Federal Register #2026-20447

Final Rule Revising Health Plan Price Transparency and Consumer Access Requirements

Federal agencies issued a final rule revising price transparency requirements for health plans and health insurance issuers. - Government agencies: The Department of the Treasury, through the Internal Revenue Service (IRS); the Department of Labor, through the Employee Benefits Security Administration (EBSA); and the Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS). - Who is affected: Non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual coverage. - Key changes: Machine-readable files must include additional context, including product type and provider network identifiers. The rule also changes data aggregation, excludes provider-to-service mappings considered unlikely, adjusts historical out-of-network data requirements, and reduces reporting frequency. - Consumer access: Plans and issuers must improve file discoverability with contact-information text files and website URL footers. Pricing information available online and on paper must also be available by phone. - Procurement scope: This is a regulatory action, not a request to purchase products or services. No products, quantities, part numbers, OEMs, or vendors are identified.

Description

This final rule amends regulations under the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code concerning price transparency reporting for non-grandfathered group health plans and health insurance issuers offering non-grandfathered group and individual coverage. It revises machine-readable file requirements, including contextual data, aggregation, provider-to-service mappings, historical out-of-network data, and reporting cadence. It also improves how consumers locate disclosed files and requires pricing information available online and on paper to also be available by phone. The rule is effective December 7, 2026.

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