A recent Mercer comment letter suggests ways to improve the proposed transparency in coverage rules, issued last fall by the departments of Treasury, Labor, and Health and Human Services. Price transparency is a critical component of improving healthcare quality, affordability and accessibility for US workers and their families.
The proposed transparency rules would require most employer-sponsored group health plans and health insurance issuers to disclose price and cost-sharing information to participants before they receive healthcare items and services. The disclosure would give estimates of any out-of-pocket costs participants must pay, while making price information accessible in a standardized format. In particular, nongrandfathered group health plans would have to:
To encourage consumers to shop for better prices, the rule would offer relief from minimum loss ratio (MLR) rebates if plans share cost savings with enrollees who choose less-expensive providers.
In Mercer’s view, transparency rules are necessary to address wide price variations, reduce waste in the healthcare system and help individuals make informed choices about their healthcare spending. Properly structured transparency rules will give participants a better upfront understanding of how much they will have to pay out-of-pocket for many healthcare services.
Mercer suggests the agencies improve the transparency rules in several ways:
Mercer also emphasizes that insurers and plan sponsors need adequate time to implement the transparency requirements. The proposed rules currently would apply on the first day of the first plan year starting only one year after the regulations are finalized. Mercer instead recommends extending that compliance deadline to the first day of the first plan year starting two years after final rules are published.