Transparency Rule & No Surprises Act Chart

On August 20, 2021, the Departments of Labor, Health and Human Services, and Treasury (the “Departments”) issued the “FAQs About Affordable Care Act and Consolidated Appropriations Act, 2021 Implementation Part 49” (the “FAQs”), which announced the deferred enforcement of some, but not all, requirements of the No Surprises Act and Transparency Rule.

The No Surprises Act protects participants in health benefit plans from surprise medical bills for emergency and non-emergency medical care (including air ambulance services), while the Transparency Rule requires plans and insurance issuers to disclose cost-sharing information, negotiated rates for in-network providers, and allowed amounts for out-of-network providers. 

Both the No Surprises Act and Transparency Rule apply to employer-sponsored group health plans, including self-funded plans and fully insured plans. The No Surprises Act also applies to grandfathered health plans; the Transparency Rule does not. The No Surprises Act and Transparency Rule do 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.  

The Chart below, originally provided in July 2021, has been revised to reflect the updated enforcement information in the FAQs. Prior guidance regarding the No Surprises Act and Transparency Rule can be found here.