Small Business Benefits
Consolidated Appropriations Act, 2021, including the No Surprises Act, and The Transparency in Coverage Rule
The Consolidated Appropriations Act, 20211, including the No Surprises Act 2, ushers in new federal mandates, such as those designed to prevent surprise medical bills. And, as provisions in the Transparency in Coverage Rule3 make healthcare price information publicly accessible, consumers will gain even more information to make informed healthcare decisions.
The changes impact most employer-sponsored, self-funded group health benefit plans. From the beginning, our dedicated team has kept abreast of policy discussions surrounding the need to prevent surprise medical bills and to provide more transparency in healthcare pricing. As requirements from all measures take effect, we will keep brokers updated on important provisions; help plans administered by Star Marketing and Administration, Inc. comply with applicable aspects; and educate members about these sweeping changes.
A timeline for provisions follows for self-funded ERISA plans.
The changes impact most employer-sponsored, self-funded group health benefit plans. From the beginning, our dedicated team has kept abreast of policy discussions surrounding the need to prevent surprise medical bills and to provide more transparency in healthcare pricing. As requirements from all measures take effect, we will keep brokers updated on important provisions; help plans administered by Star Marketing and Administration, Inc. comply with applicable aspects; and educate members about these sweeping changes.
A timeline for provisions follows for self-funded ERISA plans.
No Surprises Act provisions: effective for plan years beginning on or after 1/1/22
Transparency in Coverage Rule: effective 7/1/22
Provisions with effective date delayed pending federal guidance
Transparency in Coverage Rule and No Surprises Act: effective for plan years beginning on or after 1/1/23 and 1/1/24
Machine-Readable Files
1 The Consolidated Appropriations Act, 2021 was signed into law on Dec. 27, 2020.
2The No Surprises Act is part of the Consolidated Appropriations Act, 2021. The No Surprises Act does not apply to health reimbursement arrangements (HRAs) or other account-based group health plans, short-term, limited-duration insurance, and retiree-only plans.
3 The Transparency in Coverage rule was released on Oct. 29, 2020, by the U.S. Department of Health and Human Services, the Department of Labor, and the Department of the Treasury. The rule does not apply to health reimbursement arrangements (HRAs) or other account-based group health plans, short-term, limited-duration insurance, grandfathered plans, and retiree-only plans.
4 Important Open Negotiation and Independent Dispute Resolutions Deadlines
5 The following providers cannot provide notice and consent and their services are subject to the No Surprises Act: radiologists, anesthesiologists, pathologists, neonatologists, assistant surgeons, hospitalists and intensivists. In the case of an emergency, notice may be provided after a patient is stabilized. If notice and consent is not issued/obtained, protections of the No Surprises Act continue to apply.
1 The Consolidated Appropriations Act, 2021 was signed into law on Dec. 27, 2020.
2The No Surprises Act is part of the Consolidated Appropriations Act, 2021. The No Surprises Act does not apply to health reimbursement arrangements (HRAs) or other account-based group health plans, short-term, limited-duration insurance, and retiree-only plans.
3 The Transparency in Coverage rule was released on Oct. 29, 2020, by the U.S. Department of Health and Human Services, the Department of Labor, and the Department of the Treasury. The rule does not apply to health reimbursement arrangements (HRAs) or other account-based group health plans, short-term, limited-duration insurance, grandfathered plans, and retiree-only plans.
4 Important Open Negotiation and Independent Dispute Resolutions Deadlines
5 The following providers cannot provide notice and consent and their services are subject to the No Surprises Act: radiologists, anesthesiologists, pathologists, neonatologists, assistant surgeons, hospitalists and intensivists. In the case of an emergency, notice may be provided after a patient is stabilized. If notice and consent is not issued/obtained, protections of the No Surprises Act continue to apply.
Plan design availability and/or coverage may vary by state. Plans are administered by Star Marketing and Administration, Inc., and stop-loss insurance and ancillary coverage are provided by Trustmark Life Insurance Company.