Fees

There are Two Types of Fees Associated with the eHealth Exchange:
eHealth Exchange Network Participation Fees (Annual)
  • Annual service fee that covers the cost to support participants who exchange data under the DURSA
  • Covers ongoing support and maintenance of trust framework, specifications, service registry / provider directory, certificate management, as well as expanded support services which include: operational monitoring, PKI certificate testing, and content testing.
  • eHealth Exchange network fees are based upon a participant’s annual healthcare revenue. For governmental agencies and non-profit organizations, annual participation fees are based upon annual operating costs instead of revenue.
  • Beginning July 1, 2018, content testing fees are bundled with the Annual Participation Fee.

Health System / HIO Fee Schedule (Effective September 1, 2018)

Network Participation Component

Annual Revenue (1) of
Health System, HIO, or Other Provider
Annual Network Participation Fee*
> $500 Million$27,000
$100 Million to less than $500 Million$25,000
$10 Million to less than $100 Million$19,000
$1 Million to less than $10 Million$11,000
Less than $1 Million$5,000
1eHealth Exchange Network Participation fees are based upon a Participant’s annual healthcare revenue.  For governmental agencies and non-profit organizations, Annual Network Participation fees are based upon annual operating expense instead of revenue.  Content testing fees are bundled with the annual Network Participation fee.

*No change for Anchor Participants through 2020

Annual Revenue (2) or Represented Annual Revenue of Payers & VendorsAnnual Network Participation Fee
> $10 Billion$400,000
$2.5-10 Billion$200,000
$1.5-2.5 Billion$160,600
$1-1.5 Billion$132,000
$700-999 Million$109,175
$500-699 Million$99,550
$250-499 Million$81,125
$150-249 Million$68,200
$100-149 Million$56,100
$75-99 Million$41,800
$50-74 Million$34,100
$25-49 Million$28,325
$10-24 Million$20,900
$5-9 Million$14,575
$2-4 Million$9,350
<$2 Million$6,750
2 “Annual Revenue” is annual revenue from the most recently complete calendar year, and specifically healthcare revenue for those organizations operating in different industry sectors. 

Annual Hub Fees to Exchange within eHealth Exchange Network

Participant TypeFee to Respond to Queries Routed Through the HubFee to Initiate Queries Routed Through the Hub
Health Systems, HIOs, & Other Providers Operating in < 5 States$0 (4)$0 (4)
Health Systems, HIOs, & Other Providers Operating in 5 or More States with Annual Revenue (3) or Expenses (3) Under $500M$0 (4)$0 (4)
Health Systems, HIOs, & Other Providers Operating in 5 or More States with Annual Revenue (3) or Expenses (3) Between $500M - $3B$0 (4)$60,000 Annually (In Addition to Annual Network Participation Fee)
Health Systems, HIOs, & Other Providers Operating in 5 or More States with Annual Revenue (3) or Expenses (3) Over $3B$0 (4)$110,000 Annually
(In addition to Annual
Network Participation Fee)
Payers and Vendors Retrieving < 500K Documents Annually$0 (4)$150,000 Annually
(In addition to Annual
Network Participation Fee)
Payers and Vendors Retrieving 500K to 999K Documents Annually$0 (4)$250,000 Annually
(In addition to Annual
Network Participation Fee)
Payers and Vendors Retrieving > 1M Documents Annually$0 (4)$400,000 Annually
(In addition to Annual
Network Participation Fee)
4Included in Annual Network Participation Fee

3Based upon a Participant’s annual healthcare revenue.  For governmental agencies and non-profit organizations, annual network participation fees are based upon annual operating expense instead of revenue.

Carequality Component (In addition to Network Participation & Hub Technology Components)

Annual Health System, HIO, or Other Providers’ Carequality Fee to Exchange With

Carequality-Enabled Networks via eHealth Exchange5

Annual Health System, HIO, or Other Providers’ Carequality Fee to Exchange With
Annual Revenue (or Annual Operating Expense for Government & Non-Profits)
Applies to Health Systems, HIOs, and other providers not already connected with Carequality who do not opt-out of Carequality connectivity:
> $500 Million$13,500
$100 Million to less than $500 Million$12,500
$10 Million to less than $100 Million$9,500
$1 Million to less than $10 Million$5,500
Less than $1 Million$2,500

5Interoperability with Carequality will be available after the eHealth Exchange onboards to Carequality.  This will happen after the current version of the Data Use and Reciprocal Support Agreement (DURSA) is amended.  The eHealth Exchange has been working diligently to amend the DURSA and hopes to have that completed by mid-2019. eHealth Exchange Participants will not incur any fees related to Carequality until the eHealth Exchange has onboarded to Carequality.

Testing Fees

Participant Testing Fee: Applies to every organization onboarding for the first time to the eHealth Exchange and may apply if an existing participant changes vendors or makes substantial changes to its system once in production and are detailed in the Participant Testing Agreement. Multiple testing fees may apply if multiple systems / connection points exist.

Applicants that are using an eHealth Exchange Validated Product are only required to complete the Smoke Tests. Content Testing is required for ALL applicants and participants.

The standard testing fees to not apply for applicants that are using an approved Qualified Technology Solution (QTS) vendor.


Product Testing Fee: Applies to vendors seeking to validate their product and are detailed in the Product Testing Agreement.

Annual Vendors’ & Payers’ Carequality Fee to Exchange With

Carequality-Enabled Networks via eHealth Exchange6

Annual Revenue (or Annual Operating Expense for Government & Non-Profits)Applies to Vendors & Payers not already connected with Carequality who do not opt-out of Carequality connectivity:
> $10 Billion$200,000
$2.5-10 Billion$100,000
$1.5-2.5 Billion$80,300
$1-1.5 Billion$66,000
$700-999 Million$54,588
$500-699 Million$99,550
$250-499 Million$81,125
$150-249 Million$68,200
$100-149 Million$28,050
$75-99 Million$24,050
$50-74 Million$17,050
$25-49 Million$14,163
$10-24 Million$10,450
$5-9 Million$7,288
$2-4 Million$4,675
<$2 Million$3,375

6Interoperability with Carequality will be available after the eHealth Exchange onboards to Carequality.  This will happen after the current version of the Data Use and Reciprocal Support Agreement (DURSA) is amended to allow the Coordinating Committee to sign the Carequality Connected Agreement.  The eHealth Exchange has been worked diligently to amend the DURSA and hopes to have that completed by mid-2019. eHealth Exchange Participants will not incur any fees related to Carequality until the eHealth Exchange has onboarded to Carequality.