No Surprises Act for ERISA – Retiree Only Plans

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is sending this to remind providers that the No Surprises Act (NSA) applies to individual health plans and fully insured and self-insured group health plans, including grandfathered plans. However, there are certain plans that are exempt from the NSA requirements. These exempted plans include the following: 

• Medicare
• Medicaid 
• Ancillary products such as standalone vision and dental 
• Retiree Only plans: These are group health plans in which there is 1 or less active employees enrolled in the plan as defined under ERISA 

Blue Cross NC will include the required NSA and Qualified Payment Amount (QPA) disclosure on any explanation of payment for claims to which the NSA applies based on the plan classification and claim information. To the extent a provider disagrees with Blue Cross NC’s designation of a claim as not subject to the NSA, the appropriate venue within which to address such a disagreement is the appeal process, not the Independent Dispute Resolution (IDR) process.