What ETF Group Health Insurance Program Members Need to Know
Federal guidance on the implementation of the No Surprises Act continues to develop. ETF will update this page as more information becomes available. If you have specific questions about potential claims or costs for services, please contact your health plan.
What is the No Surprises Act?
The No Surprises Act (the Act) is a part of the Consolidated Appropriations Act of 2021 (CAA). The CAA was passed by the U.S. Congress in December of 2020. The Act portion of the legislation addresses surprise medical billing by healthcare providers and other member protections.
The new Act will provide broad protection for patients from being balanced billed for:
Emergency and stabilization services delivered by out-of-network providers or facilities,
Emergency transport by out-of-network air ambulance providers, and
Non-emergency ancillary services (e.g., anesthesia, lab services, etc.) provided by out-of-network providers when the primary service (e.g., surgery, etc.) is provided by an in-network provider, unless the patient agrees in advance to accept the charges.
The Act also requires health plans and providers to give cost estimates in advance for planned services, and for health plans to make price transparency tools and provider directories available so members can more easily shop for services. The Act also requires, in certain circumstances, health plans to continue to cover services with providers that have left a plan’s network for up to 90 days. This will allow patients to transition to a new provider available in the plan’s network.
When do the new rules take effect?
The out-of-network billing protections will go into effect starting January 1, 2022, for the three types of services listed above.
While the Act says that all new provisions go into effect January 1, 2022, the three federal agencies charged with writing the rules to implement the act—the Department of Health and Human Services, the Department of Labor, and the Department of Treasury—have all acknowledged they need additional time to write complete rules and that plans will also need more time to fully implement the rules.
The three agencies are continuing to work on rules related to advance cost estimates, called Advance Explanations of Benefits (A-EOBs), as well as new rules related to transparency tools and provider listings.
ETF will update this page when we have more information on when these provisions will be implemented.
What will change for me?
If you are a Group Health Insurance Plan (GHIP) member, your plan already provides protection against balance billing for emergency services and out-of-network ancillary services. However, you should still make every effort to go in-network for services whenever possible.
The A-EOBs described by the rule will be a new feature of the plans, though your GHIP health plan may already offer cost estimates in some form, depending upon the plan you are enrolled in. Some plans may also already have transparency tools available, but for many plans this feature will be new as well.
ETF already requires that plans make searchable provider directories available; though the federal rules may add some requirements, ETF expects that these requirements would only improve the quality of the information already available.
When will I know when I can access the new features?
Your health plan will reach out to you when each of the new features required under the Act are available. You can also check back on this webpage to keep up to date with how the changes impact ETF’s program.