3 In - Network negotiated rates; and Historical Out - of - Network rates. Notice Regarding Retiree - Only Plans If this Plan is issued as part of a retiree - only plan, as defined by ERISA 732(a) and IRC 9831(a)(2), the provisions of the Consolidated Appropriations Act of 2021 will not apply, including the provisions regarding the No Surprises Act. In a retiree - only plan, Out - of - Network Providers may bill you for any charges that exceed t he Plans Maximum Allowed Amount. Please contact your Employer or former Employer if you are unsure whether your plan is a retiree - only plan.