Federal Government Provides Relief to Self-Funded Health Plans on New Transparency Rules

December 26, 2022
Michael Bivona
Health Plans

One major health insurance story throughout much of the last few months of 2022 was the push by the federal Departments of HHS, Treasury, and Labor (“Agencies”) to increase price transparency and make plan information more accessible to plan participants. We have summarized these price transparency rules in a previous article. However, the Agencies have made significant changes to the transparency requirements. These changes have been articulated in a new FAQ released over Christmas weekend. The important aspects of the FAQ are detailed below:


 - Any entity required under the price transparency rules to submit prescription drug and healthcare spending reports will now have a grace period to submit such reports until January 31, 2023.


- Entities required to submit prescription drug and healthcare spending reports will be held to a “good faith, reasonable” standard when submitting such reports. If the entities make a good faith effort to comply with the reporting requirements and their interpretation of the requirements are objectively reasonable, then their submission will be satisfactory even if there are some errors/omissions in the content.


- Different reporting entities may submit the same data file type on behalf of the same plan (rather than forcing the separate entities coordinate to submit different data file types).


- Rather than being required to use the HIOS RxDC module to submit the required data, entities may send the information by email to [email protected]. All information that would have been submitted through the module must be given in the email.



This extension should provide much-needed relief to employers and TPAs who are feeling burdened by the onerous requirements of the new rule. The FAQ places a large emphasis on good faith effort, so employers should attempt to comply with the requirements as much as possible, including consulting those who specialize the health insurance arena.



You can read the entire new FAQ HERE.


Heather Reynolds, ESQ

CCO - Administrative Officer
FNA Insurance Services, Inc.
516-348-7199 |[email protected]



Michael Bivona

Compliance Paralegal
FNA Insurance Services, Inc.
516-348-7135 |[email protected]