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42 U.S.C. § 300gg–135 — Air ambulance services
Federal law — U.S. Code and appendices · legal_authorities
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 in a plan year beginning on or after January 1, 2022, air ambulance services (for which benefits are available under such plan or coverage) from a nonparticipating provider (as defined in [section 300gg–111(a)(3)(G) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg–111/a/3/G&num=0&edition=prelim)) with respect to such plan or coverage, such provider shall not bill, and shall not hold liable, such participant, beneficiary, or enrollee for a payment amount for such service furnished by such provider that is more than the cost-sharing amount for such service (as determined in accordance with paragraphs (1) and (2) of [section 300gg–112(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg–112/a&num=0&edition=prelim), [section 1185f(a) of title 29](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1185f/a&num=0&edition=prelim), or [section 9817(a) of title 26](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title26-section9817/a&num=0&edition=prelim), as applicable).
Source: Supplied U.S. Code snapshot — release unconfirmed · 42 U.S.C. § 300gg–135
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Stable record: federal_law:legal_authorities:record_usc_9504fc1f2ef9c53c9ec241d0
Source file: Laws/federal/codes/united-states-code/title-42/section-300gg135-air-ambulance-services--060a81461c.md
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Source location: Title 42, Chapter 6A, § 300gg–135; chapter-6a-public-health-service.md
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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 in a plan year beginning on or after January 1, 2022, air ambulance services (for which benefits are available under such plan or coverage) from a nonparticipating provider (as defined in [section 300gg–111(a)(3)(G) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg–111/a/3/G&num=0&edition=prelim)) with respect to such plan or coverage, such provider shall not bill, and shall not hold liable, such participant, beneficiary, or enrollee for a payment amount for such service furnished by such provider that is more than the cost-sharing amount for such service (as determined in accordance with paragraphs (1) and (2) of [section 300gg–112(a) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section300gg–112/a&num=0&edition=prelim), [section 1185f(a) of title 29](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1185f/a&num=0&edition=prelim), or [section 9817(a) of title 26](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title26-section9817/a&num=0&edition=prelim), as applicable).
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Federal law — U.S. Code and appendices · legal_authorities
**(a) In general** In the case of a participant or beneficiary in a group health plan who receives air ambulance services from a nonparticipating provider (as defined in section 9816(a)(3)(G)) with respect to such plan, if such services would be covered if provided by a participating provider (as defined in such section) with respect to such plan—
(1) the cost-sharing requirement with respect to such services shall be the same requirement that would apply if such services were provided by such a participating provider, and any coinsurance or deductible shall be based on rates that would apply for such services if they were furnished by such a participating provider;
(2) such cost-sharing amounts shall be counted towards the in-network deductible and in-network out-of-pocket maximum amount under the plan for the plan year (and such in-network deductible shall be applied) with respect to such items and services so furnished in the same manner as if such cost-sharing payments were with respect to items and services furnished by a participating provider; and
(3) the group health plan shall—
(A) not later than 30 calendar days after the bill for such services is transmitted by such provider, send to the provider, an initial payment or notice of denial of payment; and
(B) pay a total plan payment, in accordance with, if applicable, subsection (b)(6), directly to such provider furnishing such services to such participant, beneficiary, or enrollee that is, with application of any initial payment under subparagraph (A), equal to the amount by which the out-of-network rate (as defined in section 9816(a)(3)(K)) for such services and year involved exceeds the cost-sharing amount imposed under the plan for such services (as determined in accordance with paragraphs (1) and (
Source: Supplied U.S. Code snapshot — release unconfirmed · 26 U.S.C. § 9817
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Federal law — U.S. Code and appendices · legal_authorities
**(a) In general** In the case of a participant or beneficiary who is in a group health plan or group health insurance coverage offered by a health insurance issuer and who receives air ambulance services from a nonparticipating provider (as defined in [section 1185e(a)(3)(G) of this title](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1185e/a/3/G&num=0&edition=prelim)) with respect to such plan or coverage, if such services would be covered if provided by a participating provider (as defined in such section) with respect to such plan or coverage—
(1) the cost-sharing requirement with respect to such services shall be the same requirement that would apply if such services were provided by such a participating provider, and any coinsurance or deductible shall be based on rates that would apply for such services if they were furnished by such a participating provider;
(2) such cost-sharing amounts shall be counted towards the in-network deductible and in-network out-of-pocket maximum amount under the plan or coverage for the plan year (and such in-network deductible shall be applied) with respect to such items and services so furnished in the same manner as if such cost-sharing payments were with respect to items and services furnished by a participating provider; and
(3) the group health plan or health insurance issuer, respectively, shall—
(A) not later than 30 calendar days after the bill for such services is transmitted by such provider, send to the provider, an initial payment or notice of denial of payment; and
(B) pay a total plan or coverage payment, in accordance with, if applicable, subsection (b)(6), directly to such provider furnishing such services to such participant, beneficiary, or enrollee that is, with application o
Source: Supplied U.S. Code snapshot — release unconfirmed · 29 U.S.C. § 1185f
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