• NYSmallHealth

Health Care Transparency Now A Reality

Americans (and other nationalities recently) have begun questioning the health care system in the USA due to the skyrocketing premiums and huge out-of-pocket costs. The good news is that the Department of Labor (DOL) and the Health and Human Services (HHS) seem to have heard the international outcry - they’ve issued a final rule on health insurers mandating new, better transparency requirements, transferring more buying power to health insurance consumers and stakeholders.


This historic step makes the health insurance industry answerable to consumers via their right-to-information. The rule will have a significant impact on group health plans and health insurers in both the group and individual markets. It requires plans and issuers to disclose the following facts:


  1. Prices and cost-sharing information to enrollees and beneficiaries when they ask for it. Specifically, information on the following services must be made available to them:

  2. A list of 500 shoppable services accessible online for all plans that begin either on or after January 1, 2023.

  3. All other items and services for plans that begin on or after January 1, 2024.

  4. Rates negotiated by in-network providers as well as historical out-of-network rates should be on their website.

  5. Detailed pricing information must be made public for all plans beginning on or after January 1, 2022.


The main aim for this transparent ruling is to enable Americans to save money by shopping around for better, low-cost, higher-value healthcare. But there is an added benefit for issuers as well; they can take credit for the resultant “shared savings” payments in their medical loss ratio calculations.


Health insurance is a tricky business. Thankfully, the government under President Trump has made insurance shopping less difficult. But shopping for insurance can still be frustrating given the numerous providers, networks, plans, and rates. Contact the insurance experts at NY Small Health to aid you in your quest for better healthcare benefits for your team.


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