January 24, 2023
Blog - SeubertU
Beginning in 2023, group health plans and health insurance issuers must make an internet-based price comparison tool available to participants. The purpose of this tool is to provide consumers with real-time estimates of their cost-sharing liability from different providers for covered items and services, including prescription drugs, so they can shop and compare prices before receiving care. Upon request, plans and issuers must also provide this information in paper form or over the telephone.
For plan years beginning on or after Jan. 1, 2023, plans and issuers must make price comparison information available for 500 shoppable items, services and drugs. For plan years beginning on or after Jan. 1, 2024, price comparison information must be available for all covered items, services and drugs.
Most employers will rely on their issuers or third-party administrators (TPAs) to provide this tool and provide related disclosures on paper or over the phone upon request.
Employers should confirm that their issuers and TPAs will comply with the price comparison tool requirements beginning with the 2023 plan year and ensure this compliance responsibility is reflected in a written agreement. In addition, self-insured employers should monitor their TPAs’ compliance with this requirement, as the legal responsibility stays with the employer.