Federal No Surprises Act
Enacted in December 2020, the federal No Surprises Act (the “NSA”) includes numerous protections for members and dependents regarding ‘surprise medical bills’ for emergency services and other situations where individuals may receive large, unexpected medical bills. These federal protections are generally applicable for plan years beginning on or after January 1, 2022. We are providing some key highlights of these new protections below for your reference, as well as a consumer disclosure related to Your Rights and Protections Against Surprise Medical Bills. Additional information is also available at https://www.cms.gov/nosurprises. Below are some frequently asked questions regarding the No Surprises Act:
The NSA consumer protections apply to individuals enrolled in group major medical insurance policies issued by Nippon Life Benefits.
The NSA will apply to your Nippon Life Benefits group medical plan as follows:
- New business first effective in 2022 – immediately upon your plan’s 2022 policy effective date.
- Renewals effective in 2022 – effective beginning on your plan’s renewal date in 2022
Pursuant to the NSA, members and dependents will be protected from surprise medical bills for emergency services, air ambulance services furnished by out-of-network providers, and non-emergency services furnished by out-of-network providers at participating facilities in certain circumstances.
Surprise billing is an unexpected balance bill. This can happen when you can’t control who is involved in your care - like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. However, out-of-network providers may also be permitted to bill you for the difference between what your Nippon Life Benefits policy reimburses and the full amount charged for a service. This is called “balance billing.” This amount is generally more than in-network costs for the same service.
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 in-network cost-sharing amount (such as copayments and coinsurance) under your Nippon Life Benefits medical policy. 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.
When you receive 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 in-network cost-sharing amount under your Nippon Life Benefits medical policy. 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.
State law protections against balance billing, if applicable, may also apply. Please refer to your issued Nippon Life Benefits booklet-certificate for further information and/or contact us at 800-374-1835.
If you believe you’ve been wrongly billed, please contact us immediately at 800-374-1835. You can also visit http://www.cms.gov/nosurprises for more information about your rights under federal law.
Yes, a new medical ID card will be issued that, among other things, discloses applicable deductible and out-of-pocket maximum cost-sharing amounts. For more information on your ID card, please visit our ID card page.
Yes, Nippon Life Benefits will continue to update member communications as necessary. Members will also receive a consumer disclosure included with each explanation of benefits (EOB) when services are rendered that fall within the scope of the NSA. This consumer disclosure is also available on our website by visiting this document. We will also be amending all group medical plan documents to reflect the provisions of the NSA.
NOTHING HEREIN IS A GUARANTEE OF BENEFITS OR ELIGIBILITY. ALL TERMS, PROVISIONS, CONDITIONS, LIMITITATIONS AND EXCLUSIONS SHOWN IN YOUR NIPPON LIFE INSURANCE COMPANY OF AMERICA CERTIFICATE AND MASTER POLICY WILL GOVERN. THIS INFORMATION IS PROVIDED FOR GENERAL INFORMATIONAL PURPOSES ONLY AND IS NOT INTENDED TO OFFER LEGAL, TAX, BENEFITS, MEDICAL OR ANY OTHER PROFESSIONAL ADIVICE.