On December 19, 2025, the DOL, HHS, and IRS (the departments) proposed rules to update healthcare price disclosures required by the Transparency in Coverage final rule (TiC rule). The proposed rules were issued in response to a Trump executive order, which called on the departments to improve the accuracy, reliability, and usefulness of the disclosures. (Please see our March 4, 2025, article on Executive Order 14221.) Group health plans and insurers will need to comply with the updated rules once finalized.
Public Disclosure of Prices
The TiC rule requires nongrandfathered group health plans and insurers to publicly post machine-readable files (MRF) of their in-network (INN) negotiated rates, historical out-of-network (OON) allowed amounts, and prescription drug INN rates and historical net prices. The files are meant to be accessed by data analytics firms and researchers who compile, analyze, and reorganize the pricing data into tools that employers can use to comparison shop for healthcare coverage.
However, the disclosed data has often been difficult to access and compare due to oversize files, duplicative or useless data, a lack of contextual information, and inconsistencies in reporting across different entities. Additionally, the monthly postings have been burdensome on plans and insurers. The proposed rules seek to address these deficiencies by simplifying how data is organized and eliminating unnecessary information. Among other items, the proposed rules would:
- Reduce the reporting cadence for INN rates and OON allowed amount files from monthly to quarterly.
- Require a link on the plan’s or insurer’s website home page titled “Price Transparency” or “Transparency in Coverage” that routes directly to the publicly available web page that hosts the MRFs, as well as a text file containing the plan or insurer contact name and email address for questions on the data.
- Require plans and insurers to disclose INN rates by provider network rather than by plan, include a “change-log” MRF that reflects changes in data from the prior INN file, and identify which INN providers are actively furnishing which items and services.
- Increase the amount of OON pricing information reported by reorganizing allowed amount files by health insurance market type (e.g., small group, large group), reducing the claims reporting threshold, and increasing the reporting period.
The departments believe these changes will yield more meaningful data and also allow more organizations to analyze the data and build price comparison tools, thus making such tools more helpful and accessible to employers and creating a more competitive healthcare marketplace.
Internet Self-Service Tool
Currently, the TiC rule also requires group health plans and insurers to make cost-sharing information available to participants through an online self-service tool or by paper, upon request. Since the publication of the TiC rule, the CAA 2021 No Surprises Act (NSA) enacted a similar internet-based tool requirement, except that the cost-sharing information also needed to be available by phone. Therefore, to eliminate the need for two separate tools, the departments propose that the same information required to be disclosed under the TiC rules be required to be communicated by phone, upon request, to also satisfy the NSA cost-sharing tool provision. The departments also propose requiring a disclaimer to alert participants that their cost-sharing does not include additional amounts that OON providers may balance bill, where not prohibited by the NSA or state law.
These changes are designed to ensure participants understand their rights and potential financial responsibilities before they seek healthcare.
Employer Takeaway
Employers should be aware of the proposed updates but do not need to take any immediate action. Currently, the departments are seeking input from stakeholders regarding all elements of the proposed rules; the deadline to submit comments is February 21, 2026.
Once the rules are finalized, employers will need to consult with their insurers and TPAs to verify that they will update the publicly posted pricing files to meet the new requirements and add a telephone request option to the participant self-service tool. Fully-insured plans can contract with their carrier to fulfill and assume liability for the requirements; self-insured plans can contract with their TPA to assist with the disclosures but remain responsible for compliance. Until the proposed rules are finalized, plans must continue to comply with the existing requirements for posting MRFs.
Employers should recognize that the updates may impose additional compliance obligations but are ultimately designed to better enable plan sponsors to effectively compare various network provider rates and make informed, cost-conscious decisions about plan benefits.
Finally, the proposed rules do not significantly update the TiC prescription drug disclosure requirement, which has yet to be implemented. However, the departments indicated they intend to address the prescription drug files separately, so employers will need to stay tuned.
We will monitor developments and report relevant updates in Compliance Corner.
Read the full Transparency in Coverage Proposed Rule and Transparency in Coverage Proposed Rule — CMS fact sheet.