Final Transparency in Coverage (TiC) Rules

What’s Changing

The Departments of Labor, Health and Human Services, and Treasury have issued final Transparency in Coverage (TiC) regulations, making significant updates to the transparency requirements first established in 2020. While many of the technical changes will be implemented by insurers, third-party administrators (TPAs), and reporting vendors, employers sponsoring non-grandfathered group health plans should be aware of several new requirements and important implementation deadlines.

• Price Comparison Tools – Plans must provide personalized cost-sharing information by telephone, in addition to existing online and paper disclosure methods. Participants, beneficiaries, and enrollees must be able to obtain personalized cost-sharing estimates by calling the customer assistance number on their health plan ID card, rather than being directed to an online transparency tool. This requirement applies to plan years beginning on or after January 1, 2027.
• Surprise Billing Rules – Required balance billing disclosures must be updated to reflect protections under the No Surprises Act. The rules also clarify that compliance with the TiC consumer disclosure requirements satisfies the corresponding federal No Surprises Act price comparison obligations. This requirement applies to plan years beginning on or after January 1, 2027.
• Machine-Readable Files – The regulations substantially revise the public machine-readable file (MRF) requirements, which require plans and insurers to disclose negotiated in-network rates and historical out-of-network payment information.

In-network reporting will shift from a plan-based structure to a provider network-based structure, with additional identifying information about provider networks and coverage arrangements.

The rules also permit the exclusion of certain unlikely provider-service combinations and establish additional reporting requirements for percentage-of-billed-charges arrangements.

Out-of-network reporting will use longer historical reporting periods, a lower claims threshold, and revised aggregation rules.

Additional requirements include a new Utilization File, providing historical information about services furnished by in-network providers, and a Taxonomy File, identifying provider-specialty rules used to determine whether certain services are eligible for reimbursement.

Plans and insurers must also include attestations to be embedded in the files themselves confirming, to the best of their knowledge and belief, the accuracy and completeness of applicable MRF data.

Finally, the regulations establish additional website disclosure and contact information requirements intended to make MRFs easier to locate and access.

The MRF changes will be implemented in phases. Phase 1, beginning March 6, 2027, includes provider network-level reporting, expanded identifying information, revised out-of-network reporting, accuracy attestations, and a transition from monthly to quarterly updates for in-network and out-of-network pricing files.

Phase 2, beginning September 6, 2027, includes the new contextual file requirements and additional website disclosure provisions. The first quarterly Taxonomy File is due October 1, 2027, while the first annual Utilization File is not due until July 1, 2028.

These changes will require operational adjustments by insurers, TPAs, and reporting vendors, although the reduced reporting frequency may ultimately lessen ongoing administrative burdens.

For employers, particularly sponsors of self-funded and level-funded plans, the regulations reinforce that delegating reporting responsibilities does not necessarily eliminate the plan’s liability for noncompliance. Although TPAs and other service providers may prepare and publish MRFs and related attestations on behalf of self-funded plans, the plans generally remain responsible if those obligations are not satisfied. Employers should review vendor agreements, confirm implementation responsibilities and timelines, and obtain assurances that the necessary changes will be completed by the applicable deadlines. Beyond compliance, the enhanced transparency data may also provide employers and their advisors with better information to evaluate provider networks, monitor vendors, and identify opportunities to manage health plan costs.

IMA will continue to monitor regulator guidance and offer meaningful, practical, timely information. This material should not be considered as a substitute for legal, tax and/or actuarial advice. Contact the appropriate professional counsel for such matters. These materials are not exhaustive and are subject to possible changes in applicable laws, rules, and regulations and their interpretations.

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