2023 Health Insurance Price Comparison Requirements & What You Need to Know
2023 is here, and with the new year comes new health insurance requirements from The Department of Labor (DOL). This year, all group health plans and insurance issuers must provide internet-based price comparison tools.
Beginning on January 1, these price comparison tools are required—no exceptions—and must be available for all 2023 group health plans. For the remainder of the year, this tool must be available to compare over 500 shoppable items, services, and drugs. However, beginning in 2024, the comparison tool requirements will extend to all covered items, services, and drugs.
These new requirements are excellent news for employers who want the best coverage for their employees at the best possible price. That said, it also means that employers are now responsible for ensuring they comply with these new obligations set by the DOL.
Requirements for Plan Years Beginning in 2023
Plans and policy years beginning on or after January 1, 2023, must disclose personalized pricing information for all covered items and services as set by The Consolidated Appropriations Act, 2021 (CAA) and the Transparency in Coverage (TiC). In addition, a price comparison tool must be available to all participants, beneficiaries, and enrollees via the internet. This information must also be provided in paper form or over the phone upon request.
According to the Centers for Medicare & Medicaid Services, failure to meet these requirements can result in hefty penalties, including “a civil money penalty up to $100 per day, adjusted annually under 45 CFR part 102, for each violation and for each individual affected by the violation.”
What Exactly Does the New Health Price Comparison Tool Do?
The purpose of this tool is to provide customers with real-time estimates of their cost-sharing liability from different providers for covered items and services. In addition, this tool allows customers to shop and compare prices before receiving care. Employees should be encouraged to take full advantage of this tool to avoid unexpected out-of-pocket expenses. Utilizing these resources, they can access estimates for care, services, and prescriptions—allowing complete financial transparency ahead of doctor visits.
As of January 1, 2023, the comparison tool must include—but is not limited to—the following information:
- Estimates for an individual’s cost-sharing liability for covered items or services.
- In-network and out-of-network rates.
- Notifications for specific items or services subject to a prerequisite or prior authorization.
- Disclosure notices communicated in plain language. For example, a statement that the cost-sharing estimate for a particular item or service is not a guarantee that benefits will be provided.
Actionable Steps for Employers
According to the TiC Final Rules, fully insured group health plans will rely on their policy issuers to develop and maintain the price comparison tool requirements. Therefore, should the policy issuer fail to provide a compliant price comparison tool, the issuer—not the plan—will be in violation of the TiC Final Rules’ transparency requirements.
For employers with self-insured health plans, the Final Rules allow employers to contract with third-party services to provide the required tool. If you are an employer with a self-funded plan, don’t hesitate to contact your third-party administrator (TPA) to confirm they are in compliance; your TPA should also have updated agreements to reflect this responsibility. In this situation, it’s wise for employers to monitor their TPAs’ compliance, as the legal responsibility for this tool stays with the self-funded plan.
Beckham Insurance Group Has You Covered
While the 2023 deadline has already passed, there is still work to be done as the next January 1, 2024 deadline approaches. As the federal government finalizes these new requirements, it’s essential for employers to work with their group health plan partners to ensure they are in compliance now and also ready for the more stringent requirements in 2024.
For more information on health insurance price comparison tool requirements, please visit the Centers for Medicare and Medicaid Services. Here, you’ll find a complete list of the 500 items and services required for comparison in 2023. Or, if you are an employer searching for help in Georgia or South Carolina, simply reach out to a member of our team at Beckham Insurance Group. Located in Charleston, SC, and St. Simons, GA, we proudly offer complete access to all group health and supplemental insurance markets and products.
Creating a competitive—and compliant—benefits package that meets the needs of your business couldn’t be easier. To get started, contact us today for a free quote. We can’t wait to help you create a healthier and happier workplace!
