Oscar Health and HealthEx Leverage TEFCA Individual Access to Bring Medical Records into AI Workflows on Day One

What You Should Know

Oscar Health announced an enterprise partnership with consumer health data platform HealthEx, making Oscar one of the nation’s first health insurers to connect members’ complete medical histories on day one of coverage. The deployment targets a structural industry failure: health plans traditionally learn about new members through adjudicating retrospective claims weeks or months after care occurs, leaving out longitudinal clinical context from previous insurers and providers. Launching ahead of the 2027 Affordable Care Act (ACA) Open Enrollment period, Oscar members can opt in during digital account setup to retrieve their clinical records from hospitals, clinics, and laboratories across the country. HealthEx operates as an Individual Access Services (IAS) provider under the federally endorsed Trusted Exchange Framework and Common Agreement (TEFCA), enabling consumer-mediated health data liquidity.

TEFCA Individual Access Services (IAS) Meets Consumer Consent

The integration between HealthEx and Oscar represents one of the first production payer deployments of Individual Access Services (IAS) under TEFCA, bypassing the slow, business-to-business payer data exchanges that have long stalled health plan interoperability:

TEFCA IAS vs. Payer-to-Payer APIs: Traditional CMS-mandated payer-to-payer APIs rely on mutual B2B directory handshakes that frequently fail due to technical discrepancies and minimal compliance enforcement. HealthEx operates as an Individual Access Services (IAS) provider under TEFCA, exercising the individual’s statutory right under HIPAA to access and direct their own digital health records. Because requests originate directly under consumer consent, health systems and connected Qualified Health Information Networks (QHINs) must fulfill them without commercial obstruction. Hybrid Retrieval Performance: By synthesizing TEFCA query networks with direct HL7 FHIR endpoint lookups, HealthEx searches across 90% of U.S. clinical care locations. Across active user bases, 70% to 80% of individuals automatically retrieve clinical records from an average of four to five distinct care sites in under five minutes, capturing twice as many records as standalone FHIR-directory scrapers. Privacy and Revocable Consent Architecture: The integration is strictly opt-in and consumer-permissioned. Connecting medical records has no impact on a member’s underwriting, coverage eligibility, or premium costs, and members maintain continuous access through the HealthEx Wallet to audit what was shared or sever access at any point.

“When someone changes health plans, their health history usually stays behind,” said Priyanka Agarwal, MD, MBA, Co-Founder and CEO of HealthEx. “With HealthEx, Oscar members can choose to connect their records and bring that history with them to their new plan, so their care can be more personalized. Members always stay in control, deciding what records to share and when to stop.”