Transparency in Coverage – AECOM Benefits

In 2020, the federal government issued the Transparency in Coverage Rule, requiring health plans and insurance issuers to disclose certain pricing information for items and services that aren’t benefits under non-grandfathered plans in the individual and group markets. The rule is effective for plan years starting on or after January 1, 2022. The federal government has provided a six-month preparation period enabling plans to publicly provide this information by July 1, 2022.

Under the regulation, providers’ rates must be disclosed to the public each month. This includes negotiated rates with in-network providers, as well as provider charges and amounts previously paid to out-of-network providers. Amounts paid to out-of-network providers will reflect historical billed charges and allowed amounts paid three to six months before the publication date.

The data must be reported in the machine-readable (computer-readable) format specified in the final ruling’s technical implementation guide. As required, this data is published on publicly accessible websites, available to any person free of charge, and updated monthly.

In compliance with the Transparency in Coverage Rule and in support of the plans impacted by this requirement, the carrier links below can be used to access information and respective machine-readable files for applicable plans.

For employees in Illinois, please click here to review the Illinois Consumer Disclosure Act Essential Health Benefit List.