The No Surprises Act was signed into law on December 27, 2020. This law gives consumers new federal protections from surprise medical bills by prohibiting balance billing and limiting consumer cost sharing in certain circumstances where surprise billing has been common.
In general, the No Surprises Act protects consumers covered under group health plans and group and individual health insurance coverage. This includes consumers with a plan or coverage obtained through an employer, the Federal Employees Health Benefits Program, the Health Insurance Marketplace®, or an individual plan purchased directly from an insurance company.* The new surprise billing protections apply when these consumers receive:
- Most emergency services from out-of-network providers or out-of-network emergency facilities;
- Non-emergency services from out-of-network providers with respect to a patient’s visit to certain types of in-network health care facilities; and
- Air ambulance services from out-of-network air ambulance service providers.
If consumers are uninsured or decide not to use their health insurance for a service, the new law enables them to get a good faith estimate of the expected cost of their care up front, before receiving the service. If consumers receive a bill significantly higher than the estimate, they may be able to dispute the charges through a new federal arbitration process.
The No Surprises Act also includes other new protections related to continuity of care, provider directories, health plan insurance cards, and more. Most No Surprises Act provisions went into effect on January 1, 2022, although some have not yet been implemented. See No Surprises Act Protections: Status of Implementation (PDF).**
*For a more complete list of the types of health coverage subject to the No Surprises Act, see No Surprises Act: Overview of Key Consumer Protections (PDF). As noted above, the No Surprises Act protections generally apply to individuals who are covered by group health plans and group or individual health insurance coverage (including grandfathered health plans), and Federal Employees Health Benefits (FEHB) Program carriers. Throughout this toolkit, unless otherwise specified, terms such as “health insurance,” “health plan,” and “health coverage” are used interchangeably to refer to these coverage types. The term “health insurance issuer” (or “issuer”) refers to an insurance company (including FEHB carriers) that offers group or individual health insurance coverage.
**This Consumer Advocate Toolkit provides information on many of the new consumer protections included in the No Surprises Act. Information on additional provisions of the law will be provided in the future.
