Transparency in coverage

This information is intended for third-party developers, researchers, government entities, employers and consultants.

The Transparency in Coverage rule from the U.S. Departments of Health and Human Services, Labor and Treasury requires health insurance companies providing coverage in the individual and group markets and group health plans to publicly disclose price information for covered items and services.

Please note:

• The files below are very large and in a JSON file format that’s impractical for direct consumer use. The goal of the Transparency in Coverage rule is to give researchers and third-party developers the comprehensive data they need to create solutions that help people understand the costs associated with health care, make better price comparisons and choose the care that’s right for them.

In-network provider-negotiated payment rates between plans and providers

These files include applicable in-network rates for certain UCare networks, including rates from contracted network partners. Posted rates include negotiated rates, claims-derived amounts for providers who are reimbursed on a discount from billed charges and underlying fee schedule rates where reimbursement is based on another methodology.

Machine Readable Files

In-Network Rate File: rates for all covered items and services between the plan or issuer and in-network providers.

Allowed Amount File: allowed amounts for, and billed charges from, out-of-network providers.