Transparency in Coverage

What it does

These final rules set forth requirements that amend the regulations under the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code regarding price transparency reporting requirements for non- grandfathered group health plans and health insurance issuers offering non-grandfathered group and individual health insurance coverage. Specifically, these final rules are intended to improve the standardization, accuracy, and accessibility of public pricing disclosures in line with the goals of Executive Order 14221, "Making America Healthy Again by Empowering Patients With Clear, Accurate, and Actionable Healthcare Pricing Information." With respect to the In- network Rate and out-of-network Allowed Amount machine-readable files, these final rules aim to achieve these goals by adding new contextual files and additional data elements like product type, provider network name, and provider network identifier; changing the reporting level for aggregation of data; removing in-network rates for unlikely provider- to-service mappings; increasing the reporting period and lowering the claims threshold for out-of-network historical data; and reducing the reporting cadence. These final rules also aim to improve the findability of all publicly disclosed machine-readable files required under the Transparency in Coverage rules, including the prescription drug file, by requiring a text file containing contact information for the files, and a footer with website URLs. These final rules also require pricing information that is made available through an online consumer tool and on paper (upon request), to also be made available by phone, and establish that the satisfaction of such requirement also satisfies the requirements of section 114 of the No Surprises Act (including for grandfathered group health plans and health insurance issuers offering grandfathered group and individual health insurance coverage that are not otherwise subject to these final rules).

The Internal Revenue Service's summary, as published in the Federal Register.

What changed in the regulation

3 parts of Title 26, 29, 45 of the Code of Federal Regulations:

26 CFR 54, 29 CFR 2590, 45 CFR 147

Compared with

The Internal Revenue Service has published 22 final rules in 2026 so far, compared with 21 in all of 2025.

Counted by the Tribune from Federal Register records since Jan. 1, 2025.

Before this

3 earlier Federal Register documents under regulation identifier 0938-AV64, 1210-AC30, 1545-BR51 since Jan. 1, 2025.

• Feb. 25, 2026 Proposed rule; Extension of comment period. Private Health Insurance; Transparency in Coverage; Extension of Comment Period
• Dec. 23, 2025 Proposed rule. Transparency in Coverage
• June 2, 2025 Request for information. Request for Information Regarding the Prescription Drug Machine-Readable File Requirement in the Transparency in Coverage Final Rule

What happens next and when

These regulations are effective on December 7, 2026.

The agency's dates, word for word.

Check it yourself

• The document in the Federal Register
• Docket IRS-2025-0565 on Regulations.gov
• Title 26 on eCFR

The record as published

Source: the Federal Register (public domain). The document in the Federal Register