Proposed Rules for Price Transparency in U.S. Health Insurance Plans

Federal Agencies Propose a Reset on Health Plan Price Transparency

The federal push for health care price transparency is entering its next phase. The U.S. Departments of Health and Human Services, Treasury, and Labor have jointly released a proposed rule that would recalibrate how non-grandfathered health plans report pricing data. For insurers, TPAs, and provider partners, the changes signal a shift from volume toward usability.

At its core, the proposal is about making price transparency data easier to understand, easier to compare, and easier to manage. Regulators are acknowledging what many in the industry have experienced firsthand. Publishing massive datasets does not automatically translate into meaningful transparency.

“Transparency only works if the data is usable by real people making real decisions.”
Attributed to a senior federal health policy official

From Compliance Exercise to Practical Tool

Under current rules, health plans are required to publish monthly machine-readable files showing in-network rates, out-of-network allowed amounts, and prescription drug pricing. While well-intentioned, the result has often been sprawling files with millions of rows, many of which reflect provider-plan combinations that would never realistically occur.

The proposed rule aims to correct that imbalance by narrowing the scope of what must be reported. Instead of listing every conceivable rate across every plan variation, insurers would focus on meaningful, active provider relationships. Just as importantly, rate data would be organized by provider network rather than by individual plan, a change that better reflects how pricing is actually negotiated and applied.

For carriers, this restructuring could make compliance more manageable. For employers, regulators, and downstream analytics users, it could finally make comparisons more intuitive.

A Single Snapshot of Key Proposed Changes

• In-network rate reporting would exclude unlikely or unused provider-rate combinations, with data organized by provider network instead of by plan

This streamlined approach is designed to preserve transparency while reducing noise, storage costs, and operational friction.

Out-of-Network Data Gets a Boost

While in-network reporting becomes more targeted, the proposal moves in the opposite direction for out-of-network data. Regulators are seeking greater visibility into what plans actually pay when care falls outside negotiated networks. Expanded out-of-network reporting is expected to help regulators, employers, and consumers better understand cost variability and pricing pressure points.

For insurers, this may also bring renewed attention to claims governance, balance billing dynamics, and reimbursement strategies tied to the No Surprises Act framework.

“Out-of-network pricing is where opacity still drives cost volatility.”
Attributed to a federal health economics advisor

Quarterly Reporting and a Better Front Door

One of the most operationally significant proposals is the move from monthly to quarterly reporting of in-network rates. For carriers managing frequent contract updates across large provider ecosystems, this change could materially reduce administrative burden without meaningfully diminishing data relevance.

The rule also introduces a user-experience requirement that is difficult to ignore. Plans and issuers would be required to place a direct link to provider rate information in the footer of their public websites. The intent is simple. Transparency data should be easy to find, not buried behind search menus or compliance pages.

What This Means for the Insurance Industry

If finalized, the rule would take effect 12 months after publication in the Federal Register, giving organizations time to adjust systems, vendor relationships, and reporting workflows.

More broadly, the proposal reflects a regulatory acknowledgment that transparency is not just about disclosure. It is about decision support. By emphasizing clarity, relevance, and accessibility, regulators are signaling expectations that price data should inform underwriting, employer strategy, network design, and consumer choice.

“The goal is not more data. The goal is better data.”
Attributed to a federal regulatory spokesperson

For insurers, the message is clear. Transparency is becoming less about checking a box and more about delivering information that stands up to scrutiny, comparison, and use in a competitive market.