Smalley & Company

Critical information regarding Transparency in Coverage

Transparency in Coverage Rule, issued in 2020 by the U.S. Department of Health & Human Services, U.S. Department of Labor and U.S. Department of the Treasury and enforced beginning 7/1/22, health plans (which includes clients who sponsor employee benefit plans) and health insurance issuers must publish two separate MRFs. 

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 more information click on the link: https://www.cigna.com/legal/compliance/machine-readable-files