Updates Related to No Surprises Act

The federal No Surprises Act of 2021 seeks to protect patients from surprise medical bills from out-of-network providers. It includes provisions related to health care cost transparency, provider directory information, and member ID cards. Consistent with this legislation, Harvard Pilgrim is implementing the following effective Jan. 1, 2022:

  • Providers must disclose their participation in a member’s health plan upon scheduling a service, as well as provide information about the member’s anticipated costs, if requested.
  • If a member has a scheduled service with a provider that is out-of-network, the provider must notify the member in writing at least two days before the service is provided.
  • Failure to provide proper notification restricts the provider from billing the member except for applicable copayments, coinsurance or deductibles.
  • Providers are prohibited from balance billing members for out-of-network emergency care, out-of-network air ambulance services or care with an out-of-network provider at an in-network facility without documented consent (where applicable). Members can only be billed for the in-network cost share in this scenario.
  • Providers are required to verify and update their provider directory information every 90 days. Failure to review and update demographic information at least quarterly may result in directory suppression until such information is validated.

Updates to Member ID Cards

In addition, effective upon a group’s renewal date on or after Jan. 1, 2022, Harvard Pilgrim is updating our commercial and Medicare Enhance member ID cards to include all applicable deductible and out-of-pocket maximum amounts.

The updated information will appear on digital member ID cards. Members can print their ID card or download digital versions to Apple Wallet or Google Pay through their Harvard Pilgrim member online account. For any members who previously downloaded a digital ID, the updated member ID card will be automatically loaded.

Physical member ID cards will continue to be mailed to new members upon enrollment and to existing members if new benefits are added to the plan or there are changes to existing plan features or if there are updates to the member’s personal information. Members who do not receive a new ID card in the mail can continue to use their existing ID card as they do today.

To view a sample member ID card, please refer to our updated Member ID card flyer.

Editor’s note 1/7/2022: Corrected the fourth bullet to clarify that balance billing is prohibited for “out-of-network providers at an in-network facility.” Previous version incorrectly stated “in-network providers at an out-of-network facility.”


Publication Information

Annmarie Dadoly,
Editor

Joseph O’Riordan,
Writer

Kristin Edmonston,
Production Coordinator