Transparency Disclosure Rules for Group Health Plans


This practice note explains recently imposed disclosure requirements for group health plans arising under the Patient Protection and Affordable Care Act's (ACA's) Transparency in Coverage Rule (85 Fed. Reg. 72,158 (Nov. 12, 2020)) and certain No Surprises Act provisions, enacted as Title I of Division BB of the Consolidated Appropriations Act, 2021 (CAA) (Pub. L. No. 116-260). These rules (collectively referred to here as the Transparency Disclosure Rules) require health plans and insurers to provide a substantial amount of cost, coverage, provider, and other coverage information to eligible and covered individuals and make rate information publicly available. They apply for most employer-sponsored group health plans (both self-funded and fully insured) as well as to health insurance policies in the individual and group markets. Many of the new requirements became effective on January 1, 2022.