As of January 1st, self-insured employers and health insurance issuers with plan years starting in 2023 were required to give health plan members access to an online, shoppable tool with pricing information for 500 of the most commonly covered medical items and services. Those who don’t comply face a potential penalty of $100 per person per day per violation. HR and benefits teams – and their payer partners – have had a lot of work to do to ensure compliance, and it’s been far more challenging than expected.

While the spirit of the Transparency in Coverage (TIC) Rule is to support cost-conscious consumer decision making, increase innovation, and lower costs, we are only just beginning to understand what it takes to make pricing data available, accessible, and actionable for everyday health care consumers. If we can do it successfully, plan members will have the ability to make better health care decisions based on the true cost of care, which has the potential to reduce health care spend and improve health outcomes across the health care system. The question remains, “what will it take?”

The government may have set minimum standards for compliance, but regulators are calling on the private sector to deliver on the promise of price transparency to lower the cost and maintain – or improve – the quality of health care. Some in the health care industry see compliance as a serious burden, but it’s important to recognize that the lack of transparency has been a burden borne by patients, their families, and those ultimately paying for their care – like their employers. Self-insured employers are in a powerful position to use this information to shine a light on what they’re paying for.

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