US health plans must post leaner price files under new final rule

US health plans must post leaner price files under new final rule

6 October 2026: The Departments of Labor, Health and Human Services and the Treasury have finalised changes to the Transparency in Coverage rules that reshape the machine-readable price files published by group health plans and insurers. The final rule was published in the Federal Register on 6 October and takes effect on 7 December 2026.

Not yet independently verified. Based on the Federal Register text alone. Applicability dates differ by provision, so plans and their vendors should read the rule for their plan year. We will update this when it can be confirmed, and remove this note.

It amends the 2020 rules, which first required non-grandfathered group health plans and issuers of group and individual coverage to publish in-network negotiated rates and out-of-network allowed amounts. The departments say users of those files asked for smaller, clearer data, and they cite Executive Order 14221 of February 2025 as the direction for the update.

For the in-network rate and allowed amount files, the rule adds contextual files and data elements such as product type, provider network name and provider network identifier. It changes the level at which data is aggregated, removes in-network rates for provider and service pairings that are unlikely, lengthens the out-of-network reporting period and lowers the claims threshold. Plans and issuers will update the in-network rate and allowed amount files quarterly instead of monthly, starting on the first day of the calendar quarter after the applicability date. They must also post a text file with contact information for the files and a footer that points to the web addresses where the files sit.

Pricing information offered through the online cost-sharing tool and on paper on request must now also be available by phone. As with paper requests, a plan or issuer must give cost-sharing information for at least 20 providers a day by phone. The departments say meeting this requirement also satisfies section 114 of the No Surprises Act, including for grandfathered plans that are not otherwise covered by these rules.

The cost-sharing disclosure provisions apply to plan years, or policy years in the individual market, beginning on or after 1 January 2027, and the current rules continue until then. The departments did not finalise a proposal to require enrollment totals in the in-network rate file, after commenters said enrollment and rate data sit in separate systems. They also did not finalise the proposed timing for the change-log file.

Sources

• Departments of Labor, HHS and the Treasury: Transparency in Coverage final rule (Federal Register 2026-20447), 6 October 2026