In 2020, the federal government issued the Transparency in Coverage Rule (85 FR 72158), which requires health plans and insurance issuers to disclose certain pricing information for items and services that are benefits under non-grandfathered plans in the individual and group markets. The rule is effective for plan years starting on or after Jan. 1, 2022.

Under the regulation, providers’ rates must be disclosed to the public each month. This includes negotiated rates with in-network providers, as well as provider charges and amounts previously paid to out-of-network providers. Amounts paid to out-of-network providers will reflect historical billed charges and allowed amounts paid three to six months before the publication date.

The data must be reported in the machine-readable (computer-readable) format specified in the final ruling’s technical implementation guide. As required, this data is published on a publicly accessible website, available to any person free of charge, and updated monthly.

In compliance with the Transparency in Coverage Rule and in support of the plans impacted by this requirement, the Table of Contents File below contains an index of the applicable HMSA plans and respective machine-readable files.

Table of Contents File

• HMSA isn’t responsible for how the machine-readable file data is used or interpreted by third parties.
• HMSA isn’t responsible for end users’ local capabilities, which could impact the user’s experience when accessing machine-readable file data from this site, including local hardware, storage, and network bandwidth.
• Machine-readable files cannot be used to determine final member cost for a service. These files contain provider rates for a covered item or service, but don’t contain plan or member benefit information that can be used to estimate personalized costs. If you have questions about your benefits, please contact us or visit hmsa.com/MyAccount.
• If you’re a representative of an HMSA employer group and have questions regarding Transparency in Coverage and machine-readable files, you can find additional information at hmsa.com/Employers.