Transparency in Coverage

In 2022, the Federal Government implemented legislation to protect consumers from unexpected or “surprise” medical bills. The No Surprises Act protects individuals covered under group and individual health plans from receiving surprise medical bills for:

• Most emergency services
• Non-emergency services from out-of-network providers at in-network facilities
• Out-of-network air ambulance services

When you receive emergency care (other than ground ambulance services) or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

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What is Balance Billing?

When you see a healthcare provider, you may owe copayments, coinsurance, or deductibles. If you receive care from an out-of-network provider, they may bill you for the difference between what the Plan pays and the full amount charged. This is called balance billing.

“Surprise billing” occurs when you unexpectedly receive care from an out-of-network provider, such as during an emergency or when treated at an in-network facility by an out-of-network specialist.

You Are Protected From Balance Billing For:

Emergency Services

If you receive emergency services from an out-of-network provider, facility, or air ambulance, you can only be charged the Plan’s in-network cost-sharing amount. You cannot be balance billed for these services.

Certain Services at In-Network Facilities

If you receive services at an in-network hospital or ambulatory surgical center, certain out-of-network providers (such as anesthesia, pathology, radiology, or hospitalist services) may not balance bill you.

You are never required to give up your balance billing protections and are not required to seek care out-of-network.

Additional Protections

• You only pay your normal in-network cost-sharing amounts.
• The Plan pays out-of-network providers directly.
• Emergency services do not require prior authorization.
• Your payments count toward your in-network deductible and out-of-pocket maximum.