Transparency in Coverage Rule

In 2020, the Federal Government finalized “Transparency in Coverage” Rule, which requires health insurers and group health plans, including self-funded clients, to provide cost-sharing data to consumers via: 

• Machine-readable files: Machine-readable files must be published on a publicly available site based on the enforcement date of July 1, 2022, for plan years beginning on or after Jan. 1, 2022.  These files provide pricing data for covered items and services based on in-network negotiated payment rates and historical out-of-network allowed amounts.  A third machine-readable file for prescription* drug rates and historical costs has been delayed pending further guidance. Information in these files must be updated and published monthly. 
   
• Consumer price transparency tool: This online tool for members will include personalized, real-time, cost-share estimates for covered services and items, including pharmacy. Paper versions must be available upon request. For plan years beginning on or after Jan 1, 2023, the online tool must provide cost-share estimates for 500 shoppable services. For plan years beginning on or after Jan. 1, 2024, the online tool must provide cost-share estimates for all covered services.

STAR Institute group health plans are provided by United Healthcare. For more information on Transparency in Coverage from United Healthcare visit: https://www.uhc.com/united-for-reform/health-reform-provisions/transparency-in-coverage-rule

To access United Healthcare's Machine-readable files, please visit - Publicly available MRF Files

If you are unable to view the provided MRFs you may view the converted Text Files below (updated as of June 29, 2022):

• 2022-06-03_Health-Plan-of-Nevada-Inc_HPN-NV---Grp-HMO_allowed-amounts
• 2022-07-01_HARVARD-PILGRIM_HARVARD-PILGRIM_ALLOWED-AMOUNTS
• 2022-07-01_HARVARD-PILGRIM_HPHC-FIVE-STATES-UNITEDHEALTHCARE-OPTIONS-PPO_IN-NETWORK-RATES