On December 23, 2025, the Centers for Medicare & Medicaid Services (CMS), the Department of Labor (DOL) and the Department of the Treasury jointly published proposed rules that would update the 2020 Transparency in Coverage (TiC) requirements for health plans and health insurers to publicly post machine-readable files (MRFs) that disclose pricing for each plan or coverage they offer. Some of the proposed changes would update the 2020 rules by revising the content and format of disclosures, adding contextual files and adding data elements like product type, network name and enrollment counts.
This blog provides an overview of proposed special rules for self-insured group health plans and their service providers for posting files with in-network prices and out-of-network prices on a public website.
Read part 1 for background information about the proposed rules which would make health care pricing data clearer and a more meaningful tool for developers to rely on. Then, future tools would ideally help employers choose coverage and negotiate pricing.
Definitions
In the proposed rule, the Departments requested comments on proposed definitions.
The proposal would include “product type” in MRFs for both in-network and out-of-network files. Further, the proposal would require the “product type” be associated with the coverage option for which data is being reported.
Product Type Definition
Product type would be defined as the type of health insurance plan—for example, health maintenance organization (HMO) or preferred provider organization (PPO). “Under ERISA, self-insured plans are not currently required to be identified by product type and these traditional classifications may not necessarily apply or otherwise accurately describe a self-insured benefit arrangement. As such, the Departments seek comment on whether self-insured plans generally identify benefit package options by product type, whether there is any existing nomenclature that self-insured plans could use to accurately identify the type of benefit arrangement being offered, and whether it is practical to extend this requirement to self-insured plans,” the proposed rule says.
Health Insurance Market Definition
For out-of-network files, the proposal would make a MRF available for each health insurance market in which a health insurer offers coverage, rather than the plan or policy level. Organizing claim data by health insurance market would be useful because pricing dynamics and reimbursement rates tend to vary by market segments, the proposed rule says. The four health insurance market types would be (1) individual market, (2) large group market, (3) small group market and (4) self-insured group health plans.
For purposes of self-insured group health plans, health insurance market would be defined as all self-insured group health plans maintained by the plan sponsor. The Departments requested feedback regarding the workability of this definition.
Special Rules for Self-Insured Group Health Plans
The Departments presume self-insured plans (especially smaller ones) will contract with a service provider to manage the MRFs. “While plans and issuers are ultimately responsible for meeting these proposed requirements, the Departments expect, as assumed elsewhere, that the burden of compliance would fall primarily on issuers and TPAs, with only the largest self-insured plans likely to assume this responsibility directly,” the proposed rule says in a cost estimation section. A few special rules address how service providers can manage MRFs.
Reorganize In-Network File by Provider Network
The proposal would reorganize an “in-network rate file” by provider network rather than by plan. Under the proposal, a self-insured group health plan could permit its service provider to include plans and coverage offered in different health insurance markets in the same in-network rate file, to the extent they use the same provider network. The Departments propose to permit and encourage self-insured group health plans to allow a service provider to make available an in-network rate file for each provider network used by more than one self-insured plan.
Two conditions would apply to the special rule for self-insured group health plans with respect to the disclosure of the in-network rate file.
1) Each in-network rate file made available for a provider network includes information for all covered items and services under each plan, insurance policy or contract that uses the same provider network.
2) Additional MRFs would be required for each in-network rate file, referred to as “change-log, utilization and taxonomy file.” All of these would be required to include data from the same plans, insurance policies or contracts, including those offered by different plan sponsors and across different health insurance markets, if applicable, that directly correspond with the in-network rate file.
Reorganize Out-of-Network Allowed Amount Files by Health Insurance Market Type
The proposal would require out-of-network reporting at the health insurance market level, rather than the plan or policy level.
Allow Service Providers to Aggregate by Health Insurance Market Type Across Multiple Self-insured Plans
For out-of-network files, “The Departments have determined that allowing aggregation of allowed amount data only across self-insured group health plans offered by different plan sponsors maintains the market division grouping necessary to make the data more actionable for research and analysis,” the proposed rule says.
If the rule is finalized as proposed, then a self-insured group health plan may permit their service provider to include the required allowed amount and billed charge information in a single allowed amount file for more than one self-insured group health plan, including those offered by different plan sponsors with which the other party contracts, provided certain conditions are met.
Self-Insured Plans Are Responsible for Compliance
Regarding contractual arrangements, the proposed rule says, “if a plan or issuer chooses to enter into such an agreement and the party with which it contracts fails to provide compliant information, the plan violates the transparency disclosure requirements.” This means that once the rules are finalized, self-insured plans will need to prepare for compliance by updating service provider contracts, verify the service providers’ files, include all the required information, and then monitor that the publicly posted files are live and updated at the required cadence.
Next Steps
The Departments seek feedback by February 23, 2026 on all elements of the proposed rule, including opportunities for further standardization and burden reduction. As we wait for final transparency in coverage regulation, self-insured plans might consider other transparency compliance issues, including DOL’s proposed rules announced January 29, 2026 on pharmacy benefit manager fee transparency.
Developed by International Foundation Information Center staff. This does not constitute legal advice. Please consult your plan professionals for legal advice.
