Per the No Surprises Act (NSA), a component of the Consolidated Appropriations Act passed in December of 2020, beginning with renewals on or after January 1, 2022, health plans and health issuers offering group and individual health insurance coverage must issue a plain language notice regarding employee’s rights under the No Surprises Act. The notice must contain:
- The restrictions on balance billing in certain circumstances;
- Any applicable state law protections against balance billing (n/a for self-funded plans);
- The requirements under Code section 9816, ERISA, section 716, and PHS Act section 2799A-I; and
- Information on contacting appropriate federal agencies in the case that an individual believes that a provider or facility has violated the restrictions against balance billing.
Beginning with plan years on or after January 1, 2022, the No Surprises Act prohibits members from being balance billed if they seek care in an out-of-network facility in an emergency situation where they do not have the opportunity to select an in-network provider or facility. Additionally, they cannot be balance billed when they receive nonemergency care at an in-network hospital but are unknowingly treated by an out-of-network physician or laboratory without written consent. Members only pay in-network deductible and out-of-pocket amounts.
The Notice must be provided in the following three ways: (i) it must be made publicly available, (ii) it must be posted on a public website of the plan or issuer, and (iii) it must be included on each EOB for an item or service with respect to which the requirements under the NSA apply.
Group health plans should take the following actions to ensure compliance with the notice requirements:
Employers should consider posting the notice in the same location as other worksite postings and notices. Additionally, plan sponsors should consider other methods of making this notice publicly available such as including a copy of the notice in their open enrollment materials, including the notice in new hire packets, or separately distributing the notices (via email or mail) to employees.
Posted on a Public Website of the Plan or Issuer
The regulations issued with respect to disclosures by healthcare providers and facilities require that the public website be searchable and accessible free of charge, without having to establish a user account, password or other credentials, accept any terms or conditions, and without having to submit any personal identifying information such as a name or email address. It is recommended that an employer consider posting the notice or a link to the notice on the employer’s main Human Resources website, if available, and on the plan’s website.
Diversified Group Response: Diversified Group will be posting a copy or link to the notice on our main corporate website at https://www.dgb-online.com/.
Included on each EOB
Diversified Group Response: Notice language will be added to EOBs issued with respect to plan years beginning on or after January 1, 2022 for claims that fall under NSA protections.
The model notice can be found on the DOL website under Requirements Related to Surprise Billing. Additionally, you can find a PDF copy of the notice that has been edited to include the information self-funded employers are required to include here.