Share with your friends

Proposed regulations: Transparency in health plans, insurance coverage

Transparency in health plans, insurance coverage

The U.S. Treasury Department and IRS along with the Departments of Labor and Health and Human Services today released for publication in the Federal Register proposed regulations (REG-118378-19) setting forth requirements for group health plans and health insurance issuers in the individual and group markets to disclose cost-sharing information upon request to a participant, beneficiary or enrollee (or that person’s authorized representative), including an estimate of such individual’s cost-sharing liability for covered items or services furnished by a particular provider.


Related content

Under these proposed rules, plans and issuers would be required to make such information available on an internet website and, if requested, through non-internet means. The aim would be to allow a participant, beneficiary or enrollee (or authorized representative) to obtain an estimate and understanding of the individual’s out-of-pocket expenses and to allow this person to “effectively shop for items and services.”

The proposed rules also include measures to require plans and issuers to disclose in-network provider negotiated rates, and historical out-of-network allowed amounts through two machine-readable files posted on an internet website. This measure would be intended to allow the public to have access to health insurance coverage information that can be used to understand health care pricing and potentially address the rise in health care spending.

Read the proposed regulations [PDF 605 KB] (60 pages) as published in the Federal Register on November 27, 2019. 

The KPMG logo and name are trademarks of KPMG International. KPMG International is a Swiss cooperative that serves as a coordinating entity for a network of independent member firms. KPMG International provides no audit or other client services. Such services are provided solely by member firms in their respective geographic areas. KPMG International and its member firms are legally distinct and separate entities. They are not and nothing contained herein shall be construed to place these entities in the relationship of parents, subsidiaries, agents, partners, or joint venturers. No member firm has any authority (actual, apparent, implied or otherwise) to obligate or bind KPMG International or any member firm in any manner whatsoever. The information contained in herein is of a general nature and is not intended to address the circumstances of any particular individual or entity. Although we endeavor to provide accurate and timely information, there can be no guarantee that such information is accurate as of the date it is received or that it will continue to be accurate in the future. No one should act on such information without appropriate professional advice after a thorough examination of the particular situation. For more information, contact KPMG's Federal Tax Legislative and Regulatory Services Group at: + 1 202 533 4366, 1801 K Street NW, Washington, DC 20006.

Connect with us


Want to do business with KPMG?


loading image Request for proposal