In 2020, the Federal Government finalized “Transparency in Coverage” Rule, which requires health insurers and group health plans, including self-funded clients, to provide cost-sharing data to consumers via:
- Machine-readable files: Machine-readable files must be published on a publicly available site based on the enforcement date of July 1, 2022, for plan years beginning on or after Jan. 1, 2022. These files provide pricing data for covered items and services based on in-network negotiated payment rates and historical out-of-network allowed amounts. Information in these files must be updated and published monthly.
- Consumer price transparency tool: This online tool for members will include personalized, real-time, cost-share estimates for covered services and items, including pharmacy. Paper versions must be available upon request. For plan years beginning on or after Jan 1, 2023, the online tool must provide cost-share estimates for 500 “shoppable” services. For plan years beginning on or after Jan. 1, 2024, the online tool must provide cost-share estimates for all covered services.
CARTI’s Group Medical Benefits are Administered by UMR (a subsidiary of UnitedHealth Group). The Machine Readable Files and Consumer Price Transparency Tool can be accessed here.
NOTE: When accessing the tool, please search for “CARTI-GROUP” to see applicable data, as an example, below is how the entries will appear:
- 32286. 2022-07-03_CARTI-GROUP-HEALTH-BENEFIT-PLAN_CARTI-GROUP-HEALTH-BENEFIT-PLAN_allowed-amounts.json.gz
- 4391. 2022-07-01_CARTI-GROUP-HEALTH-BENEFIT-PLAN_index.json