No Surprises Act Health Care Protections

In October 2020, the federal government issued the “transparency in coverage” final rule under the Federal No Surprises Act. The rule provides protection against balance or “surprise” billing under certain circumstances such as when you seek emergency care, and phases in new transparency requirements on most group health plans and health insurers.

Health insurance carriers that provide coverage to state employees will begin publicly posting two machine-readable files (MRFs) on their websites in July. In 2023, federal laws will require all health plans to offer price comparison tools to help you see what health care services will cost before you receive care. The MRFs are a step towards ensuring health plans and insurers will meet the upcoming requirements.

The MRFs include data related to the following:

  • In-Network File: All negotiated rates with in-network (INN) providers for all covered items and services.
  • Allowed-Amount File: Billed charges and allowed amounts for covered items and services provided by out-of-network (OON) providers.

More information about the No Surprises Act protections for state employees is accessible via the EBD website (www.mi.gov/employeebenefits). Members should visit their insurance carrier’s website or contact their customer service center for specific costs under their plan.

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