Employee Health Benefits

  1. Health Insurance
  2. Flex Spending
  3. Dental
  4. Vision
  5. Life Insurance

Health Insurance Plan Information

Transparency of Coverage Notice – Machine-Readable Files

Under the Patient Protection and Affordable Care Act (ACA), non-grandfathered group medical plans and health insurers are required to provide cost information in three machine-readable files. The following plans are not required to provide this information: (1) grandfathered plans, (2) excepted benefits such as stand-alone dental and vision benefits and most EAPs, (3) account-based plans such as Health Reimbursement Arrangements, Health Savings Accounts, and health Flexible Spending Accounts, (4) retiree only plans (fewer than two participants who are current employees), (5) expatriate plans, and (6) short-term, limited duration insurance. 

In fulfillment of this requirement, below are links to both the P32H and AH websites containing the required machine-readable files:

HPHC - https://www.harvardpilgrim.org/public/machine-readable-files
Allways Health - https://www.allwayshealthpartners.org/meet-us/transparency-regulations

These files contain the following required information:

  1. An in-network rate file that includes cost information for all covered services except for prescription drug. The file must include certain information on network negotiated reimbursement rates by billing codes.
  2. Cost information for out-of-network providers by billing code. The file must include allowed amounts and billed charges for covered services furnished by an out-of-network provider during the 90-day time period that begins 180 days before publication of the file.
  3. Negotiated rates and historical net prices for prescription drugs (in and out of network). After regulations were issued in November 2020, Congress enacted the Consolidated Appropriations Act of 2021 (CAA), which also contains a drug reporting requirement. The requirement for public disclosure in a machine-readable file for prescription drugs, which is required by the November 2020 regulations, is being delayed while regulators consider whether the prescription drug machine-readable file requirement remains appropriate.