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Public Access Requirement

On October 29, 2020, the Department of Health and Human Services, the Department of Labor, and the Department of the Treasury jointly released the Transparency in Coverage final rule. One of the requirements of the rule that group health plans and issuers must meet is to make certain price information accessible to plan participants and other stakeholders. This is known as the Public Access Requirement. There are three files that must be updated monthly and include the following detailed pricing information:

  • In network: Negotiated rates for all covered items and services between the plan or issuer and in-network providers.
  • Out of network: Historical payments to, and billed charges from, out-of-network providers. Files are not required if there are fewer than 20 claims for a service for a provider.
  • Prescription drugs: In-network negotiated rates and historical net prices for all covered prescription drugs at the pharmacy location level (this requirement is delayed pending further rulemaking).

Premera has created a link that will take Whitman employees to our monthly updated data. The URL to the file site is https://premera.sapphiremrfhub.com, which will be live beginning July 1, 2022.