HEALTH INSURANCE SOLUTIONS

MyPeak Resources

Consolidated Appropriations Act

 

No Surprises Act

Intended to protect consumers from some unpredicted medical bills after receiving care from out-of-network providers. This allows negotiation for reimbursement through an independent dispute resolution process.

Learn more:  Federal Guideline

ID Card Requirements

Requires health plan IDs to include both in-network and out-of-network information about deductibles and out-of-pocket maximum limitations, as well as a phone number or website to obtain additional information.

Learn more: Federal Guideline

Advanced EOB

A database must be created that includes a list of providers and facilities that are in-network and must be verified and updated every 90 days.

Learn more: Federal Guideline

Mental Health Parity

Requires insurance coverage for mental health conditions, including substance use disorders, to be no more restrictive on coverage than any other medical condition. 

Learn more: Federal Guideline

Provider Directory Requirements

A database must be created that includes a list of providers and facilities that are in-network and must be verified and updated every 90 days.

Learn more: Federal Guideline

Transparency

 

Machine Readable Files

Requires health plans to publicly post machinereadable files that allow data to be analyzed by computer systems for further processing. See below:

2022-12-19_PEAK-HEALTH_index

2022-12-19_PEAK-HEALTH_1640004-Allied-Health-Solutions–AHS-_in-network-rates

2022-12-19_PEAK-HEALTH_1640009-WVUHS-Union-Choice_in-network-rates

2022-12-19_PEAK-HEALTH_1640001-Peak-WVUM_in-network-rates

Learn More: Federal Guideline

Member Cost Transparency Tool

Members can use the price transparency tool located in the member portal to understand healthcare expenses and see cost-share estimates. 

Learn More: Federal Guideline