New Federal Rule Makes Plan Pricing Data Easier to Find
HHS just proposed changes that could finally make comparing healthcare plan costs straightforward for employers.
If you've ever tried to get straight pricing information from a health plan—you know, simple questions like "What will this procedure actually cost my employee?"—you've probably felt like you were speaking different languages. That's about to change. The Department of Health and Human Services just released a new proposed rule that could make health plan pricing as clear as your cell phone bill.
What Changed
On December 23rd, HHS, Treasury, and Labor rolled out new price transparency requirements for health plans and insurers. The big changes: plans must simplify their pricing data, report quarterly instead of monthly, and—here's the kicker—post a direct link to provider rate information right in the footer of their websites. No more hunting through 47 different PDFs to find out what your network actually charges. The rule applies to all non-grandfathered group and individual health plans, and becomes effective 12 months after it's finalized.
Who This Affects
This hits virtually every employer offering health benefits in New York, unless you're still running one of those rare grandfathered plans from 2010. Whether you're a 15-person construction company in Albany or a 150-employee tech firm in Brooklyn, your health plan will need to make their pricing data actually usable. The transparency requirements apply to both fully-insured plans and self-funded arrangements, so size doesn't matter here—if you offer health benefits, this affects you.
What You Need to Do
- Wait for the final rule (expected within the next few months), then mark your calendar for 12 months after publication
- Ask your current health plan how they're preparing to comply—their systems need significant updates
- Start thinking about how easier price comparison might change your renewal strategy
- Review whether your current plan's provider network makes sense if pricing becomes more transparent
The NY Angle
New York already operates its own All-Payer Claims Database (NY APCD), which collects healthcare claims data statewide. This federal rule should complement that effort by providing more granular, network-specific pricing information. For NY employers, this creates a double advantage: state-level claims data showing overall healthcare trends, plus federal requirements giving you real-time pricing for your specific network. That's powerful ammunition when you're negotiating renewals or considering plan changes. As we discussed in our recent post about pushing back during renewal season, having actual data changes everything at the negotiating table.
Need help navigating this? Benton Oakfield's compliance team works with businesses like yours every day. We can review your current setup and make sure you're covered. Reach out - it's what we do.
Photo by Gustavo Fring on Pexels
