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Transparency in Coverage Reporting and Cost-Sharing Disclosures

The Affordable Care Act (ACA) requires issuers of a Qualified Health Plan (QHP) offered on the public Exchange to disclose certain information to the Exchange, the Department of Health and Human Services (HHS), the state insurance commissioner and the public.  These reporting and disclosure requirements also apply to non-grandfathered plans and issuers offering coverage outside of a public Exchange.  While the information to be reported is similar, these plans and issuers will not be required to report information to the Exchange.

The information to be reported includes, but is not limited to, claims practices, enrollment data and cost-sharing for out-of-network services.  It is believed that disclosure of this information will enable consumers to better understand how plans reimburse claims, the adequacy of provider networks and other relevant information.

Enforcement of this requirement is delayed until regulations are issued by HHS.