Your deductible and out-of-pocket maximum amounts have been added to your ID card due to new federal requirements. Your copays have been removed from your ID card to allow the addition of your deductible and out-of-pocket maximum amounts.
Review your member benefit documents for any additional financial responsibilities related to medical or pharmacy benefits.
You are protected from balance billing for: Emergency services. If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance).
You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections. You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
If you are enrolled in a commercial plan (individual, small group, large group, self-funded, level-funded, Medicare Supplement plans), the No Surprises Act applies.
The No Surprises Act does not apply to Medicaid and Medicare (except for Medicare Supplement).