Benefits Legal and Administrative Plan Documents and Notices

Federal regulations require employers to provide employees with specific information (“notices”) concerning their rights and responsibilities under a benefits program on an annual basis. These notices cover a variety of topics and may not apply to everyone.

Information

 

Legal and Administrative Notices

This document includes the following Employee Retirement Income Security Act (ERISA) notices: COBRA, HIPAA, WHCRA, CHIP, QLSC, CCDN, GINA.

No Surprise Act (NSA) / Consolidated Appropriations Act, 2021

The U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, and the Office of Personnel Management, issued “Requirements Related to Surprise Billing; Part I,” an interim final rule that will restrict excessive out of pocket costs to consumers from surprise billing and balance billing. Surprise billing happens when people unknowingly get care from providers that are outside of their health plan’s network and can happen for both emergency and non-emergency care. Balance billing, when a provider charges a patient the remainder of what their insurance does not pay, is currently prohibited in both Medicare and Medicaid. This rule will extend similar protections to Americans insured through employer-sponsored and commercial health plans.

Among other provisions, the interim final rule:

  • Bans surprise billing for emergency services. Emergency services, regardless of where they are provided, must be treated on an in-network basis without requirements for prior authorization.
  • Bans high out-of-network cost-sharing for emergency and non-emergency services. Patient cost-sharing, such as co-insurance or a deductible, cannot be higher than if such services were provided by an in-network doctor, and any coinsurance or deductible must be based on in-network provider rates.
  • Bans out-of-network charges for ancillary care (like an anesthesiologist or assistant surgeon) at an in-network facility in all circumstances.
  • Bans other out-of-network charges without advance notice. Health care providers and facilities must provide patients with a plain-language consumer notice explaining that patient consent is required to receive care on an out-of-network basis before that provider can bill at the higher out-of-network rate.

These provisions will provide patients with financial peace of mind while seeking emergency care as well as safeguard them from unknowingly accepting out-of-network care and subsequently incurring surprise billing expenses.

The interim final rule implements the first of several requirements passed with bipartisan support in title I (the “No Surprises Act”) of division BB of the Consolidated Appropriations Act, 2021. The regulations for group health plans, health insurance issuers, and FEHB Program carriers, will take effect for plan, policy, or contract years beginning on or after January 1, 2022.

For more information go to www.cms.gov, or No Surprises Act Notice