No Surprises Act

No Surprises Act: What to know

The No Surprises Act protects consumers who get coverage through their employer (including a federal, state, or local government), through the Health Insurance Marketplace® or directly through an individual health plan, beginning January 2022, these rules:

• Ban surprise billing for emergency services. Emergency services, even if they’re provided out-of-network, must be covered at an in-network rate without requiring prior authorization.

• Ban balance billing and out-of-network cost-sharing (like out-of-network co-insurance or copayments) for emergency and certain non-emergency services. In these situations, the patient’s cost for the service cannot be higher than if these services were provided by an in-network provider, and any coinsurance or deductible must be based on in-network provider rates.

• Ban out-of-network charges and balance billing for ancillary care (like an anesthesiologist or assistant surgeon) when provided by out-of-network providers at an in-network facility.

• Ban certain other out-of-network charges and balance billing without advance notice. Health care providers and facilities must provide patients with a plain-language consumer notice explaining that patient consent is required to get care on an out-of-network basis before that provider can bill the patient.

For patients who don’t have insurance, these rules make sure they’ll know how much their health care will cost before they get it, and might help them if they get a bill that’s larger than expected.

The rules don’t apply to people with coverage through programs like Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care or TRICARE because these programs have other protections against high medical bills.