Health Care Transparency and No Surprises Act Requirements | Employer Compliance Summary

Group health plans and health insurance issuers are subject to many new requirements designed to increase health care transparency and protect consumers against surprise medical bills. These requirements come from final rules regarding transparency in coverage (TiC Final Rules), which were issued by the Departments of Labor, Health and Human Services and the Treasury (Departments) in November 2020, and the Consolidated Appropriations Act, 2021 (CAA), which was signed into law in December 2020.

The reforms broadly apply to group health plans (including fully insured plans, self-insured plans and level-funded plans) and health insurance issuers of individual and group coverage. In general, most employers will rely on their issuers, third-party administrators (TPAs) and other service providers to satisfy most of the new requirements, including the obligations to provide machine-readable files (MRFs) and a cost comparison tool and submit detailed reports on prescription drug spending. Employers should confirm that their written agreements with their issuers, TPAs or other service providers are updated to address this compliance responsibility.

KEY REFORMS
Key reforms related to transparency and surprise medical bills include:  

• MRFs with detailed price information
• Self-service cost comparison tool
• Reporting on prescription drug costs
• Prohibition on gag clauses
• Broker compensation disclosures
• Ban on balance billing
• Continuity of care requirements

IMPORTANT DEADLINES
The new requirements have various effective dates. Some key deadlines are as follows:

• MRFs—Plan years beginning on or after Jan. 1, 2022 (or July 1, 2022, if later);
• Self-Service Cost Comparison Tool—Plan years beginning on or after Jan. 1, 2023
• Reporting on Prescription Drug Costs—Dec. 27, 2022