Sec. 404. Limitation on balance billing for emergency services
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A health care provider that provides any emergency service to an individual enrolled in a group health plan, group health insurance coverage, or individual health insurance coverage and that is not an in-network provider of such plan or coverage shall not impose a charge on such individual for such emergency service, other than any cost-sharing that would otherwise be applicable if the physician was an in-network provider of such plan or coverage. The Secretary may impose a civil monetary penalty, in the same manner as such penalties are authorized under section 1128A of the Social Security Act ( 42 U.S.C. 1320a–7a ) for violations of balance billing prohibitions under part B of title XVIII of such Act ( 42 U.S.C. 1395j et seq.), on any provider that violates the requirement under subsection (a).
In this section: The term cost-sharing has the meaning given the term in section 1302(c)(3) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18022(c)(3) ). The term emergency service has the meaning given such term in section 2719A(b)(3)(B) of the Public Health Service Act (42 U.S.C. 300gg–19a(b)(3)(B)). The terms group health plan , group health insurance coverage , and individual health insurance coverage have the meanings given such terms in section 2791 of the Public Health Service Act ( 42 U.S.C. 300gg–91 ).
The term Secretary means the Secretary of Health and Human Services. This section shall apply to plan years beginning after December 31, 2019.
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- 42 USC 1320a–7a
- 42 USC 300gg–19a(b)(3)(B)
- 42 USC 300gg–91
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Sec. 404
Limitation on balance billing for emergency services
Cite42 USC 1320a–7a
Cite42 USC 300gg–19a(b)(3)(B)
Cite42 USC 300gg–91
Cites 5Cited by 0 across 0 sources