b'The NO SURPRISES Act .plan will pay their share directly to theDeductible - An amount you could owe out-of-network providers and facilities. during a coverage period (usually one year) for covered health care services before your plan 2.Your health plan generally must:begins to pay anything.(a) cover emergency services withoutEmergency Medical Condition - An illness, requiring you to get prior approval forinjury, symptom (including severe pain), services; (b) cover emergency services byor condition severe enough to risk serious out-of-network providers; (c) base whatdanger to your health if you didnt get medical you owe the provider or facility (i.e., yourattention right away.sharing of the costs) on what it would pay an in-network provider or facility andNetwork Provider (aka a Preferredshow that amount in your explanation ofProvider or Participating Provider) - A benefits; and (d) count any amount youprovider who has a contract with your health pay for emergency services or out-of- insurer or plan who has agreed to provide network services toward your deductibleservices to members of a plan (usually at and out-of-pocket limit. discounted rates).Finally, here are some excerpts from definitionsOut-of-Network Provider (Non-Preferred offered by CMS that may help you apply the NoProvider or Non-Participating Provider) -Surprises Act to your personal situation: A provider who doesnt have a contract with Balance Billing - When a provider bills youyour plan to provide services. Many plans for the balance remaining on the bill thatcover out-of-network providers at reduced your plan doesnt cover. This amount is therates, but some exclude coverage from non-difference between the actual billed amountnetwork providers unless it satisfies the and the allowed amount. restrictive definition of an emergency.Claim - A request for a benefit (includingFor more information about the No Surprises Act, visit the CMS reimbursement of a health care expense) madewebsite at cms.gov/nosurprises/Ending-Surprise-Medical-Bills. by you or your health care provider to your health insurer or plan for items or services you think are covered.Coinsurance - Your share of the costs of a covered health care service, calculated as a percentage (e.g., 20%) of the allowed amount for the service. You generally pay coinsurance plus any deductibles you owe. If you have questions Copayment (aka copay) - A fixed amountabout this article or (e.g., $15) you pay for a covered health carewould like to discuss service, usually when you receive the service. your companys health Cost Sharing - Your share of costs for servicesinsurance progam, feel that a plan covers that you must pay out offree to contact me at your own pocket (sometimes called out-of- (801) 263-8000 or pocket costs). info@wmimutual.com. SWPMA News / Spring 202221'