COMMISSIONER'S CORNER

DECEMBER 2021/JANUARY 2022


Q. I have been hearing a lot in the news about the No Surprises Act. What is it and how will it affect Wyoming citizens?

A. This is a very good and timely question. The No Surprises Act was passed by Congress on January 12, 2021 as part of the Consolidated Appropriations Act of 2021, and it goes into effect on January 2, 2022. Generally, this law is intended to protect consumers throughout the country, including Wyoming, from balance bills or surprise bills from their health care providers. I encourage you to read a more detailed description of this new law on the DOI website under the “Latest Public Service Announcements” tab.


Balance billing occurs when a health care provider bills a patient after the patient’s health insurance company has paid its portion. The balance bill is for the difference between the amounts the provider charges and the price the insurance company sets, after the patient pays any co-pay, co-insurance, or deductible. It can also occur when a consumer gets health care services from an out-of-network provider or at an out-of-network facility. Surprise billing occurs when a patient receives a balance bill after unknowingly receiving care from an out-of-network provider or an out-of-network facility, such as a hospital. This can occur in emergency and non-emergency situations.


Under the new federal law, Wyoming consumers are protected from emergency out-of-network medical bills including air ambulances, and non-emergency services at an in-network facility. Remember, you are still responsible for cost sharing amounts that may include copays, coinsurance, and deductibles under your health plan. You can still consent in advance to receive care from an out-of-network provider in some situations and agree to pay the provider amounts above your in-network co-pay, co-insurance, or deductible costs. The new law also requires insurance companies to keep their provider directories updated and to limit consumers’ co-pays, co-insurance, or deductible to in-network amounts if they rely on inaccurate information in a provider directory.


Jeff Rude, Wyoming Insurance Commissioner

https://sites.google.com/a/wyo.gov/doi/commissioner-s-corner/rude%20jeff%20%282%29.JPG?attredirects=0

Commissioner

Jeffrey P. Rude

COMMISSIONER'S CORNER - PRODUCER QUESTION

Q. Can the Department of Insurance provide an opinion whether an insurer is engaging in rebating or improper promotional or marketing activities?

A. If you are an insurer or producer, you can submit a detailed written proposal to the department for review. Please allow reasonable time for a review to be completed before instituting a program that might be considered a violation of state law.

Below are the applicable Wyoming statutes:

W.S. § 26-13-102. Unfair methods and deceptive acts prohibited.

No person shall engage in this state in any trade practice which is defined in this article as or is determined pursuant to this article to be an unfair method of competition or an unfair or deceptive act or practice in the business of insurance.

W.S. § 26-13-110. Rebates and favors as to life, disability and annuity contracts prohibited.

(a) Except as otherwise provided by law, no person shall:

(i) Knowingly permit or offer to make or make any contract of life insurance, life annuity or disability insurance, or agreement as to that contract other than as expressed in the contract issued thereon;

(ii) Pay, allow or give or offer to pay, allow or give in any manner as inducement to the insurance or annuity:

(A) Any rebate of premiums payable on the contract;

(B) Any special favor or advantage in the dividends or other benefits thereon;

(C) Any paid employment or contract for services of any kind; or

(D) Any valuable consideration or inducement not specified in the contract.

(iii) In any manner give, sell or purchase or offer or agree to give, sell, purchase or allow as inducement to the insurance or annuity or in connection therewith, and whether or not to be specified in the policy or contract, any agreement of any form or nature promising:

(A) Returns and profits;

(B) Any stocks, bonds or other securities, or interest present or contingent therein or as measured thereby, of any insurer or other corporation, association or partnership; or

(C) Any dividends or profits accrued or to accrue thereon.

W.S. § 26-13-112. Unfair discrimination, rebates and favors prohibited for property, casualty and surety insurers.

(a) No property, casualty or surety insurer or any employee or representative thereof, and no broker or agent shall pay, allow or give, or offer to pay, allow or give, in any manner, as an inducement to insurance, or after insurance has been effected, any valuable consideration or inducement of any kind not specified or provided for in the policy, except to the extent provided for in an applicable filing with the commissioner as provided by law.