Sanford Health Plan continues to actively prepare for the requirements of the various phases of the Transparency in Coverage Rule.

The Transparency in Coverage rule is a federal regulation finalized in 2020 requiring health insurers and plan sponsors in individual and group markets to disclose negotiated prices and historical net plan allowable amounts for all covered items and services, including prescription drugs.

The first of the three phases will go into effect on July 1, 2022. On this date Sanford Health Plan will publish two machine-readable files. The first file will contain pricing information for covered items and services for each in-network provider rates and the second file will contain historical payments to out-of-network providers for billed charges. The files will be available on our public Transparency in Coverage webpage and updated monthly.

As we approach phases 2 and 3, Sanford Health Plan will share additional information about the price comparison tools.

• Phase 2: By January 1, 2023, a price comparison tool will be available to members. The tool contains pricing for 500 medical items and services, so members can quickly get an estimate before receiving care.
• Phase 3: By January 1, 2024, the price comparison tool will be enhanced to include pricing for all items and services.

For additional information on the Transparency in Coverage rule and how it impacts your business, view our FAQs and the CMS Transparency in Coverage Fact Sheet. You can also contact your account executive with further questions.