The Departments request comments on all aspects of the proposed rule by February 23, 2026. In particular, they seek comments on some of the special rules applicable to self-insured plans and how they would be affected by rules, including requirements to report the plan type and enrollment data.

Background on the price transparency disclosure requirements

The proposed rule builds on the final Transparency In Coverage (TiC) rule issued by the Departments in 2020. (See our November 5, 2020 insight.) For plan years beginning on or after January 1, 2022, the TiC final rule requires non-grandfathered group health plans and insurers to publish on a public website three separate machine-readable files (MRFs):

• An in-network rate file disclosing in-network rates for all covered items and services
• An out-of-network allowed amount file disclosing out-of-network allowed amounts and the associated billed charges
• A prescription drug file disclosing in-network rates and historic net prices for covered items and services. The prescription drug MRF requirement is on hold awaiting technical guidance from the Departments. (See our October 17, 2023 insight.)

The final TiC rule requires health plans and insurers to make an internet-based self-service tool available to participants to disclose the price and cost-sharing liability for covered items and services, including prescription drugs. Upon request, plans and issuers must provide this information in paper form. This requirement became applicable in January 2023.

The No Surprises Act, enacted in 2020, also required an internet-based price comparison tool, and specified that the information must be available over the phone as well as online. The No Surprises Act also extended the requirement for a price comparison tool to grandfathered plans.  (See our January 14, 2021 insight.)

The proposed rule advances the February 2025 executive order on improving healthcare price transparency, which we discussed in our March 21, 2025 insight.

The proposed rule on price transparency disclosure requirements

Most of the changes in the proposed rule that was published in the December 23, 2025 Federal Register relate to the content of the large MRFs that health plans and insurers must post on a public website for health policy and pricing research, not for use by plan participants. However, the proposed rule would also revise the requirement to make cost-sharing information available to participants, beneficiaries and enrollees through an internet-based, self-service price comparison tool.

The proposed rule would be effective 12 months after it is finalized for the MRF changes, and for plan years beginning on or after January 1, 2027 for the price comparison tool changes.

Changes to machine-readable file requirements

The newly proposed rule requires several changes to the MRFs that non-grandfathered group health plans and insurers must publish.

Updated schedule for reporting

The group health plan or insurer would have to update the in-network rate and out-of-network allowed amount MRFs quarterly (as opposed to monthly as currently required).

In-network rate files

The in-network rate files would be required to be organized by provider network rather than plan. The Departments state that requiring network-level reporting would streamline how rates are reported, reducing the number and size of in-network rate files. Plans would also have to report the product name of the plan option (e.g., HMO or PPO).

In addition, plans and insurer would be required to exclude from the in-network rate files the data for services that providers would be unlikely to perform because the service is not in their area of specialty (e.g., exclude rates for podiatrists to perform heart surgery). Finally, plans would have to report a numerical enrollment number for each plan represented in the file.

Out-of-network allowed amount files

The out-of-network allowed amount files would be organized by health insurance market type (i.e., large group, small group, individual, and self-insured). The self-insured group health plan market would include all self-insured group health plans maintained by the plan sponsor. Administrators of self-insured group health plans may aggregate out-of-network allowed amounts for more than one plan, including those offered by different self-insured plan sponsors.

The Departments state that this change will result in more out-of-network data being made available.

New file requirements

In addition to the three MRFs currently required, plans and insurers would also be required to post additional files, including a change-log file, a utilization file, a taxonomy file and a plain text file on a group health plan’s or insurer’s website that includes links to the MRFs and contact information.

Disclosure requirements

A group health plan or insurer would be allowed to enter into a written agreement under which another party (e.g., as a third-party administrator) posts the MRFs on its public website on behalf of the plan, including if the plan does not have a website. However, if the files are posted on a service provider’s website, and the plan maintains a public website but chooses not to host the files separately on that website, it must provide a link on its own public website to the location where the files are made publicly available.

Special rules for self-insured plans

Self-insured plans may enter into a written agreement under which another party (e.g., a third-party administrator or healthcare claims clearinghouse) provides the information required. However, if the party with which the plan contracts fails to meet the requirements, the plan would violate the transparency disclosure requirements. This is the same as the current rule.

The proposed rule would also allow self-insured plans to enter into an agreement to permit the other party to create a single in-network rate MRF using provider network information from its other clients and across different health insurance markets. However, this may only occur if the file meets specific standards, including that each in-network MRF made available for a provider network must include the information for all covered items and services under each plan that uses the same provider network and each change-log, utilization and taxonomy MRF must include the information for the same plans represented in the MRF.

Similarly, self-insured plans would be allowed to enter into an agreement to permit the other party to create a single out-of-network allowed amount file for more than one self-insured group health plan (including those offered by different plan sponsors with which the other party has an agreement) provided that the out-of-network allowed amount and billed charge data in relation to a particular item or service is omitted if it would require disclosure of out-of-network allowed amounts in connection with fewer than 11 different claims for payment across all of the plans (including those offered by different plan sponsors) included in the out-of-network MRF.

Price comparison tool

The proposed rule would require that both grandfathered and non-grandfathered plans and insurers provide the same price and cost sharing information whether viewed online or in print or provided by telephone, upon request. The proposed rule would also update the required disclosure notice that accompanies the price comparison tool.

Additional guidance is expected

The Departments have indicated they will address implementation of the prescription drug file separately in future guidance.

Implications for plan sponsors

Under the current TiC rules, plan sponsors generally rely upon their third-party administrators to comply with the machine-readable file and price comparison tool requirements. If the proposed rules are finalized, it is likely that plan sponsors will need to more closely monitor the compliance efforts by their third-party administrators.

Plan sponsors should review the potential changes in the proposed rule with their professional advisors and administrators to determine the likely impact on their plans.