The Transparency in Coverage (TiC) rules, issued under Public Health Service (PHS) Act § 2715A and incorporated into ERISA § 715 and Internal Revenue Code (IRC) § 9815, require group health plans to (1) give participants personalized cost-sharing estimates and (2) post public machine-readable files (MRFs) of in-network rates, out-of-network allowed amounts, and prescription drug pricing.
On October 6, 2026, the Departments of the Treasury, Labor, and Health and Human Services (the Departments) published a final rule that overhauls the MRF formats, reduces update frequency for the in-network and out-of-network files from monthly to quarterly, adds new contextual files and an accuracy attestation, and requires cost-sharing estimates to be available by phone. The rules are effective December 7, 2026, with requirements phasing in from plan years starting January 1, 2027 through July 1, 2028. The Departments also provided a fact sheet to summarize the changes.
On October 7, 2025, the Departments also published FAQs Part 75 announcing some of the new file formats and that the Prescription Drugs MRF format should be finalized by May 2027, with the goal that plans start posting monthly Prescription Drug MRFs with attestations by December 1, 2027.
For nearly all employers, the insurance carrier or third-party administrator (TPA) builds and posts the MRFs and runs the price tool with real-time cost-sharing via web, paper, and phone. Employers with written fully insured carrier agreements can shift liability to the carrier for compliance. However, when the plan is self-funded, the employer can contractually delegate responsibility for MRFs and price tools but cannot absolve the employer of ultimate liability. Therefore, the employer should retain sufficient records demonstrating the carrier or TPA is regularly complying with TiC requirements for their self-funded plans.
Applies to:
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Non-grandfathered group health plans of any size, both fully insured and self-funded. There is no small-employer exemption.
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Grandfathered plans: Exempt from the MRF requirements, but the phone price comparison requirement under No Surprises Act (NSA) § 114 (IRC § 9819, ERISA § 719) still applies. The final rules confirm that meeting the TiC phone, online, and paper disclosure rules also satisfies NSA § 114.
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Not subject to TiC: Excepted benefits (e.g., stand-alone dental and vision, health FSAs), account-based plans such as HRAs, short-term limited-duration insurance, and retiree-only plans.
Go Deeper:
The rules implement Executive Order 14221 (February 25, 2025), which directed the Departments to make pricing data standardized, accurate, and enforceable. Regulators and data users found the original 2022 files too large, duplicative, and inconsistent for use. The final rules respond by reorganizing files around provider networks, trimming implausible data, adding files that explain the data, and holding plans accountable through a signed attestation in each file.
What's Changing:
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Requirement |
What Changes |
Applies Beginning |
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Participant price comparison tool with real-time cost-sharing estimates |
Estimates must now be available by phone at the customer service number displayed on the ID card, in addition to the online tool and paper. Like paper requests, the plan may limit phone requests to 20 providers per day, but must tell the caller. |
Plan years beginning on or after January 1, 2027 |
|
In-network rate file (a prospective contracted pricing file) |
One file per provider network (rather than per plan) which must show network name and ID. Each network’s participating plans’ names, HIOS ID or EIN, and product type (e.g., PPO) must be reported, and CMS guidance calls for a Table of Contents File to be used for this requirement. Most carriers/TPAs will likely need to build or rebuild this file accordingly. |
March 6, 2027; first quarterly posting April 1, 2027 (still updated monthly until then) |
|
Out-of-network allowed amount file (a retroactive billed and allowed pricing file) |
One file per market (individual, small group insured, large group insured, and self-funded) instead of per plan (although plans represented in the data are still named). Claims threshold drops from 20 to 11 different claims per item or service in a given market. The reporting window widens from the 90-day period that begins 180 days before the file is published, to the 6-month period that begins 9 months before the file is published. |
March 6, 2027; first quarterly posting April 1, 2027 (still updated monthly until then) |
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Attestation (for the In-network Rate File, the Allowed Amount File, the Prescription Drug File, the Utilization File, and the Taxonomy File) |
Similar to the Hospital Price Transparency required attestation today, each file must attest that the data is true, accurate, and complete and encode the identity of a senior official. |
Files published on/after March 6, 2027 |
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Prescription drug file |
Content not substantively changed by this rule; remains a monthly update as drug prices change too often for quarterly files to be meaningful. |
This file has been delayed. |
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Taxonomy file (new) |
Explains which provider specialties were excluded from which services in the in-network file. |
September 6, 2027; first posting October 1, 2027 |
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Text file (new) |
A .txt file in the website’s root folder with the page URL, a direct link to the files, and a monitored contact email. Updated within 7 days of any change. |
September 6, 2027; first posting October 1, 2027 |
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Website footer link (new) |
Home page footer link labeled “Price Transparency” or “Transparency in Coverage” pointing to the page that hosts the files. |
September 6, 2027 |
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Utilization file (new) |
For each In-network Rate File, a new Utilization File lists services actually paid (whether paid by the plan or member) and the in-network providers who were paid, for the most recent plan year ending at least 6 months earlier. |
First posting July 1, 2028; annually each July 1 thereafter |
Who Does What:
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Fully Insured Plans |
Self-Insured Plans |
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Who builds and posts the files |
Carrier |
TPA or other service provider (usually), under a written agreement |
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Who runs the phone, paper, and online price tool with real-time cost-sharing |
Carrier |
TPA (and PBM for drug pricing) |
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Who is liable if not done |
Carrier only, if a written agreement requires it to comply |
The plan remains liable even when the TPA agrees to do the work and agrees to the attestations |
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Employer's role |
Confirm the written agreement exists |
Confirm the agreement, monitor the TPA, and document follow-up |
Self-insured plans and their sponsors carry the most risk. The written agreement allows delegating the responsibility for the work but not the legal accountability; so, periodic monitoring is part of prudent plan oversight. If the employer maintains a public health plan website and the MRFs are hosted on the TPA’s site, the rules call for a link from the plan’s own website to the files.
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