For Consumers

Self-funded group health plans and surprise billing

The Federal No Surprises Act protects consumers with self-funded group health plans (SFGHPs) from surprise billing. This includes any emergency services they receive from a behavioral crisis facility. If an employer self-insures and wants to offer its employees more protections, it must opt-in to follow Washington state law. 

New ground ambulance services protections and attestation

During the 2024 legislative session, Second Substitute Senate Bill (SSB) 5986 was enacted to add ground ambulance services balance billing protections to the Balance Billing Protection Act (BBPA) (RCW 48.49.200).  

We are contacting all SFGHPs that are currently opted in to inform them that to maintain their opt-in status, they will need to update their attestation to include the full suite of balance billing protections under the BBPA. 

To be sure that SFGHP employees and their dependents have all of the BBPA’s balance billing protections, and that accurate information is available on our website, We will need to receive your new attestation by Dec. 31, 2024.  If we do not receive the attestation by that date, we will need to disenroll your plan from the opt-in to BBPA consumer protections beginning Jan. 1, 2025.   

Attest to the full suite of protections under the BBPA  

How to opt-in to the Balance Billing Protection Act

A self-funded group health plan must notify the Office of the Insurance Commissioner at least 15 days before it intends to participate in the Balance Billing Protection Act. If the plan is administered by a third-party administrator, that administrator must also follow the law. 

Opt-in is for a full year unless the self-funded plan selects to automatically renew. The plan can participate for any calendar or plan year and must notify the OIC at least 15 days before the end of the year to opt-out.