Regulations & Compliance

Transparency in Health Plans Coverage (TiC) CMS-9915-F

The Transparency in Coverage final rule released in 2020 by the Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury delivers a US presidential executive order on improving price and quality transparency in USA’s healthcare.

Under the Transparency in Coverage Rule, enforced since July 1st 2022, health plans (which includes clients who sponsor employee benefit plans) and health insurance issuers must publish two separate data sets.

In Network: Negotiated rates for all covered items and services between the plan or issuer and in-network providers
Out of Network: Allowed amount paid to, and billed charges from, out-of-network providers for all covered services within a 90-day period

For detailed information, in machine-readable format (MRF), about the health insurance cost for the plans and coverage offered by VeEX in the USA, please visit:

https://www.cigna.com/legal/compliance/machine-readable-files

This link leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.