Skip to main navigation Skip to main content Skip to footer For Individuals & Families For Medicare For Providers For Brokers Español For Employers: For Employers Medical Savings and Spending Accounts (HRA/HSA/FSA) Wellness, Mental Health, and Behavioral Pharmacy Dental and Vision Cost Control Strategies Supplemental Health Solutions Who We Serve Overview Small Employers (51 - 499) Medium Employers (500 - 2,999) Large Employers (3,000+) Hospitals and Health Systems Higher Education K-12 Education State and Local Governments Taft-Hartley and Federal Membership and Affinity Groups Third Party Administrators Health Insurance for Expats IGO/NGOs Multinational Businesses Why Cigna Overview Industry Insights Overview Informed on Reform Workplace Wellness Consumer-Driven Health Plans Log in to Employer Portal
Home Employers Industry Insights Informed on Reform Health Care Reform NewsTri-Agencies Finalize Transparency in Coverage Rule

Article | 30 October 2020

Tri-Agencies Finalize Transparency in Coverage Rule

On Oct. 29, 2020, the U.S. Departments of Health and Human Services, Labor, and Treasury (tri-agencies) released a prepublication version of a final rule on Transparency in Coverage. Initially proposed last year, the rule requires most group health plans and health insurance issuers in the individual and group markets to disclose price and cost-sharing information for all covered items and services to participants and enrollees. This rule is separate from a similar rule requiring hospitals to disclose price information set to take effect on Jan. 1, 2021. Both rules follow through on a 2019 Executive Order designed to increase price transparency for consumers and competition among all hospitals and health insurers.

Disclosing Cost-Sharing Information and Negotiated Rates
The final rule requires most group health plans and health insurance issuers in the individual and group markets to disclose cost-sharing information to customers upon request. The information must be available through a self-service tool online and, if requested, in paper form. The cost-sharing information must be made available for all procedures, medical tests, drugs, durable medical equipment, and any other item or service a customer may need for which the costs are payable, in whole or in part, under the terms of a plan or coverage. Calculations must consider all applicable forms of cost sharing – including deductibles, coinsurance requirements, and copayments – but do not include premiums, balance billing amounts for services received from out-of-network providers, or the cost of non-covered items or services.

In addition to providing personalized cost-sharing information, health plans and health insurers must also publicly disclose in-network provider negotiated rates and historical out-of-network allowed amounts online through two separate machine-readable files. A third file must also be posted to disclose negotiated rates with pharmacies and average historical net prices for prescription drugs, taking into account any rebates or discounts received. Historical pricing information must be provided for a 90-day period beginning 180 days prior to file publication.

Cigna believes health care consumers should have easy access to information that allows them to make better informed decisions. While we support and encourage meaningful and actionable price transparency, we believe public disclosure of negotiated rates would confuse consumers, result in higher prices for health care, and return the health care system to a fee-for-service orientation by encouraging focus on unit costs rather than quality and total cost of care.

Medical Loss Ratio Program Rules for Shared Savings Plans
Insurers that incentivize consumers with plan provisions that encourage the use of services from lower-cost, higher-value providers – and share the resulting savings with consumers – will be allowed to take credit for the “shared savings” payments in medical loss ratio (MLR) calculations beginning with the 2020 MLR reporting year.

Effective Dates
Effective Jan. 1, 2022, plans and issuers must make applicable data files publicly available. Personalized cost-sharing information must be made available for 500 services (as determined by the tri-agencies) beginning Jan.1, 2023, and cost-sharing information for all items and services are required beginning Jan. 1, 2024.

For more details on the final rule, review the information at these links:

  • Read the final rule [PDF]
  • Read the Centers for Medicare & Medicaid Services fact sheet

We encourage you to bookmark Informed on Reform, where we continuously update information on legislation and regulatory changes impacting health plans.

Related Resources

Informed on Reform News Informed on Reform FAQs Informed on Reform

As the health care landscape continues to evolve, Informed on Reform breaking news alerts are expanding to cover a broader range of topics. We will continue to provide updates and alerts on the Affordable Care Act as well as any key federal legislation, regulations or executive orders that could potentially impact health plans.

Page Footer

I want to...

Get an ID card File a claim View my claims and EOBs Check coverage under my plan See prescription drug list Find an in-network doctor, dentist, or facility Find a form Find 1095-B tax form information View the Cigna Glossary Contact Cigna


Individuals and Families Medicare Employers Brokers Providers

Secure Member Sites

myCigna member portal Health Care Provider portal Cigna for Employers Client Resource Portal Cigna for Brokers

The Cigna Group Information

About The Cigna Group Company Profile Careers Newsroom Investors Suppliers The Cigna Group Third Party Administrators International Evernorth

 Cigna. All rights reserved.

Privacy Legal Product Disclosures Cigna Company Names Customer Rights Accessibility Report Fraud Sitemap


Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of South Carolina, Inc., and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see a listing of the legal entities that insure or administer group HMO, dental HMO, and other products or services in your state). Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of Cigna Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT); (ii) Life Insurance Company of North America (“LINA”) (Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY (“NYLGICNY”) (New York, NY), formerly known as Cigna Life Insurance Company of New York. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna.

All insurance policies and group benefit plans contain exclusions and limitations. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. This website is not intended for residents of New Mexico.

Selecting these links will take you away from to another website, which may be a non-Cigna website. Cigna may not control the content or links of non-Cigna websites. Details