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Spotlight Mandate: Provide a cost estimate with an advanced explanation of benefits (EOB)

Senior caucasian doctor using stethoscope to measure patients blood pressure

In order to provide transparency on the cost, cost-sharing and deductible of a service, when BCBSND receives a request for a good faith estimate for a covered service from a provider or a member prior to the service being provided, BCBSND will issue an advanced EOB to the member that includes the following:

  • Provider network status
  • Contracted rate
  • Good faith estimate from provider
  • Good faith estimate of cost-sharing
  • Various disclaimers

The advanced EOB will be distributed to the member and will be available in electronic and paper formats.

Who it applies to: Fully insured group health plans, self-funded group health plans and individual plans—including all grandfathered plans.

Effective date: Effective date is pending further rulemaking.

Action required: No member or employer group action is needed at this time; action will depend on rulemaking.