Transparency in health care

What is the transparency ruling?

In October 2020, the federal government issued the "transparency in coverage" final rule. The rule imposes new transparency requirements on most group health plans and health insurers in the individual and group markets. The purpose of the requirements is to enable consumers to make informed health care purchasing decisions.

What does this mean for Priority Health members?

The rule initially requires health plans and issuers, including Priority Health, to disclose pricing information related to the individual and group markets.

This includes information related to:

  • Negotiated rates for items and services between Priority Health and in-network providers
  • Historical payments to out-of-network providers based on plan type

In compliance with the ruling, Priority Health will begin publicly posting files with the above information to Priority Health's website in July 2022. We will continue to work directly with government officials to ensure we are meeting all requirements within this ruling as they are issued.

Following the initial rate and payment disclosure requirements, the rule also lays out additional self-service cost estimation service provisions beginning in 2023.

While Priority Health has long been an industry leader when it comes to transparency, this ruling will help spur further innovation in the cost estimation space, and provide consumers with additional opportunities to better understand the cost of their health care.

Making costs clear

Priority Health believes that health care costs should be clear. That is why we provide our members with a variety of tools and resources that they need to make informed health care decisions, including our unique Cost Estimator.

We are proud to be leading the charge when it comes to transparency in health care. We believe everyone deserves to have the knowledge at their fingertips that helps them engage in their health care and make the best decisions for themselves and their families.

As we move forward into 2023 and beyond, we will not only meet the requirements, but will enhance our current services, continuing to empower our members with valuable tools and resources.