---
kind: "section"
citation: "45 C.F.R. § 156.220"
title: "45"
number: "156.220"
heading: "Transparency in coverage."
url: "https://uscodex.org/cfr/45/156.220"
---

# §156.220. Transparency in coverage.

- (a) **Required information.** A QHP issuer must provide the following information in accordance with the standards in [paragraph (b)](#b) of this section:
  - (1) Claims payment policies and practices;
  - (2) Periodic financial disclosures;
  - (3) Data on enrollment;
  - (4) Data on disenrollment;
  - (5) Data on the number of claims that are denied;
  - (6) Data on rating practices;
  - (7) Information on cost-sharing and payments with respect to any out-of-network coverage; and
  - (8) **Information on enrollee rights under title I of the Affordable Care Act.**
- (b) **Reporting requirement.** A QHP issuer must submit, in an accurate and timely manner, to be determined by HHS, the information described in [paragraph (a)](#a) of this section to the Exchange, HHS and the State insurance commissioner, and make the information described in [paragraph (a)](#a) of this section available to the public.
- (c) **Use of plain language.** A QHP issuer must make sure that the information submitted under [paragraph (b)](#b) is provided in plain language as defined under [§ 155.20](/cfr/45/155.20.md) of this subtitle.
- (d) **Enrollee cost sharing transparency.** A QHP issuer must make available the amount of enrollee cost sharing under the individual's plan or coverage with respect to the furnishing of a specific item or service by a participating provider in a timely manner upon the request of the individual. At a minimum, such information must be made available to such individual through an Internet Web site and such other means for individuals without access to the Internet.

## Notes

### Source

Source: 77 FR 18469, Mar. 27, 2012, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 18021-18024, 18031-18032, 18041-18042, 18044, 18054, 18061, 18063, 18071, 18082, and 26 U.S.C. 36B.

### Source

Source: 76 FR 77411, Dec. 13, 2011, unless otherwise noted.