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Five Things To Know About The Transparency In Coverage Rules

Transparency in Coverage rules have been established by the Centers for Medicare & Medicaid Services (CMS) and require health plans and self-funded employer groups to post on their public website machine-readable files containing the following pricing information:

  • In-network provider contracted rates for items and services
  • Out-of-network allowed amounts and billed charges for items and services

To comply with the Transparency in Coverage rule, Univera has made the above information available on our website.

Here are the top things self-funded groups should know about the initiative:

  1. Starting July 1, 2022, self-funded employer groups are required to share contracted prices and out-of-network allowed amounts for health care items and services on their public websites.
  2. To fulfill this requirement, please place this link
    [ ] on your website.
  3. Machine-readable files are designed for a machine (i.e., computer) to read and are not user- friendly for members.
  4. A better user experience for Univera members will be to login to their online account to access our Estimate Medical Costs Tool, which will help most members estimate out-of-pocket costs based on their health insurance benefits.
  5. If needed, here is sample copy to accompany the link on your website:
    Machine-Readable Price Transparency Files: As required by the federal Transparency in Coverage rules, here are machine-readable files containing the amounts paid for medical services. Please note that these files are designed for developers or data aggregators and are not consumer friendly. Members are encouraged to use the Univera Healthcare Estimate Medical Costs Tool instead.”


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