As of January 1, 2023, group health plans and health insurance carriers must maintain an internet-based price comparison tool available for participants, beneficiaries and enrollees that details 500 specific health-related items and services. This requirement was issued to comply with final rules regarding Transparency in Coverage (“TiC Final Rules”), issued in November 2020 by the Departments of Labor, Health and Human Services and the Treasury (“Departments”).

The Departments anticipate this tool will provide consumers with realtime estimates of their cost-sharing liability from different providers for covered items and services, allowing them to compare prices before receiving medical care. The TiC Final Rules require that this information be provided electronically, in paper form or via phone if requested, to comply with the transparency requirements.

Employers will primarily rely on their health insurance carriers, for fully insured plans or third-party administrators (“TPAs”), for self-insured plans to develop and maintain the price comparison tool and provide disclosures electronically, via hard-copy or over the phone, upon request. Providing this price-comparison tool is not required for plans with grandfathered status, excepted benefits (such as limited-scope vision and dental benefits), and for account-based plans, such as FSAs, HRAs and HSAs.

Beginning in 2024, price comparison tools will be required for all covered items and services, not just the 500 services specified in 2023. Employers with fully insured health plans should confirm their health insurance carrier is complying with the price comparison tool requirements for 2023, on their plan’s behalf, and expects to broaden the tools in 2024. Employers with self-insured plans should reach out to their TPAs (or other applicable service providers) to confirm they are in compliance with price comparison tools in 2023 and will expand the tools by the January 1, 2024 deadline.

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