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Transparency in Coverage
On November 12, 2020, the Departments of Health and Human Services, Labor and the Treasury finalized the Transparency in Coverage Rule that requires health insurers and group health plans to disclose certain pricing information.
Beginning July 1, 2022, group health plans and issuers of group or individual health insurance must post pricing information for covered items and services. This pricing information can be used by third parties, such as researchers and app developers to help consumers better understand the costs associated with their health care.
The files linked to below are machine readable files.
- Table of Contents
- In-Network Pricing Information
- Out-of-Network Pricing Information - Commercial Group Plans
- Out-of-Network Pricing Information - Self-Funded Plans
Note - The files are very large, which may cause issues when downloading them. If you are experiencing problems, please try a different web browser or check your Internet/Wi-Fi speed.
For our non-Medicare Advantage members, you may access the price transparency tool through our member portal. Sign up or login in with an existing account, select My Cost, then Cost Estimation Tool. This tool is limited to 500 shoppable services and will expand to all services as of January 1, 2024.
For more information about Transparency In Coverage, visit the CMS website at cms.gov/healthplan-price-transparency.
