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 and WPS Health Plan comply with CMS requirements(Final Rule CMS-9915-F) and have posted Machine Readable Files (MRFs) that display the cost for in-network rates and allowed amount rates for providers.
Additionally, WPS has a Price Comparison tool available that contains 500 shoppable items and services.
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 and WPS 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.
For additional information, see our Price Transparency MRF User guide.
WPS Health Insurance and WPS Health Plan have a consumer cost estimation comparison tool available.
For more information on the Price Estimation Tool, see the Price Transparency Estimation Tool User Guide.
Functionality including the ability to populate an “estimate only” member-specific benefit and out-of- pocket cost information is now available.
Please note: Customized estimates are available based on your specific benefit plan and cost sharing by logging in to your customer portal through WPS or by contacting the WPS Customer Service number on your ID card.
If you do not have your ID card available, you can find the applicable Customer Service number by visiting: wpshealth.com/contact.