Transparency in Coverage Rules
Twin Termite and Pest Control Employee Benefit Plan Information for Transparency in Coverage Rule:
Access machine readable files (MRF’s) provided by Kaiser Permanente (https://healthy.
kaiserpermanente.org/southern- california/front-door/machine-readable) that Twin Termite and Pest Control has contracted with to provide its employee health benefit plans in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.
In 2020, the Departments of Health and Human Services (HHS), Labor (DOL), and Treasury released regulations (rules) on a longstanding item within the Affordable Care Act (ACA), called “Transparency in Coverage” (TiC). These regulations provided new details on the application of the complicated TiC section within the ACA, which had generally gone unenforced. The 2020 rules introduced new forthcoming TiC enforcement dates, to be implemented in staggering intervals, beginning July 1, 2022.
TiC regulations require health insurers and group health plans to create machine readable files (MRFs) that contain the negotiated rates for in-network providers and allowed amounts derived from historical claims for out-of-network providers and make those files publicly available. They must be made available on an open access website effective July 1, 2022, or on the anniversary of your plan, for plans effective August 1, 2022 or later. As the link to the carrier files must be posted to a public site, posting to an internal site such as your benefits administration system or company intranet, would not be in compliance with the regulation. Below are the links to insurance carrier websites. Note, the machine readable files are data, and are intended to be used by computer systems, not humans.
What’s next? In 2023, the consumer facing, online cost estimators will be implemented. We are monitoring how this these requirements will be met and will keep you up to date as we know more.