Mandating Transparency in Health Plan Data and Pricing for Lower Costs
This Act mandates greater transparency in employer-sponsored group health plans by requiring service providers (like PBMs) to share de-identified claims and pricing data with plan fiduciaries. This allows plan managers to audit costs, ensure fair compensation, and negotiate better rates. For citizens enrolled in these plans, this means increased oversight aimed at reducing hidden costs and improving the overall value of their health coverage.
Key points
Health plan managers gain the right to audit de-identified claims and pricing information to ensure service providers comply with the plan terms and fair compensation.
Contractual clauses that restrict or unduly delay access to claims data or hide details about pricing formulas are now void and prohibited.
Service providers who violate these transparency rules face significant daily civil penalties of $10,000.
Expired
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