Employee Health Insurance
New requirement under the Transparency in Coverage Rule, issued in 2020 by the U.S. Department of Health & Human Services, U.S. Department of Labor and U.S. Department of the Treasury.
Enforced beginning 7/1/22, health plans (which includes clients who sponsor employee benefit plans) and health insurance issuers must publish two separate Machine Readable files (MRFs).
In Network: Negotiated rates for all covered items and services between the plan or issuer and in-network providers.
Out of Network: Allowed amount paid to, and billed charges from, out of network providers for all covered services within a 90-day period.