TRANSPARENCY IN COVERAGE

At Common Ground Healthcare Cooperative (CGHC), we are committed to delivering trusted and understandable information to members. To this effect we are providing the following resources:

 

 

Transparency in Coverage Disclosure

The Transparency in Coverage Disclosure provides members important information to help them ensure their services will be covered as outlined in their insurance plan and to help them understand their costs. You can view the Transparency in Coverage Disclosure by clicking the button below.

Transparency of Pricing Data

In 2020, the federal government created new regulations that require health insurers and group health plans to provide cost-sharing data to consumers. This is called the “Transparency in Coverage” rule. These new requirements offer consumers tools to better understand their healthcare costs.

 

We are meeting the requirements of the Transparency in Coverage Rule and upholding our value of putting our members first by making health care costs available to consumers.

 

  • Machine-Readable Files (MRF):

        These files provide pricing data for covered items and services. CGHC began posting machine-readable files publicly on the            website starting on July 1, 2022, and we update these files monthly.

 

         The Transparency in Coverage Rule requires three types of Machine-Readable Files:

 

      • In-Network Negotiated Payment Rates (MRF #1)
      • Historical Out-of-Network Allowed Amounts (MRF #2)
      • Prescription Drug Rates and Historical Costs – the federal government has delayed this requirement pending further guidance.

 

IMPORTANT – Machine-Readable Files are the first step in making this information more available to consumers. However, these files are not consumer-friendly. They require specialized software to open and view the data and are designed for use by researchers, regulators, and application developers. CGHC doesn’t provide or support any software needed to view these files. To view the Machine-Readable Files, please use the MRF links above.

 

  • Price Transparency Tool: (coming in 2023!)

       This online tool will give members personalized, real-time, cost-share estimates for covered items and services, including                 pharmacy. Member Services will also be able to provide the information to members on the phone or provide paper versions         upon request. The tool will be released in two stages:

 

      • Starting on January 1, cost-share estimates for 500 shoppable services, as defined by the federal government, will be available within the Price Transparency Tool.
      • Starting 1/1/2024, the online tool will provide cost-share estimates for all covered services.

Web Access to Member Healthcare Data

In 2020, the Interoperability and Patient Access Rule was created to make health care data more available to consumers. CGHC is happy to provide members with easy access to their healthcare data that we maintain via either a web portal or a mobile app of the member’s choosing. Before enrolling in this service, CGHC recommends you learn more about Protecting your Data and Selecting an App.

 

To utilize this feature of your coverage you will need to:

 

    • Obtain an invitation code for enrollment purposes by calling our Member Services team at 877-514-2442.
    • Visit our Connected Health web page and click the “Enroll” button.
    • Enter the invitation code given to you by our Member Services team and click “Next”.
    • Enter your Member ID from your insurance card (be sure to include leading-zeroes and any dashes).
    • Enter your date of birth and your zip code and click “Next”.
    • Select your mobile phone number and click “Send Code”.
    • Enter the verification code you receive via the text message and click “Next”.
    • Select or enter an email address to receive a security code and click “Next”. This will become your username.
    • Enter the security code you receive in your email to confirm your identity.
    • After your email is confirmed, you will be asked to create a password.
    • Your account setup is now complete. Click on the Sign in link to sign into your account.

 

If you have any questions or need additional assistance, please contact us!

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