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Under this regulation:
The regulation also requires in-network cost-sharing to be calculated using payment amounts that would have applied to an in-network provider based on a “recognized amount” for non-air ambulance services (which will be the “qualifying payment amount” (QPA) in most cases) and the lesser of billed charges or QPA for air ambulance services. The out-of-network cost-sharing will apply toward the member’s in-network deductible and annual out-of-pocket maximum.
Who it applies to: Fully insured group health plans, self-funded group health plans and individual policies – including all grandfathered plans.
Effective date: Plan years beginning on or after Jan. 1, 2022
Action required: No member or employer group action is needed at this time; changes will be made within BCBSND systems.