How will your clients and employees schedule their vaccine appointments?

REMINDER: Geisinger Health Plan launches price estimator tool

Healthcare just got easier, more affordable and more accessible to our members. A new online shopping tool is now available exclusively to Geisinger Health Plan (GHP) members with an active member portal account. With the Geisinger Cost Transparency tool, you can compare cost and quality for many common medical services, as well as complex episodes of care. You’ll not only see the average historical cost for a procedure, but an estimate of out-of-pocket expenses based on the benefit plan you’re currently enrolled in.   

Get advice from doctors, plan your healthcare spending and know you’re getting the best all-around care available. Ready to try it? Just choose “Find a Provider” in the member portal to access the tool. 

The cost information provided is an estimate and is for informational purposes only. Contact GHP or your doctor to get actual pricing and coverage for a specific procedure. Price is just one of many factors in determining a care plan. Factors like quality, convenience, and access to care are not included in the estimate. The tool is available only to members who have an active Geisinger member portal account.

IRS Allows Face Masks and Other Personal Protective Equipment as Qualified Expenses

The IRS issued an announcement clarifying that the purchase of personal protective equipment, such as masks, hand sanitizer and sanitizing wipes, are qualified medical expenses if used for the primary purpose of preventing the spread of coronavirus. The announcement applies to expenses incurred on or after January 1, 2020. This will permit these expenses to be paid tax-free with HSAs, Archer MSAs, health FSAs, and HRAs.  The announcement also allows employers and plan administrators to amend their plans to include these expenses. Announcement 2021-7 will appear in IRB 2021-15, dated April 12, 2021.

Regulation spotlight: what is the No Surprises Act?

On December 27, 2020, the No Surprises Act was signed into law as a part of the Consolidated Appropriations Act, 2021. The main takeaways from this act are as follows:

Consumer Protections

Consumers are protected from surprise bills received in emergency and nonemergency settings. Plans or issuer cannot impose cost-sharing requirements on participants who see an out-of-network (OON) provider that exceed the cost-sharing requirements that would apply if a participant had an in-network (IN) provider. 

Providers are prohibited from balance billing participants more than IN cost sharing amounts for all OON emergency facility and professional services for: post-stabilization care at OON facilities until participant can be safely transferred to a different facility; air ambulance transports (emergency or nonemergency); and OON services delivered at or from an IN facility unless provider follows the notice and consent process required.

Transparency

Plans must maintain up-to-date provider directory, offer price comparison information via phone, and develop web price comparison tool keyed to specific geographic regions and participating providers. Health plans must include new information on insurance ID cards for plan years beginning on or after January 1, 2022 that includes: all plan deductibles, including IN and OON deductible amounts if applicable; maximum out-of-pocket costs, including IN and OON out-of-pocket cost limits if applicable; and, phone number and web address for consumer assistance information, including information on IN providers. 

Beginning in 2022, plans and insurers that receive a provider’s advanced estimates on a participant’s scheduled service must provide the participant a notice (in most cases within one business day) stating whether the provider is IN as to the schedule service and the contracted rate for the service based on relevant billing and diagnostic codes. Plans and insurers must also furnish a good faith estimate of how much the health plan will pay for the scheduled services.

Out of Network Rates Determinations and Independent Dispute Resolution Process

Within 30 days of a plan or insurer paying or denying payment, parties may voluntarily negotiate payment terms. If, after the 30-day open negotiation period, a resolution is not reached, either party may invoke the independent dispute resolution (IDR) procedures by providing notice to Health and Human Services and the other party. Each party will offer a payment amount. An arbitrator will select one amount or the other, using factors enumerated in the law. Note, the arbitrator cannot split the difference and is not allowed to factor in the billed charge or Medicare rate as benchmark.

Prohibition on Pricing Information Gag Clauses

Health plans or insurers are prohibited from entering agreements with providers, TPAs, or other service provider to directly or indirectly restrict the plan or issuer from providing provider-specific cost of services or quality of care information or electronically accessing de-identified claim information for a participant or beneficiary on request and consistent with Health Insurance Portability and Accountability Act, Genetic Information Nondiscrimination Act, and American with Disability Act. Plans or insurers must annually attest to their compliance with the gag clause requirements. 

This document is provided for informational purposes only, not for the purpose of providing legal advice.

Stay informed about COVID-19 

Geisinger.org/coronavirus is full of the most up-to-date information about the latest on COVID-19 including vaccine FAQs, our safety checklist, community resources and much more.

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Fast Facts:

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