Transparency in Health Care Coverage Rule
In compliance with the Transparency in Coverage Rule, issued in 2020, health plans and health insurance issuers must publish two separate Machine-Readable Files (MRFs) containing In-Network and Out-Of-Network details. Auvil Fruit Co is pleased to provide the following information to participants.
The rule requires most group health plans and health insurance issuers to disclose price and cost-sharing information to participants, beneficiaries, and enrollees. Pricing includes negotiated rates, billed charges and allowed amounts paid for out-of-network providers, and the negotiated rate and historical net price for prescription drugs. The files contain the following details:
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.
The links provided below by our carrier lead to the MRFs that are made available in response to the federal Transparency in Coverage Rule. The MRFs are formatted to allow participants, researchers, regulators, and application developers to easily access and analyze data.
Please review the carrier site below and direct any additional questions to the carrier.
