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Self-Funded ERISA Health Plans May Opt Into New Law Regarding Out-of-Network Service Providers
Haynes and Boone CDG, LLP via Lexology; registration required
[Guidance Overview] July 30, 2018
"The NJ Act [provides for]: [1] A limitation on payments by a patient who receives emergency/urgent care services, or inadvertent out-of-network services, to the in-network cost-sharing for such services (whereby the remaining provider fees may be billed to the health benefit plan); [2] Certain binding arbitration procedures ... [3] Automatic assignment to the healthcare provider of any benefits payable by the patient's health benefit plan for emergency/urgent care services or inadvertent out-of-network services; [4] A prohibition on the waiver or rebate by an out-of-network healthcare provider of any deductible, copayment, or coinsurance owed by the patient under the terms of his health benefit plan as an inducement for such patient to seek healthcare services from that provider."
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