No Surprises Act

The Consolidated Appropriations Act of 2021 contains the “No Surprises Act”. The following items of The No Surprises Act apply to individual, small group, and large group fully insured and self-funded plans, including both grandfathered and non-grandfathered plans, and coverage offered through an Exchange generally, for plans beginning on or after 01/01/2022.

  • Balanced Billing – The law will limit balance billing , including emergency services and air ambulance services
  • ID Cards – New ID cards must include deductibles and Out-of-Pocket limits
  • Provider Directories – Amongst other items provider directories must be updated every 90 days
  • Advanced Explanation of Benefits – Members can request, in advance, an estimate of what their out-of-pocket costs will be for services scheduled in advance.
  • Price Comparison Tool – Members can, either by phone or online, shop for services from different providers
  • Continuity of Care – Plans must provide continuity of care for 90 days to participants with certain conditions, in the event their provider leaves the network.
  • Insurers cannot impose Out-of-Network cost-sharing requirements that are greater than those applied to In-Network services. (for example if an insurer/plan imposes a 10% co-insurance for In-Network services, they cannot charge a co-insurance larger than 10% for Out-of-Network services)

These are just some of the items contained in the first part of the No Surprises Act due to go into effect on January 01, 2022