What you need to know about the cost of covered items and services

Centers for Medicare & Medicaid Services’ Transparency in Coverage Rule requires health insurers and group health plans to provide cost-sharing data to consumers. This data will be available on our website by the individual deadlines imposed by this Rule. 


Data will be available as follows:

Machine-readable files

These files will be published monthly beginning July 1, 2022, for Scripps Health Plan benefit plan years beginning on or after January 1, 2022. The file makes available negotiated payment rates for covered items and services based on in-network negotiated payment rates and historical out-of-network allowed amounts. Requirements and a due date for a prescription drug file are pending. 


In-Network 

These machine-readable monthly files will provide negotiated rates for all covered items and services between the health plan and In-Network Providers.



Out-of-Network

These machine-readable monthly files will provide historical payment information, including billed and allowed amounts to and from Out-of-Network Providers.


Consumer price transparency tool

Beginning after January 1, 2023, Scripps Health Plan will make available an online tool for members that will include personalized, real-time cost share estimates for covered services and items related to 500 shoppable services. Paper versions will be available upon request. After January 1, 2024, the cost share estimates must be available for all covered services and items.