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When the federal Consolidated Appropriations Act (CAA) passed in 2021, it set off a major transparency push in the health insurance industry. The core idea is simple: consumers should be able to understand the cost of care before they receive services. But for that to work on even the most basic level, health plans and their contracted providers must be able to share pricing information freely.
 
Historically, many provider agreements included language that restricted the release of certain price or quality details. These provisions, known as “gag clauses,” effectively gagged insurers and plans from disclosing the rates they pay providers – whether publicly or even to other contracted providers. As a result, key data that would help members compare costs and shop for care often stayed locked away.
 
The CAA changed that. Its transparency rules ban gag clauses entirely in Major Medical plans, meaning they can no longer exist in any contract between a plan (or issuer) and a provider. The law also requires plans to attest each year, by December 31, that their provider contracts do not contain gag clauses and that they will not enter into agreements containing them in the future.
 
Because employers with fully insured plans are not involved in provider contracting between the carrier and its network(s), they have no direct obligations under the Gag Clause Prohibition Compliance Attestation (GCPA). The insurance issuer completes the attestation on behalf of the fully insured plan, and once that filing is submitted, both the plan and the employer are considered compliant.
 
Employers with level-funded or self-funded plans, however, do have an annual responsibility. These employers operate their own health plans and do not have an insurance issuer managing provider contracts on their behalf. Even though most rely on a third-party administrator (TPA) or administrative services only (ASO) network, the plan itself is the entity that must attest.
 
That doesn’t necessarily mean employers must dig through contract language on their own. It does mean they need to coordinate with whichever partner manages their provider network(s) – typically the plan’s TPA or ASO vendor. Those partners may submit the attestation on the employer’s behalf, but the employer remains the responsible party. And because there are many ways to self-fund – especially for larger employers in multiple states; the level of involvement may vary plan to plan.
 
All group medical plans – fully insured, self-funded, and level-funded – must submit the annual Gag Clause Prohibition Compliance Attestation (GCPA) by December 31. Attestations are filed through the Center for Medicare & Medicaid Services (CMS) Health Insurance Oversight System (HIOS), which requires one-time registration before submitting.

Why the rule matters

The CAA’s transparency framework, including price comparison tools, machine-readable files, and cost sharing estimates, can only work if plans and providers are able to disclose information freely. The annual gag clause attestation is CMS’s way of confirming that this foundation stays intact.
 
Health care transparency is a long, complicated journey. Unlike retail or travel, medical care is not always predictable. You often do not know what you need until a provider evaluates you, and one step in care can uncover something that changes the entire course of treatment. Prices also vary by location, provider, and clinical approach. While removing gag clauses will not solve those complexities by itself, it is an important first milestone in building a system where cost information can flow more openly.
 
Even though the “Gag Clause” process is largely invisible for fully insured groups, it remains a critical compliance step for self-funded and level-funded employers. As more midsize employers move into alternative funding arrangements, this requirement becomes increasingly important.
 
Refer to the W&B Compliance Wiki for more information on gag clause compliance and other key regulatory requirements.