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Spotlight Mandate: Price comparison tool and cost estimator

Focused young woman in glasses managing monthly budget.

Health plans are required to maintain a price comparison tool, available by phone and online, that allows members to compare cost-sharing amounts for items and services provided by participating providers.

BCBSND’s internet-based self-service price comparison tool will be offered online, by phone and in paper upon request. The comparison tool will start with pricing information on the 500 most common shoppable services and will subsequently expand a year later to all covered services. The tool (to the extent practicable) will allow an enrolled member to search for and compare cost-sharing amounts for items and services based on geographic area, benefit plan, year and participating providers.

Who it applies to: All members of fully insured group health plans, self-funded group health plans and individual policies will have access to the price comparison tool to estimate costs.

Effective dates: The Departments have indicated the price comparison tool and cost-estimator requirements are largely duplicative of the separate Transparency in Coverage rule issued in 2020. The Departments will issue rulemaking in 2022 to reconcile the duplicative requirements and provide additional guidance for the first publication years.

  • 500 common shoppable services—plan and policy years beginning on or after Jan. 1, 2023
  • All remaining shoppable services—plan and policy years beginning on or after Jan. 1, 2024

Action required: BCBSND will work directly with self-funded plans to obtain any needed information. Self-funded plans will also have the option to create and publish their own files if they prefer this method.