Benefits Verified

Transparency in Coverage final rules revise health plan price-disclosure files

Jurisdiction
Federal (US)
Effective date
2026-12-07
Who it covers
Non-grandfathered group health plans and insurers
Status
Verified against an official source

The law, summarized

  • Treasury/IRS, DOL (EBSA) and HHS final rules published October 6, 2026 are effective December 7, 2026 (91 FR 63748).
  • They change the in-network rate and out-of-network allowed-amount machine-readable files: new contextual files, added data elements such as product type and provider network name and ID, changed aggregation, a longer reporting period and lower claims threshold for out-of-network data, and a reduced reporting cadence.
  • Plans must post a text file with contact information for their machine-readable files and a footer with website URLs.
  • Pricing information available through the online consumer tool and on paper must also be available by phone; doing so also satisfies No Surprises Act section 114, including for grandfathered plans.
StateHR Take · AI-generated analysis, not legal advice

Who should act: Employers that sponsor group health plans, especially self-insured plans. Ask your TPA or carrier how and when they will update your machine-readable files and add phone access to pricing, and get that commitment in writing, since the plan stays responsible for compliance. Some provisions may phase in on later applicability dates. Confirm the details in the official source before acting.

Generated 2026-10-17T11:30-05:00

Official sources

  • www.federalregister.gov
    https://www.federalregister.gov/documents/2026/10/06/2026-20447/transparency-in-coverage
  • www.govinfo.gov
    https://www.govinfo.gov/content/pkg/FR-2026-10-06/pdf/2026-20447.pdf