1 Consolidated Appropriations Act of 2021 Notice Consolidated Appropriations Act of 2021 (CAA) The Consolidated Appropriations Act of 2021 (CAA) is a Federal law that includes the No Surprises Act as well the Provider transparency requirements that are described below. Surprise Billing Claims Surprise Billing Claims are claims that are subject to the Federal No Surprises Act requirements: • Emergency Services provided by Non-Participating Providers; • Covered Services provided by a Non-Participating Provider at an Participating Facility; and • Non-Participating Air Ambulance Services. No Surprises Act Requirements Emergency Services As required by the CAA, Emergency Services are covered under your Plan: • Without the need for Precertification; • Whether the Provider is Participating or Non-Participating; If the Emergency Services you receive are provided by a Non-Participating Provider, Covered Services will be processed at the Participating benefit level. Note that if you receive Emergency Services from a Non-Participating Provider, your Out-of-Pocket costs will be limited to amounts that would apply if the Covered Services had been furnished by an Participating Provider. However, Non-Participating cost-shares (i.e., Copayments, Deductibles and/or Coinsurance) will apply to your claim if the treating Non-Participating Provider determines you are stable, meaning you have been provided necessary Emergency Care such that your condition will not materially worsen and the Non-Participating Provider determines: (i) that you are able to travel to an Participating Facility by non-emergency transport; (ii) the Non-Participating Provider complies with the notice and consent requirement; and (iii) you are in condition to receive the information and provide informed consent. If you continue to receive services from the Non-Participating Provider after you are stabilized, you will be responsible for the Non-Participating cost-shares, and the Non-Participating Provider will also be able to charge you any difference between the Maximum Allowed Amount and the Non-Participating Provider’s billed charges. This notice and consent exception does not apply if the Covered Services furnished by a Non-Participating Provider result from unforeseen and urgent medical needs arising at the time of service. Non-Participating Services Provided at a Participating Facility When you receive Covered Services from a Non-Participating Provider at a Participating Facility, your Out-of-Pocket costs will be limited to amounts that would apply if the Covered Service had been furnished by a Participating Provider. However, if the Non-Participating Provider gives you proper notice of its charges, and you give written consent to such charges, claims will not be covered. This means you will be responsible for Non-Participating cost-shares for those services and the Non-Participating Provider can also charge you any difference between the Maximum Allowed Amount and the Non-Participating Provider’s billed charges. This Notice and Consent process described below does not apply to Ancillary Services furnished by an Non-Participating Provider at a Participating Facility. Your Out-of-Pocket costs for claims for Covered Ancillary Services furnished by a Non-Participating Provider at a Participating Facility will be limited to amounts that would apply if the Covered Service had been furnished by a Participating Provider. Ancillary Services are one of the following services: (A) Emergency Services; (B)