form, upon request.
4
This information must be available for plan years (in the individual market,
policy years) beginning on or after January 1, 2023, with respect to the 500 items and services
identified by the Departments in Table 1 in the preamble to the TiC Final Rules,
5
and with
respect to all covered items and services, for plan or policy years beginning on or after January 1,
2024.
6
Internal Revenue Code (Code) section 9819, Employee Retirement Income Security Act
(ERISA) section 719, and Public Health Service (PHS) Act section 2799A-4, as added by section
114 of division BB of the CAA, require plans and issuers to offer price comparison guidance by
telephone and make available on the plan’s or issuer’s website a “price comparison tool” that (to
the extent practicable) allows an individual enrolled under such plan or coverage, with respect to
such plan year, such geographic region, and participating providers with respect to such plan or
coverage, to compare the amount of cost-sharing that the individual would be responsible for
paying under such plan or coverage with respect to the furnishing of a specific item or service by
any such provider. This requirement is applicable with respect to plan years (in the individual
market, policy years) beginning on or after January 1, 2022.
Q3: How do the different regulatory and statutory requirements for the self-service price
comparison tools under the TiC Final Rules and the CAA interact?
The TiC Final Rules created a comprehensive set of requirements for plan and issuer disclosure
of estimated cost-sharing information through an online tool, and in paper form, upon request.
These requirements for the disclosure of cost-sharing information would allow a participant,
beneficiary, or enrollee to request cost-sharing information for a discrete covered item or service
by billing code or descriptive term, according to the participant’s, beneficiary’s, or enrollee’s
request. Further, the TiC Final Rules require a plan or issuer to provide cost-sharing information
for a covered item or service in connection with an in-network provider or providers, or an out-
of-network allowed amount for a covered item or service provided by an out-of-network
provider, according to the participant’s, beneficiary’s, or enrollee’s request, permitting the
individual to specify the information necessary for the plan or issuer to provide meaningful cost-
sharing liability information.
Because the price comparison methods required by the CAA are largely duplicative of the
internet-based self-service tool component of the TiC Final Rules, the Departments intend to
propose rulemaking and seek public comment regarding, among other issues, whether
compliance with the internet-based self-service tool requirements of the TiC Final Rules satisfies
the analogous requirements set forth in Code section 9819, ERISA section 719, and PHS Act
section 2799A-4. These provisions, however, add a requirement that was not imposed under the
TiC Final Rules: that price information also must be provided over the telephone upon request.
Therefore, the Departments intend to propose rulemaking requiring that the same pricing
information that is available through the online tool or in paper form, as described in the TiC
Final Rules, must also be provided over the telephone upon request.
4
26 CFR 54.9815-2715A2(b), 29 CFR 2590.715-2715A2(b), and 45 CFR 147.211(b).
5
85 FR 72158, 72182 (Nov. 12, 2020).
6
26 CFR 54.9815-2715A2(c)(1), 29 CFR 2590.715-2715A2(c)(1), and 45 CFR 147.211(c)(1).
3