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42 U.S.C. § 300gg–131 — Balance billing in cases of emergency services
Federal law — U.S. Code and appendices · legal_authorities
**(a) In general** In the case of a participant, beneficiary, or enrollee with benefits under a group health plan or group or individual health insurance coverage offered by a health insurance issuer and who is furnished during a plan year beginning on or after January 1, 2022, emergency services (for which benefits are provided under the plan or coverage) with respect to an emergency medical condition with respect to a visit at an emergency department of a hospital or an independent freestanding emergency department—
(1) in the case that the hospital or independent freestanding emergency department is a nonparticipating emergency facility, the emergency department of a hospital or independent freestanding emergency department shall not bill, and shall not hold liable, the participant, beneficiary, or enrollee for a payment amount for such emergency services so furnished that is more than the cost-sharing requirement for such services (as determined in accordance with clauses (ii) and (iii) of [section 300gg–111(a)(1)(C) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg–111/a/1/C&num=0&edition=prelim), of [section 9816(a)(1)(C) of title 26](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title26-section9816/a/1/C&num=0&edition=prelim), and of [section 1185e(a)(1)(C) of title 29](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1185e/a/1/C&num=0&edition=prelim), as applicable); and
(2) in the case that such services are furnished by a nonparticipating provider, the health care provider shall not bill, and shall not hold liable, such participant, beneficiary, or enrollee for a payment amount for an emergency service furnished to such individual by such provider with respect to such em
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 300gg–131
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Stable record: federal_law:legal_authorities:record_usc_48ee005edce97e2e6e7b3f20
Source file: Laws/federal/codes/united-states-code/title-42/section-300gg131-balance-billing-in-cases-of-emergency-services--ffd22c3e03.md
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Passage SHA-256: 1643c9764b93b0045d656c23a3fbb92d29f1f45e118e68bebe12460ad2725659
Source location: Title 42, Chapter 6A, § 300gg–131; chapter-6a-public-health-service.md
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**(a) In general** In the case of a participant, beneficiary, or enrollee with benefits under a group health plan or group or individual health insurance coverage offered by a health insurance issuer and who is furnished during a plan year beginning on or after January 1, 2022, emergency services (for which benefits are provided under the plan or coverage) with respect to an emergency medical condition with respect to a visit at an emergency department of a hospital or an independent freestanding emergency department—
(1) in the case that the hospital or independent freestanding emergency department is a nonparticipating emergency facility, the emergency department of a hospital or independent freestanding emergency department shall not bill, and shall not hold liable, the participant, beneficiary, or enrollee for a payment amount for such emergency services so furnished that is more than the cost-sharing requirement for such services (as determined in accordance with clauses (ii) and (iii) of [section 300gg–111(a)(1)(C) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg–111/a/1/C&num=0&edition=prelim), of [section 9816(a)(1)(C) of title 26](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title26-section9816/a/1/C&num=0&edition=prelim), and of [section 1185e(a)(1)(C) of title 29](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1185e/a/1/C&num=0&edition=prelim), as applicable); and
(2) in the case that such services are furnished by a nonparticipating provider, the health care provider shall not bill, and shall not hold liable, such participant, beneficiary, or enrollee for a payment amount for an emergency service furnished to such individual by such provider with respect to such emergency medical condition and visit for which the individual receives emergency services at the hospital or emergency department that is more than the cost-sharing requirement for such services furnished by the provider (as determined in accordance with clauses (ii) and (iii) of [section 300gg–111(a)(1)(C) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg–111/a/1/C&num=0&edition=prelim), of [section 9816(a)(1)(C) of title 26](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title26-section9816/a/1/C&num=0&edition=prelim), and of [section 1185e(a)(1)(C) of title 29](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1185e/a/1/C&num=0&edition=prelim), as applicable).
**(b) Definition** In this section, the term “visit” shall have such meaning as applied to such term for purposes of [section 300gg–111(b) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg–111/b&num=0&edition=prelim).
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Federal law — U.S. Code and appendices · legal_authorities
**(a) Coverage of emergency services**
(1) **In general** — If a group health plan provides or covers any benefits with respect to services in an emergency department of a hospital or with respect to emergency services in an independent freestanding emergency department (as defined in paragraph (3)(D)), the plan shall cover emergency services (as defined in paragraph (3)(C))—
(A) without the need for any prior authorization determination;
(B) whether the health care provider furnishing such services is a participating provider or a participating emergency facility, as applicable, with respect to such services;
(C) in a manner so that, if such services are provided to a participant or beneficiary by a nonparticipating provider or a nonparticipating emergency facility—
(i) such services will be provided without imposing any requirement under the plan for prior authorization of services or any limitation on coverage that is more restrictive than the requirements or limitations that apply to emergency services received from participating providers and participating emergency facilities with respect to such plan;
(ii) the cost-sharing requirement is not greater than the requirement that would apply if such services were provided by a participating provider or a participating emergency facility;
(iii) such cost-sharing requirement is calculated as if the total amount that would have been charged for such services by such participating provider or participating emergency facility were equal to the recognized amount (as defined in paragraph (3)(H)) for such services, plan, and year;
(iv) the group health plan—
(I) not later than 30 calendar days after the bill for such services is transmitted by such provider or facility, sends to the provid
Source: Supplied U.S. Code snapshot — release unconfirmed · 26 U.S.C. § 9816
Stored review status: release_metadata_unconfirmed. Incoming connection: Explicit cross-reference supplied in source Markdown; currentness and applicability require review.
Federal law — U.S. Code and appendices · legal_authorities
**(a) Coverage of emergency services**
(1) **In general** — If a group health plan, or a health insurance issuer offering group health insurance coverage, provides or covers any benefits with respect to services in an emergency department of a hospital or with respect to emergency services in an independent freestanding emergency department (as defined in paragraph (3)(D)), the plan or issuer shall cover emergency services (as defined in paragraph (3)(C))—
(A) without the need for any prior authorization determination;
(B) whether the health care provider furnishing such services is a participating provider or a participating emergency facility, as applicable, with respect to such services;
(C) in a manner so that, if such services are provided to a participant or beneficiary by a nonparticipating provider or a nonparticipating emergency facility—
(i) such services will be provided without imposing any requirement under the plan for prior authorization of services or any limitation on coverage that is more restrictive than the requirements or limitations that apply to emergency services received from participating providers and participating emergency facilities with respect to such plan or coverage, respectively;
(ii) the cost-sharing requirement is not greater than the requirement that would apply if such services were provided by a participating provider or a participating emergency facility;
(iii) such cost-sharing requirement is calculated as if the total amount that would have been charged for such services by such participating provider or participating emergency facility were equal to the recognized amount (as defined in paragraph (3)(H)) for such services, plan or coverage, and year;
(iv) the group health plan or health insurance i
Source: Supplied U.S. Code snapshot — release unconfirmed · 29 U.S.C. § 1185e
Stored review status: release_metadata_unconfirmed. Incoming connection: Explicit cross-reference supplied in source Markdown; currentness and applicability require review.