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Transparency in Coverage FAQs

Transparency in Coverage (Final Rule CMS-9915-F) mandates qualified health plan (QHP) providers to provide price transparency for consumers to know the cost of a covered item or service before receiving care.

Beginning July 1, 2022, most health plans and issuers of group or individual health insurance will begin posting pricing information for covered items and services.

WPS Health Insurance will comply with the CMS federal mandate (Final Rule CMS-9915-F) to provide Machine Readable Files (MRFs) that will display the cost for in-network rates and allowed amount rates from providers.

In-network rates are covered items and services between the plan or insurer within the WPS Health Insurance or WPS Health Plan network of providers.

Allowed amounts provide the health plan coverage maximum for items and services from providers who are not in WPS Health Insurance or WPS Health Plan networks.

WPS Health Insurance Health Plan Machine Readable Files can be accessed here:

Self-funded plans may post a link on their website or another method of their choice.

WPS Health Insurance and WPS Health Plan are working to ensure a consumer cost estimation comparison tool is made publicly available on or before Jan. 1, 2023.

For more information on the Price Estimation Tool, see the Resources Guide.

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