — updated monthly. Files must be published by January 1, 2022.
- Consumer Price Transparency Tool: An online tool with personalized, real-time cost-share estimates for all covered services and items, including Rx, with paper versions available upon request. The tool’s effective date is January 1, 2023, for 500 designated services, and January 1, 2024, for all other services.
UnitedHealth Group has long supported actionable price and quality transparency for consumers and currently offers transparency tools to a significant portion of members. Compliance with laws and regulations applicable to members is a fundamental commitment of UnitedHealth Group. UnitedHealth Group intends to comply with the new rule requirements by leveraging the full capabilities of UnitedHealth Group, UnitedHealthcare and Optum. This will also bring differentiated value to customers and members and reduce the total cost of care. UnitedHealthcare is committed to helping all customers comply with the new rule. Customers can expect timely and relevant information regarding potential administrative costs as more details become available.
For more information and for answers to commonly answered questions, please refer to the Transparency in Coverage FAQs.