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TO YOUR RETIREMENT
Jan. 1, 2022
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected by federal law from surprise billing or balance billing.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.
You are protected from balance billing for:
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as deductibles, copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.
You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have the following protections:
You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
Your health plan generally must:
Cover emergency services without requiring you to get approval for services in advance (prior authorization).
Cover emergency services by out-of-network providers.
Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.
If you believe you’ve been wrongly billed, you may contact the Department of Labor or your medical vendor.
Visit the Department of Labor’s website (www.dol.gov/ebsa)or call the Employee Benefits Security Administration (EBSA) Toll-Free Hotline at 1–866–444–EBSA (3272) for more information about your rights under federal law.
We want to stay connected with our retirees!
Please help us keep our contact information updated by sending us any changes to your phone number or email address. New information should be sent via email to firstname.lastname@example.org.
Sept. 23, 2021
STP Retiree Open Enrollment Begins Oct. 4
Pre-65 Retirees, Pre-65 Spouses of Retirees and Surviving Spouses will begin 2022 Open Enrollment on Oct. 4 and end on Oct. 21. This enrollment will be online in Ceridian Dayforce.
A 2022 Retiree Benefits Brochure and Ceridian Dayforce login instructions will be emailed on Sept. 27. Additionally, STP will be utilizing the CallFire system to communicate Open Enrollment reminders and updates via phone call. If your personal email address is not on file with STP, please provide this information to the Benefits Department by emailing email@example.com or calling 361-972-4000.
If you have any questions about Open Enrollment, please email us at firstname.lastname@example.org or call 361-972-4000.
March 31, 2021
Notice Regarding 2020 Form 1095(C) for STP Retirees
Pursuant to recent guidance from the federal government, the STP Pre-65 Medical Plan will not send 2020 Form 1095(C) to retired employees this year. The form is available upon request and will be provided within thirty (30) days of the date a request is received.
To request a copy of your 2020 Form 1095(C) or if you have any questions, please contact email@example.com.