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Transparency in Coverage (TiC) Under the ACA Toolkit
Practical Law Toolkit w-041-6401 (Approx. 5 pages)
Transparency in Coverage (TiC) Under the ACA Toolkit
by Practical Law Employee Benefits & Executive Compensation
| Maintained • USA (National/Federal) |
A collection of resources to help employers and their advisors comply with cost transparency requirements under the Affordable Care Act (ACA) that apply to group health plans and health insurers. The ACA's transparency requirements were implemented through extensive final regulations issued by the administrative agencies in November 2020.
Under the Affordable Care Act (ACA), employer-sponsored group health plans and health insurers must comply with extensive cost-transparency disclosure and reporting requirements regarding the health coverage they provide to participants and beneficiaries. Known as the ACA's transparency in coverage (TiC) rules, these requirements:
- Were added under Section 2715A of the Public Health Service Act (PHSA) (42 U.S.C. § 300gg-15a).
- Are also part of the Employee Retirement Income Security Act of 1974 (ERISA) and Internal Revenue Code (Code).
- Were implemented under final regulations issued by the Departments of Labor (DOL), Health and Human Services (HHS), and Treasury (collectively, Departments) in November 2020 (85 Fed. Reg. 72158 (Nov. 12, 2020)).
The TiC final regulations consist of two general requirements. Under the TiC participant disclosure rules, plans and insurers must furnish cost-sharing information on request to participants and beneficiaries. These disclosures include estimates of an individual's cost-sharing liability for covered items or services furnished by a health provider. Under the TiC public disclosure rules, plans must publicly post on a website three machine-readable files (MRFs) that include:
- In-network rates with providers for all covered services.
- Out-of-network allowed amounts and billed charges for covered services.
- Negotiated rates and historical net prices for prescription drugs.
This Toolkit contains resources to help employers and their advisors comply with the TiC participant and public disclosure requirements under the ACA, as implemented.