The No Surprises Act protects people from surprise out-of-network bills.
The No Surprises Act limits surprise out-of-network bills and adds transparency and reporting duties for group health plans.
The Basics for Employers.
A plain-English summary. This is general information, not legal advice, and the rules change, so check the current text.
Surprise Bills
People are protected from surprise bills for emergency care and for out-of-network providers at in-network facilities.
Plan Transparency
Plans must keep provider directories accurate and show deductible and out-of-pocket information on ID cards.
Annual Attestations
Plans attest each year that their contracts have no gag clauses and report prescription drug costs.
How it plays out.
The No Surprises Act protects people in group health plans from surprise bills for emergency care, certain care from out-of-network providers at in-network facilities and air ambulance services. It limits what a person can be charged and sets a dispute process between plans and providers.
Much of the work falls on plans and carriers, but employers that sponsor plans have duties too, including making sure notices and ID card information are right, and that the plan is not applying cost sharing in a way the law does not allow.
Employers also meet the same law through the gag clause attestation and through price and network transparency rules. Those are separate, and the carrier or administrator often handles the filing, though the plan sponsor remains responsible.
Where This Shows Up in Your Plan.
ERISA, ACA Reporting and Form 5500 Support
How we help with the filings, notices and plan documents.
Employer Benefits Guides: Eligibility, Plan Design, Life Events and Rules
Eligibility, plan design and life-event rules in one place.
What to check.
Ask for Carrier Confirmation
Get written confirmation the carrier follows the rules.
Review ID Cards
Check that cards show the required information.
Check Notices
Confirm required notices are on the carrier’s materials.
Calendar Attestations
Track the annual attestation due dates.
Mistakes to avoid.
Assuming It Is the Carrier’s Job
The plan sponsor shares responsibility.
Missing the Attestation
It is due each year.
Ignoring Self-Funded Differences
Self-funded plans carry more of the work.
Other Rules Employers Work With.
Mental Health Parity
29 U.S.C. 1185a
Newborns’ and Mothers’ Health Protection Act
29 U.S.C. 1185
Women’s Health and Cancer Rights Act
29 U.S.C. 1185b
Laws and Rules Referenced
No Surprises Act (Public Law 116-260, Division BB) — The statute or rule text from its official or public source.
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