The information collection requirements contained in the proposed rule titled âTransparency in Coverage,â published November 27, 2019 (84 FR 65464), would require group health plans and health insurance issuers offering coverage in the individual and group markets to disclose to a participant, beneficiary, or enrollee (or an authorized representative on behalf of such individual), the estimated cost-sharing liability for covered items or services from a particular provider or providers, thereby allowing a participant, beneficiary, or enrollee to obtain an accurate estimate and understanding of their potential out-of-pocket expenses and to effectively shop for covered items and services. Group health plans and health insurance issuers would be required to make such information available through a self-service tool on an internet website. The self-service tool must provide the information through real-time responses and allow users to search for cost-sharing information for covered items and services. The self-service tool must also allow users to input information necessary to learn the out-of-network allowed amount for a covered item or service and have the capability to refine and reorder results. Group health plans and health insurance issuers would also be required to make this information available as a disclosure in written form. Both the self-service tool and the paper disclosure would be required to include several disclaimer statements relevant to information provided through the disclosure and could be provided by using a model notice developed by the Departments. Additionally, group health plans and health insurance issuers would be subject requirements to disclose in-network provider negotiated rates and historical payment data for allowed amounts for covered items and services furnished by out-of-network providers through two digital files in a machine-readable format to be specified by the Departments. The Negotiated Rate file and the Allowed Amount file must be posted publicly on an internet website.
The overall burden has decreased from 28,618,546 to 11,010,784 hours, resulting in a total burden reduction of approximately -17,607,761 hours. Over the same period, the associated cost has increased from $1,036,852,972 to $1,105,621,876, resulting in a reduction of approximately $68,768,904. Although the 2025 proposed rules introduce new requirements that increase burden, the significant reduction in the overall burden hours is primarily due to removal of first- and second-year one-time burden for issuers and TPAs to develop and implement their internet-based self-service tool, which were incurred in 2022 and 2023. Additionally, the overall reduction in burden is partially driven by updated count of issuers and TPAs, which lowered the total number of affected entities.
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No
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No
Yes
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No
Jamaa Hill 301 492-4190
Reginfo record details
Yes
The data collections will be used as a common form between HHS, DOL, and Treasury.
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table that charts list of RCF
Agency/Sub Agency
RCF ID
RCF Title
RCF Status
IC Title
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Form CMS-10715 Transparency in Coverage Model Notice
CMS-10715 Transparency in Coverage - Supporting Statement.docx
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