The following information DOES NOT impact eligible retirees or covered dependents of the Retiree Welfare Plan.
Attention ALL Eligible Active Members and Covered Dependents
Over the last few months, we have provided information in the Engineer regarding the No Surprises Act (NSA) which became effective April 1, 2022 for our active eligible members and their covered dependents of the Welfare Fund. Below you will find additional information regarding NSA. Please read this information and share with your covered dependents.
These regulations will help protect our members and families from surprise billing. The following Q&A is from https://www.cms.gov/nosurprises/consumers/new-protections-for-you.
What are surprise medical bills?
If you have health insurance and get care from an out-of-network provider or at an out-of-network facility, your health plan may not cover the entire out-of-network cost. This can leave you with higher costs than if you got care from an in-network provider or facility. In the past, in addition to any out-of-network cost sharing you might owe, the out-of-network provider or facility could bill you for the difference between the billed charge and the amount your health plan paid. This is called “balance billing.” An unexpected balance bill from an out-of-network provider is also called a surprise medical bill.
What are the new protections if I have health insurance?
If you get health coverage through your employer, the Public Health Exchange, or an individual health insurance plan you purchase directly from an insurance company, these new rules will:
- Ban surprise bills for emergency services, even if you get them out-of-network and without approval beforehand (prior authorization).
- Ban out-of-network cost-sharing (like out-of-network coinsurance or copayments) for all emergency and some non-emergency services. You can’t be charged more than in-network cost-sharing for these services.
- Ban out-of-network charges and balance bills for supplemental care (like anesthesiology or radiology) by out-of-network providers who work at an in-network facility.
- Require that health care providers and facilities give you an easy-to-understand notice explaining that getting care out-of-network could be more expensive and options to avoid balance bills. You’re not required to sign this notice or get care out-of-network. Please be sure that you are thoroughly reading ALL notices and forms that are given to you at a provider/facility. DO NOT SIGN any form unless you understand what you are signing. If you have any questions, please contact Member Services at (708) 579-6600.
What if I don’t have health insurance or choose to pay for care on my own without using my health insurance?
If you don’t have insurance or choose to pay for care without using your insurance (also known as “self-paying” for care), these new rules make sure you can get a “good faith estimate” of how much your care will cost, before you get care.
Are there exceptions to these protections?
If you are an eligible pre-Medicare member/covered dependent of the Retiree Welfare Plan, the NSA rules do not apply to you. You are already protected against surprise medical billing if you have coverage through Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE.
If you are receiving care from an out-of-network provider/facility for services that are covered under the No Surprises Act, you will receive a Standard Notice and Consent documents. The out-of-network provider/facility is required to provide this information separate and apart from other forms that you must complete and sign. It is imperative that you thoroughly read this information before providing your consent. You are not required to sign this form. However, if you do not sign this form, the out-of-network provider/facility may terminate your treatment plan.
In accordance with the Consolidated Appropriations Act, 2021 (CAA) which included the No Surprises Act (NSA) regulations, the Midwest Operating Engineers Welfare Fund (the “Plan”) must comply with the Continuity of Care provisions. The Continuity of Care provisions are effective for services received on or after April 1, 2022.
Below is a SAMPLE of the Bronze PPO medical ID card. The back of this card contains additional information pursuant to the Consolidated Appropriations Act (CAA) for the health plan option’s in/out of network deductible and in/out of network, out of pocket medical/Rx maximums.
Effective April 1, 2022, plans must create a process to verify the accuracy of their provider databases and update at least every 90 days. If the participant was informed the provider was a participating provider when in fact a non-participating provider, the plan cannot impose higher cost-sharing that would apply for participating provider and must apply the participating deductible and OOP.
Effective January 1, 2023, plans must offer price comparison guidance by telephone and make available on the public website of the plan or issuer a price comparison tool that allows an enrolled individual to compare the amount of cost-sharing that the individual would be responsible for paying for items and services by a participating provider, by geographic region.
The Fund Office is currently working with BCBS of Illinois and HST Care Connect Network in creating price comparison tools for the membership to utilize.