Over $1.3 trillion is spent on private health insurance, with per-enrollee spending by private insurers growing by 61.6% from 2008 to 2022. The primary reason for this increase in per enrollee spending is a result of the increase in health care prices, with the Consumer Price Index for medical services growing at an average rate of 3.1% per year compared to 2.6% per year for the Consumer Price Index for All Urban Consumers. Prior to 2022, employers and employees had very little access to understand expected health care costs for services and procedures, but that all changed with the Transparency in Coverage Rule and the Consolidated Appropriations Act.

The Transparency in Coverage Rule has five goals that meaningfully impact health care consumers, as listed below:

  1. Establish a market-driven health care system
  2. Enable comparison shopping
  3. Expose real-time pricing information and out-of-pocket liability 
  4. Stabilize and reduce the price of health care services
  5. Empower, inform, and incentivize action from consumers

The pursuit of these goals upon plan sponsors began July 1st, 2022 when the first phase of the Rule became enforceable with the publication of two machine-readable files (In-Network Negotiated Rates and Out-of-Network Historical Billed Amount). The pursuit continued into 2023 and 2024, when the second and third phases of the Rule required that health care consumers be equipped with a cost-comparison shopping tool for 500 identified items and services (2023) and then all covered items and services (2024).

Complete your profile to continue reading and get FREE access to BenefitsPRO, part of your ALM digital membership.

  • Critical BenefitsPRO information including cutting edge post-reform success strategies, access to educational webcasts and videos, resources from industry leaders, and informative Newsletters.
  • Exclusive discounts on ALM, BenefitsPRO magazine and BenefitsPRO.com events
  • Access to other award-winning ALM websites including ThinkAdvisor.com and Law.com

© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.