For years, employers have made significant investments in healthcare benefits without always having the visibility into prices, provider arrangements, and claims information that they might expect when overseeing other major business expenditures. Recent legislative and regulatory developments reflect a significant shift toward greater transparency.
Federal transparency requirements are expanding access to healthcare pricing and cost information. The Transparency in Coverage rules require non-grandfathered group health plans and health insurance issuers offering non-grandfathered coverage to publicly disclose specified pricing information through machine-readable files. In October 2026, federal regulators finalized amendments intended to further improve the accessibility, standardization, and reliability of these disclosures.1 The new regulations take effect December 7, 2026, with significant machine-readable-file requirements becoming applicable in phases in 2027.
The Consolidated Appropriations Act, 2021 (CAA) also added provisions generally prohibiting group health plans and issuers from entering into agreements that restrict access to specified cost or quality-of-care information and certain claims and encounter information or restrict the sharing of certain information with business associates consistent with applicable privacy requirements.2 Plans and issuers must attest annually to compliance with the gag clause prohibition.
The CAA also requires certain health plan brokerage and consulting service providers expecting at least $1,000 in direct or indirect compensation to disclose specified compensation information to the responsible plan fiduciary.
As the saying goes, with opportunity comes responsibility. As transparency expands, so too does the focus on how plan sponsors consider and respond to the information available to them.
Price transparency is often discussed as a compliance or disclosure issue. For employers sponsoring ERISA-covered health plans, however, the broader conversation also intersects with existing fiduciary responsibilities.
ERISA requires plan fiduciaries to discharge their duties solely in the interest of participants and beneficiaries and for the exclusive purpose of providing benefits and defraying reasonable expenses of administering the plan. Fiduciaries must also act with the care, skill, prudence, and diligence that a prudent person acting in a like capacity and familiar with such matters would exercise under similar circumstances.3
Greater access to pricing information itself does not establish a separate fiduciary standard, convert every healthcare purchasing decision into a fiduciary act, or dictate a particular outcome. Rather, transparency creates a more informed environment in which significant plan decisions are made, increasing the importance of both the fiduciary process and the record documenting it.
One consequence of greater transparency is that plan fiduciaries may have access to more information without necessarily having a clear answer as to what that information means for the plan. Healthcare arrangements are complex, and cost is rarely the only consideration. Network access, quality, participant needs, contractual terms, service capabilities, and other relevant factors may all inform a fiduciary’s evaluation of a particular arrangement.
This distinction is important because fiduciary prudence generally focuses on the process surrounding a decision, rather than whether the decision can later be characterized as the least expensive option.4 Transparency, therefore, should not be viewed simply as a mandate to pursue the lowest available price. Rather, additional information becomes another input into the fiduciary process, to be considered in light of the plan’s particular circumstances and objectives.
As the volume of available information grows, plan sponsors may find themselves addressing issues that historically received less visibility. What information was available? How was it considered? Were material costs or contractual provisions discussed? What factors ultimately informed the decision? These process-oriented considerations illustrate the increasingly important connection between transparency and effective fiduciary governance.
A thoughtful fiduciary process has limited evidentiary value if there is little record of what actually occurred. Months or years after a decision is made, the individuals involved may change, institutional knowledge may diminish, and the considerations underlying a particular decision may become difficult to reconstruct.
Documentation therefore serves as an important component of an established fiduciary process. DOL guidance recognizes the importance of documenting fiduciary decisions, the basis for those decisions, and the processes used to carry out fiduciary responsibilities. A contemporaneous record can capture the information considered, issues discussed, questions raised, advice received, and rationale underlying significant decisions. It can also provide continuity as committee membership changes and responsibility for plan governance transitions over time.
Effective documentation should capture more than the ultimate decision. A meaningful record reflects the process that led to it. If a committee reviews a service-provider arrangement, for example, recording only that the arrangement was approved provides limited insight into the considerations underlying that approval. Documentation that captures the materials reviewed, significant considerations discussed, and basis for the committee’s action provides a more complete account of the fiduciary process.
Price transparency represents an important opportunity for employers. Greater access to information can provide greater visibility into healthcare spending, vendor relationships, and plan performance. Yet access to information is only one part of the equation. As fiduciaries receive additional information, maintaining an appropriate record of how material information was considered in connection with significant plan decisions becomes increasingly important.
This does not mean that every fiduciary decision requires a particular outcome or an exhaustive written analysis. Rather, documentation should be proportionate to the significance of the decision and sufficient to create a meaningful record of the process undertaken. Committee minutes, decision records, materials presented to fiduciaries, and related governance documentation can collectively help preserve that history.
Over time, this record can serve another important purpose: continuity in the plan’s fiduciary process. Healthcare arrangements are routinely revisited, contracts are renewed, service providers change, and committee membership evolves. A consistent documentation framework can help future fiduciaries understand not only what their predecessors decided, but also the considerations that informed those decisions.
That is the specific role of Wealthspire Healthcare Fiduciary Services. We help plan sponsors document their fiduciary process and maintain a consistent record surrounding significant healthcare plan decisions. We do not replace the employer’s decision-making authority or the substantive roles performed by its attorneys, consultants, brokers, carriers, or other service providers. Instead, our focus is on creating a clear and defensible record of the fiduciary process that helps plan sponsors demonstrate how they carried out their responsibilities when significant decisions are subject to scrutiny.
As healthcare becomes more transparent, plan sponsors will have access to information that historically may have been difficult to obtain. The next evolution is not simply greater access to information, but a clearer record of how relevant information was considered as part of the plan’s fiduciary process. Could your healthcare fiduciary process withstand greater scrutiny? Contact Wealthspire to discuss how we can help mitigate fiduciary risk.
Sources:
1 Centers for Medicare & Medicaid Services, Transparency in Coverage Final Rules (CMS-9882-F), Oct. 5, 2026; 91 Fed. Reg. 63748 (Oct. 6, 2026).
2 Consolidated Appropriations Act, 2021, Pub. L. No. 116-260, Division BB; ERISA § 724.
3 Employee Retirement Income Security Act of 1974 § 404(a)(1), 29 U.S.C. § 1104(a)(1).
4 U.S. Department of Labor, Employee Benefits Security Administration, Understanding Your Fiduciary Responsibilities Under a Group Health Plan.
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