Machine-readable files: what employer plans must post.
Group health plans must make cost data public in machine-readable files. In most cases the carrier or administrator posts them, so the useful step is confirming who is responsible for yours.
What the rule requires.
Three Files
The rule calls for an in-network rate file, an out-of-network allowed amount file, and a prescription drug file. Each file serves a different purpose, and large files can be hard to read without special software. Employers generally rely on the carrier or administrator to produce them rather than building them in-house.
Free And Public
The files must be publicly available at no charge, with no account, password, or personal information required to open them. That means an employee, broker, or researcher can open them without registering. If you check the link and it asks for a login or personal details, raise it with your carrier or administrator.
Updated Monthly
The files must be updated monthly, and the most recent update date must be clearly shown. A stale date is the easiest sign to spot that something needs attention. Put a periodic reminder on your compliance calendar to open the link and look at the date.
Which Plans
The rule applies to group health plans and issuers offering group coverage, for plan years beginning on or after January 1, 2022. Check the effective date against your own plan year, since renewal dates differ from group to group. If you are unsure whether the rule applies to your arrangement, ask your carrier, administrator, or benefits counsel.
Who Is Excluded
Grandfathered plans, health reimbursement arrangements and other account-based plans, and short-term limited duration insurance are excluded. Excluded plans may still have other disclosure duties, and a plan’s status can change at renewal. Confirm with counsel or your carrier whether your own plan falls into one of these categories.
Good Faith Protections
Good faith errors that are corrected promptly, temporary website outages, and good faith reliance on another entity’s information are not violations, unless the plan knew or should have known the information was incomplete or inaccurate. Because the protection depends on facts such as how quickly a problem is corrected, keep a record of what you asked for and when. Benefits counsel can advise on how it applies to your plan.
What each file contains.
In-Network Rate File
The plan or issuer name and identifier, billing codes with plain-language descriptions, and the applicable negotiated rates. This file is usually the largest and the hardest for non-specialists to read. Ask your carrier or administrator for a plain-language explanation of what it shows for your plan, and whether it covers your network.
Out-Of-Network File
Allowed amounts and billed charges drawn from a 90 day window that begins 180 days before publication, omitted when fewer than 20 different claims would be reported. Because of the claim minimum and the look-back window, some entries may be missing or thin for smaller plans. Ask your carrier or administrator how this file is built for your plan and where it is posted.
Prescription Drug File
Drug codes, negotiated rates, and historical net prices, with a 20 claim minimum for the net price data. The drug file is tied to the pharmacy benefit, so it may come from a different party than the medical files. Ask who is responsible for it and whether that party also posts it.
Form And Manner
Files must follow the format guidance issued by the Departments of Labor, Treasury, and Health and Human Services. Formats and technical details can be updated by the agencies, so the party posting your files should follow the current guidance. Ask your carrier or administrator how they keep up with changes.
Aggregation Allowed
Out-of-network amounts may be aggregated across plans and issuers and hosted by a third party, and the plan must link to the file if it is not also on its own site. Hosting by a third party is common, so the plan’s own website may only point to the files. Make sure the link works and that you know which party is responsible if something goes wrong.
Existing Laws Still Apply
The rule does not override other federal or state privacy and security obligations. Posting files does not replace privacy and security duties under other laws. Ask your carrier or administrator how personal information is protected, and consult counsel if you have questions about your own obligations.
Source: 29 CFR 2590.715-2715A3.
What plan sponsors can do.
Confirm Who Posts
Ask the carrier or administrator to confirm in writing that it posts the files for your plan. A written confirmation names the responsible party, the web address, and the update schedule. File it with your plan documents so you can answer questions without hunting through old emails.
Insured Plans
An insured plan meets the rule if it requires its issuer to provide the information under a written agreement. If the issuer fails, the issuer, not the plan, violates the rule. Even so, it is wise to keep the agreement and check that the files exist. Ask benefits counsel to review the agreement language, since responsibility can depend on the exact terms and the facts.
Self-Funded Plans
A plan may use a written agreement with a third party such as an administrator or clearinghouse. If that party fails to comply, the plan violates the rule. Self-funded employers carry more of the responsibility, so the written agreement should name who posts the files, how often, and who corrects errors. Have benefits counsel review the terms before you rely on them.
Get The Link
Ask for the public web address of the files so you can confirm they are posted and current. Open the link yourself and look at what is shown. Note the date, the file names, and whether the files load, and send any problems to your carrier or administrator in writing.
Check The Update Date
Because the files must be updated monthly, a stale update date is worth raising with the carrier or administrator. Check the date a few times a year, not only once, and ask for a reason if it falls behind. Keep a note of each check, including who you contacted and what they said.
Keep The Agreement On File
Keep the written agreement with your plan documents so you can show who is responsible for posting. Add a reminder to review it at renewal or when you change carriers or administrators. A signed copy that is easy to find saves time if a question comes up from an auditor, a broker, or an employee.
Three questions to settle.
Who Posts Our Files
Ask which entity posts them and where, and get it in writing. Ask for the name of the entity, the web address where the files are posted, and who to call if the link stops working. Keep the response with your plan documents for the plan year.
Is The Agreement In Writing
Confirm the arrangement is documented, not just assumed. Ask for a copy and look at what it says about who posts, how often, and what happens if the files are late. If the answer is only a verbal promise, request it in writing.
How Current Are The Files
Ask when they were last updated and how often that happens. Ask for the most recent posting date, the usual schedule, and what happens when a posting is missed. A clear answer suggests a working process, while a vague one is worth following up.
Common Questions About Machine-Readable Files
Does a small employer post its own files?
An insured plan can meet the rule through a written agreement that requires the issuer to provide the information. If the issuer fails, the issuer violates the rule, not the plan.
Do account-based plans have to post?
No. Health reimbursement arrangements and other account-based group health plans are excluded.
Are grandfathered plans covered?
No. Grandfathered plans are excluded from the rule.
How often are the files updated?
Monthly, with the most recent update date clearly shown.
Can CFH help?
We can help you confirm who posts the files and gather the written agreement for your plan documents.
Is this legal advice?
No. This page summarizes the regulation. Your attorney can advise on your specific plan.
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