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Group Health Plan Information

Changes to Group Health Plan Transparency

Ron's Staffing of Illinois is here to provide you with the information you need on recent changes to laws governing group health plans in Illinois. Our SBMA clients that sponsor SBMA Minimal Essential Coverage plans will need to implement changes to remain compliant with the law. We understand the necessary steps to ensure compliance with changes in the laws surrounding group health plan transparency. The Department of Health and Human Services issued the transparency coverage final rules that require issuers of group health plans and health insurance to disclose pricing information in three separate files free of charge on a public website.

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The Required Machine-Readable Files

In accordance with the transparency coverage final rules, information on our group health plans should now be made available in separate machine-readable files. SBMA MEC plans are self-funded and assisted by the SBMA. The employer or plan sponsor is responsible and legally obligated to comply with changes to the law. Self-insured employers should provide a link on their public website where viewers can access the machine-readable files. The three separate files required include the following:

  • In-network provider negotiated rates for covered items and services
  • Historical payments and billed charges from out-of-network providers
  • In-network negotiated rates and historical net prices for covered prescription drugs

Legal Obligation for Self-Insured Employers

Self-insured employers can satisfy compliance obligations by providing a link to the location of the required files on their public website. They can also enter into a written agreement for another party to make the required information public. According to the “non-duplication” rule, as long as the required information is made available, it doesn’t need to be duplicated. SBMA can act as this other party and plans to update user agreements as they are renewed. Sponsors of a MEC plan should provide a button on their website designated “Transparency in Coverage,” followed by “Click here to access information about our company’s group health plan’s payments to, and billed charges from, providers.”

Take the Necessary Steps to Remain Compliant

We recommend that employers and sponsors that do not have a website instead provide a notice to their plan participants that information about the company’s group health plan’s payments to and billed charges from providers is available on the SBMA website. The transparency in coverage rules is part of a more extensive set of transparency rules that affect every aspect of health care in the United States. Transparency in coverage rules is the first to affect employers and employer-sponsored group health plans. For more information and guidance, contact the SBMA compliance department with any questions you may have.

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