No Surprises Act Regulations: Prohibition on Surprise Bills & Balance Billing

August 31, 2021

On July 13, 2021, the Departments of Treasury, Labor, and Health and Human Services (the “Departments”) published Interim Final regulations entitled “Requirements Related to Surprise Billing; Part One” (“Regulations”) which go into effect on September 13, 2021.  The Regulations implement provisions of the No Surprises Act which, effective plan years beginning on or after January 1, 2022, protect plan participants from surprise bills and balance billing. The No Surprises Act applies to employer-sponsored group health plans, including self-funded plans, fully insured plans, and grandfathered plans. It does not apply to HRA plans (or other account-based plans), voluntary dental and vision plans administered under a separate policy or agreement, or retiree-only plans. 

Employers and plan sponsors will need to review and amend their plans and policies to ensure compliance with the No Surprises Act. 

The Regulations are summarized in the chart here.

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