States may seek tougher enforcement of health plan transparency disclosures

State insurance regulators are thinking about whether they should push health plans to post what they pay for care in an easier-to-use format.

The federal government began requiring insurers and self-funded employer health plans to comply with federal transparency in coverage, or TiC, rules starting in July 2022.

Today, however, “TiC” information is difficult to find, and many of the files that are posted are too difficult for laypeople to use, according to Sabrina Corlette, co-director of Georgetown University’s Center on Health Insurance Reforms.

Corlette is preparing to give members of the National Association of Insurance Commissioner’s Health Insurance Committee a briefing on the state of TiC data files Thursday, at an in-person NAIC meeting in Chicago.

Making the federal price transparency rules work better might be one way to help patients shop for care and hold down costs, Corlette argues in a slidedeck included in an NAIC meeting packet.

In theory, improving TiC rules could also increase the amount of information employers and brokers have to design and manage employers’ own health plans.

Related: Why can’t employers bargain for lower health care prices? A plan director explains

The federal rules already require health insurers and employer plans to publish what they pay for in-network care and out-of-network care, for all covered items and services, in a machine-readable form.

Corlette notes that the parties involved in improving the TiC files will include self-funded employer plans, insurers, state insurance regulators, the U.S. Labor Department and the Centers for Medicare and Medicaid Service, 

Some of the changes Corlette suggests include requiring issuers to:

• Share standardized summaries of their TiC data.
• Use standard formats.
• Provide a data directory or library index for the TiC files.
• Meet data quality standards.