New requirements for employer-sponsored health plans to report price information for in-network costs to plan participants are set to take effect shortly.

While much of the "heavy lifting" will be done by health insurance carriers for fully insured plans, by third-party administrators (TPAs) for self-funded plans, and by pharmacy benefit managers (PBMs) for carved-out prescription drug benefits, employers are ultimately responsible for ensuring that this information is ready and available, said Jay Kirschbaum, benefits compliance director and senior vice president at World Insurance Associates, based in Washington, D.C.

"We've spent the last 20 or 30 years teaching our participants to be bad consumers of medical care by shielding them from actual prices," said Kirschbaum, speaking March 30 at the Society for Human Resource Management's Employment Law & Compliance Conference in Washington, D.C.

"Medical costs have been too high for a long time," he observed. "One of the reasons is third-party payers—primarily, insurance companies interposed between health services providers and patients." Beginning in the 1970s, the rise of managed care, such as health maintenance organizations, "took us even further away from costs associated with care, so employees had no idea what the actual prices were."

He's hopeful that this situation may be set to change.

The new price transparency requirements stem from the Consolidated Appropriations Act, 2021, which included the No Surprises...

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