Group health plans and health insurance issuers will be required to make an internet-based price comparison tool available to participants, beneficiaries, and enrollees for plan years beginning on or after January 1, 2023.
The tool will be used to provide consumers with estimates of their cost-sharing liability from different providers on covered services and items. Plans and issuers are required, upon request, to supply this information over the phone or in paper form.
In most cases, issuers or third-party administrators (TPAs) have developed and will maintain the price comparison tool and provide requested disclosures. The price comparison tool requirement applies to group health plans (including self-insured and level-funded plans) and health insurance issuers of individual and group coverage.
Employers with fully insured health plans should confirm that their issuer will comply with the tool requirements for 2023 plan years. Additionally, employers should secure compliance responsibility through a written statement.
Employers with self-insured plans should contact their TPAs to confirm compliance for 2023 plan years. It is imperative that employers monitor their TPA’s compliance with the requirement as the legal responsibility for the tool belongs with the self-insured plan.
2023 plan years – Plans and issuers will provide price comparison information for 500 shoppable items, services, and drugs.
2024 plan years – Price comparison information must be made available for all covered items, services, and drugs.
If you have any questions about the price comparison tool or its requirements, please contact your dedicated Creative Benefits, Inc. team member.