Transparency in health care

Priority Health believes that health care costs should be clear, and we are proud to have long been leading the charge when it comes to cost transparency. Everyone deserves to have knowledge at their fingertips that helps them engage in their health care and make the best decisions for themselves and their families.

In October 2020, the Federal government issued new requirements for health plans and health insurers designed to increase the availability of health care cost information related to Individual and most group plans. The Transparency in Coverage rule includes a phased approach to developing cost transparency services.

Phase 1: Machine-readable pricing files

The first item in the rule requires that machine-readable pricing files be made publicly available. These files provide negotiated rates for items and services between Priority Health and in-network providers; and certain historical payments to out-of-network providers.

We have provided links to machine-readable files in .json format, as required by CMS. They are extremely large (over 100GB) so plan accordingly.

Click on the plan type to access the associated in-network rate files. If unsure, the Table of Contents indicates alignment of groups with plan types. For the out-of-network historical detail, select the Out-of-Network file.

Phases 2 & 3: Future transparency requirements

As we move forward into 2023 and beyond, we will be working to enhance our self-service estimation services and ensure alignment with the next series of transparency rule timelines and requirements.

  • Calculating a "real time" estimate of your out-of-pocket share for a wide variety of items and services covered in plan.

We will continue to work directly with government officials and available guidance documentation to ensure we are meeting all requirements within this ruling as they are issued.