Preparing for the New Year
Surprise Medical Bills
Surprise medical bills occur when patients unexpectedly receive care from out-of-network health care providers, resulting in unexpected fees. This often happens when a patient goes into an in-network hospital for treatment, such as surgery or emergency care, but unbeknown to the patient, an out-of-network doctor is involved in their treatment.
Key Takeaways
- The No Surprises Act is designed to protect patients from receiving surprise medical bills when there are gaps in coverage for emergency services and certain services provided by out-of-network clinicians at in-network facilities, as well as by air ambulance.
- The No Surprises Act will hold patients responsible for their in-network cost-sharing portion while giving providers and insurers the opportunity to negotiate reimbursement.
- The No Surprises Act will allow providers and insurers to access an independent dispute resolution process in the circumstance that disputes surface around reimbursement. The legislation does not set a benchmark reimbursement amount.
- The No Surprises Act requires both providers and health plans to assist patients in examining health care cost information.
The Act applies to plan or policy years beginning on or after January 1, 2022. Filice Insurance will be following the upcoming guidelines as they are announced and provide updates as needed.
A full link to the American Hospital Association’s Detailed Summary of the No Surprises Act is below:
CAA Updates:
Mental Health Parity (MHP) NQTL
Comparative Analysis
Applies to: Group health plans and health insurers that offer mental health and/or substance use disorder benefits
- Insured and self-insured arrangements (unless the self-insured plan has followed the opt-out procedures)
- Plans of all sizes, though an exemption is available for plans maintained by a small employer
- Does not apply to retiree-only plans
Effective February 10, 2021
A full link to the webinar is below:
https://acrisure.citrixdata.com/d-sc145836cbcdc45518d191af037aa68d4
COVID-19 Updates:
Coverage Mandates
The Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security (CARES) include certain COVID-19 related coverage requirements on group health plans and health insurers.
- Diagnostic Testing
- Over-the-Counter (OTC) Test (8 per month, effective January 15, 2022)
- Vaccines
States may enact additional coverage requirements that go beyond those mandated by federal law. These states’ requirements apply only to insured health plans; self-insured health plans are exempt but may choose to comply on a voluntary basis.
A full link to the webinar is below:
https://acrisure.citrixdata.com/d-sc145836cbcdc45518d191af037aa68d4
