For emergency services:

Plan participants will no longer be required to pay more than the in-network cost-sharing amount for out-of-network emergency care services (including air ambulances).
Plans covering emergency room services in a hospital or independent free-standing emergency department may not require preauthorization determinations.
Out-of-network emergency expenses must count towards a participant's in-network deductible and out-of-pocket maximum.
The cost-sharing amount for emergency services may not be greater than a median amount based on in-network rates.

For non-emergency services:

Balance billing by out-of-network service providers for services performed at an in-network facility (e.g., out-of-network anesthesia services) will not be permitted, unless the participant is given advance written notice and consents to such out-of-network care.
Neither the plan nor the out-of-network provider may require the patient to pay more than the plan's usual cost-sharing for in-network provider services.
As in the emergency services context, out-of-network costs must count towards a participant's in-network deductible and out-of-pocket maximum.

Independent dispute resolution

The Act includes an IDR process, administrated by an independent, unbiased entity, for use by plans or insurers and out-of-network providers to settle payment disputes. The parties must participate in a 30-day open negotiation process, and if they are unable to resolve the matter at the end of the 30-day period, the dispute may be submitted by either party to the IDR entity to determine the payment amount for the service. The IDR entity must choose between the two offers made by the parties and may not award another amount. This process is designed to require each party to propose its best offer.

Instant Insights /

The No Surprises Act: How does it affect employer-sponsored health plans?

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