Oct 11, 2021
The Consolidated Appropriations Act (CAA) of 2021 outlines various healthcare related provisions impacting health plans, our clients, and our members. Today Blue Shield is providing updates on the Insurance ID Card (Section 107 of Division BB) and Broker/Consultant Compensation Disclosures (Section 202 of Division BB), and Surprise Billing (Section 133 of Division BB) provisions of the CAA.
Blue Shield teams are working to implement other provisions of the CAA. The Centers for Medicare and Medicaid Services (CMS), Departments of Labor (DOL), Health and Human Services (HHS), and the Department of Treasury issued guidance impacting the No Surprises Act of the CAA and provisions of the Transparency in Coverage Final Rule. The guidance described the agencies’ enforcement discretion and deferment of certain requirements. The guidance and requirements are still subject to future rulemaking. Blue Shield of California continues to pursue solutions to meet requirements of these mandates, and will provide updates accordingly.
Insurance ID Cards
As part of the Insurance ID Card provision, Blue Shield will include additional information on member ID cards and will reissue ID cards to all members upon enrollment or renewal in a 2022 plan. Members can expect to see the following new information displayed on the back of their ID card:
- Any in network and out-of-network deductible applicable to their plan
- Any out-of-pocket maximum limitations applicable to their plan
- Blue Shield’s Customer Service phone number and website address where they can seek further assistance
Please note: Specific out-of-network deductible and out-of-pocket maximum limitation information is based on the enrollee’s plan or coverage. This may include both medical and pharmacy deductibles when applicable.
Samples of the new ID Card design can be viewed here. As a reminder, Blue Shield is honoring members’ communications preferences, whether print or digital.
Broker/Consultant Compensation Disclosures
The Consolidated Appropriations Act of 2020 (CAA) Section 202 created compensation disclosure requirements for health insurance brokers and consultants to employer-sponsored group health plans for contracts executed on or after December 27, 2021.
Blue Shield has no disclosure obligation under Section 202.
For fully funded groups, Blue Shield is a direct insurer and therefore, is not compensated for providing brokerage or consulting services. For self-funded or flex-funded groups, Blue Shield is primarily a Third-Party Administrator (TPA) and therefore, is not compensated for providing brokerage or consulting services.
Surprise Billing
On Thursday September 30, the Biden Administration issued a second rule implementing the surprise billing reforms in the No Surprises Act of the CAA. The new rule provides information on the independent dispute resolution (IDR) process for out-of-network billing disputes if providers and health plans are unable to reach an agreement on an out-of-network rate. It also clarifies that a health plan’s median contract rate for an item or service is the appropriate out-of-network payment amount for the IDR, unless credible evidence is submitted otherwise.
Blue Shield is closely following all regulatory guidance and working to implement requirements to meet timely compliance. They will share more information on how these changes will impact you and their members as it becomes available.
