Admiral Communities Transparency in Coverage Statement
Admiral Communities
Transparency in Coverage Statement
In accordance with the federal Transparency in Coverage Rule, issued by the U.S. Departments of Health and Human Services (HHS), Labor (DOL), and the Treasury, Admiral Communities is providing access to machine-readable files that contain certain detailed pricing information for the group health plan(s) we make available to eligible employees.
These files are intended to increase transparency by making health plan pricing data publicly available in a standardized, machine-readable format.
1. What These Files Contain
The machine-readable files include information for the Admiral Communities group health plan(s) (the “Plan”) about:
In-Network Rates File
Negotiated rates for covered items and services between the Plan (through its insurer or third-party administrator) and in-network providers.
Out-of-Network Allowed Amounts File
Historical allowed amounts and billed charges for covered items and services furnished by out-of-network providers, aggregated as required by regulation.
These files are published and maintained by our health insurance carrier and/or third-party administrator on our behalf.
2. Format & Technical Nature of the Files
The machine-readable files are designed for use by researchers, regulators, and technology developers, not as a consumer-friendly tool. Specifically:
The files are provided in JSON or similar machine-readable formats required by the federal Transparency in Coverage Rule.
The files can be very large, may require specialized software or tools to download, open, and analyze, and may not be easily interpreted by individuals without technical expertise.
The files are updated on a regular basis (at least monthly, as required by regulation) by our carrier/TPA to reflect changes in rates or provider arrangements.
For more personalized and consumer-friendly cost estimates (such as estimating your out-of-pocket costs for a specific service), employees and covered members should use the cost estimator, member portal, or customer service tools provided by the health plan, rather than relying solely on these machine-readable files.
3. Accessing the Machine-Readable Files
You can access the machine-readable files for Admiral Communities’ employee health plan(s) at the link(s) below:
Machine-Readable Files URL(s):
[Insert Carrier/TPA Transparency in Coverage URL here – e.g.,https://transparency-in-coverage.[carrier].com/[your-group-id]]
If the link above does not work or you are unsure which file corresponds to your specific plan option(s), please contact our benefits team or your health plan’s member services number for assistance.
4. Important Limitations & Disclaimers
The machine-readable files do not provide personalized benefit information, cost-sharing details, or real-time out-of-pocket costs for specific individuals.
Actual member cost will vary based on:
the terms of your specific plan option,
your remaining deductible or out-of-pocket status,
the services you receive,
coding and billing practices of providers, and
any applicable preauthorization or medical management requirements.
The existence of a negotiated rate in the file does not guarantee that:
a service will be covered;
a provider will be in-network on the date of service; or
a particular benefit, network, or cost-sharing level applies to any specific individual.
For detailed questions about coverage, eligibility, or specific costs, employees and covered members should:
Review their plan documents and Summary of Benefits and Coverage (SBC); and
Contact their health plan’s customer service number (on the back of the ID card); or
Reach out to Admiral Communities’ HR/Benefits team for guidance.
Nothing in this Transparency in Coverage Statement is intended to:
Alter or replace the terms of the plan documents, insurance policies, or member contracts;
Provide legal, tax, financial, or medical advice; or
Create any rights or benefits that are not already provided under applicable law or plan documents.
In the event of any inconsistency between the information in the machine-readable files and the governing plan documents or policies, the plan documents/policies control, subject to applicable law.
5. Questions & Contact Information
If you have questions about this Transparency in Coverage Statement or need help locating or understanding the machine-readable files, you may contact:
Admiral Communities – Benefits/HR Contact
Email: [email protected]
Phone: 865-427-5009
Mailing Address: P.O. Box 22284 Knoxville, TN 37933