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).  

In December, we contacted all SFGHPs that had opted in to follow the BBPA to notify them that if they wanted to include the new ground ambulance protections, they would need to update their attestation by Dec. 31, 2024. Any SFGHP that missed the deadline will have another chance to submit their attestation next year, but it must be submitted to our office 15 days before the plan year starts.

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 our office 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 our office at least 15 days before the end of the year to opt out.