New Federal Laws Affect Health Insurance Plans

Jan. 1, 2022

We’re committed to ensuring you have appropriate information to make informed health care decisions that are right for you and your family. Our custom tools help you understand your options under your health benefit plans; including out-of-pocket cost estimates, information about physicians and facilities participating in our networks, and information about provider quality.

We want to share information about two federal laws – the Transparency in Coverage Final Rule and the Consolidated Appropriations Act – that may affect you beginning Jan. 1, 2022. Here are some ways the new laws may affect your health insurance coverage:

Surprise Billing

You may now have more protection from balance billing and surprise billing. When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing. 

  • Providers and facilities that haven’t signed a contract with your plan are “out-of-network.”
  • Balance billing happens when out-of-network providers bill you for the difference between what your plan agreed to pay and the full amount charged for a service. Surprise billing happens when you get an unexpected balance bill.

Member ID Cards

  • Member ID cards for health insurance plans have to include your deductible, out-of-pocket maximum and customer service contact numbers.
  • This information helps you and your provider know how much you’ll pay when you visit a doctor or fill a prescription.
  • Check out this flier  to see what’s changing.

PCP Selection

  • You have the right to choose a Primary Care Physician/Practitioner (PCP) in your plan’s network (for you and any other family members on your plan.)
  • If you don’t choose one, your plan will assign one to you, which you can change later if you want.
  • You can look for a PCP in your network by using our Provider Finder ®.

OB/GYN Care

  • You don’t need a referral from your PCP to see an obstetrics/gynecology (ob/gyn) provider.

Continuity of Care

  • If you’re pregnant or being treated for certain serious conditions and your doctor leaves your plan network, you may be able to keep seeing them for up to 90 days.*

Provider Directory

  • Insurance companies and plans have to update the list of providers for their plans within specified timeframes.

Mental Health Parity

  • Mental health parity means that any mental health and substance use disorders that are covered by health insurance must be covered comparably to other medical conditions.
  • Insurance companies and plans have to share information about how limits on mental health and substance use disorder benefits compare to limits on other medical benefits.

Gag Clauses

  • Insurance companies and health plans can’t add language to their contracts that keeps providers, plans or members from requesting cost or quality information.

Broker and Consultant Compensation

  • Insurance brokers have to share information about how much they’re paid by insurance companies to enroll members or groups.

*Members in their second or third trimester of pregnancy can continue to see their provider up to six weeks postpartum.

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