The U.S. Treasury Department and IRS (jointly with the Labor Department and the Department of Health and Human Services) this afternoon released for publication in the Federal Register a final rule (T.D. 9929) to require group health plans and health insurance issuers in the individual and group markets to disclose, upon request, cost-sharing information to a participant, beneficiary, enrollee or that person’s authorized representative.
The final rule also requires health plans and issuers to disclose in-network provider rates, historical out-of-network allowed amounts and the associated billed charges, and negotiated rates for prescription drugs.
Under the final rule, plans and issuers are required to make the information available on an internet website and, if requested, in paper form. The purpose is to allow a participant, beneficiary, enrollee or authorized representative to obtain an estimate and understanding of the individual’s out-of-pocket expenses and to allow the person to “effectively shop” for items and services.
The final rule [PDF 1 MB] (153 pages as published in the Federal Register on November 12, 2020) is intended to give access to health coverage information that can be used to understand health care pricing and “potentially dampen the rise in health care spending.”
The purpose of this report is to provide text of the 153-page final rule.
The KPMG name and logo are trademarks used under license by the independent member firms of the KPMG global organization. KPMG International Limited is a private English company limited by guarantee and does not provide services to clients. No member firm has any authority to obligate or bind KPMG International or any other member firm vis-à-vis third parties, nor does KPMG International have any such authority to obligate or bind any member firm. The information contained 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.