No Surprises Act

Effective January 1, 2022

The No Surprises Act, a section of the Consolidated Appropriations Act, contains new protections for members from surprise medical bills from out-of-network providers. The law contains balance billing protections for care received in emergency settings and in certain in-network facilities from out-of-network providers. There are also notable provisions relating to provider directories, continuity of care, health care cost transparency, and more.

Provider directories

Providers are now required to verify their contact information every 90 days. Failure to update or attest to current information will result in the removal of a provider from the provider directory. If you do not see your provider listed in the directory, please contact Member Services.

Continuity of care

If your provider leaves the network, you have up to 90 days to continue coverage (from the date you are notified the provider left/is leaving the network) with your provider at your in-network level of benefits or until the end of their treatment, whichever comes first. You must meet a qualifying condition to continue coverage. Please call member services to find out if you qualify.

Health care cost transparency

Member ID cards

Tufts Health Plan is revising member ID cards, beginning with effective dates of January 1, 2022. The revised member ID cards will include additional details (e.g. in- and out-of-network deductibles and out-of-pocket maximums) to comply with new requirements as part of the 2021 Consolidated Appropriations Act (CAA). These details will be explained with the letter that accompanies every new member ID card received via postal mail. Digital member ID cards will also be updated and available through the secure member portal.