The appropriations act passed earlier this year contains a provision that expands the traditional Explanation of Benefits to what is now called an Advanced EOB. Starting with plan years with a renewal of January 1, 2022, group health plans must provide this on request. This must contain
- Whether or not the provider or facility is in network – if so, the contracted rate under the plan for the provider or service
- Good faith estimate of the cost of services to be provided, which includes the total cost of services, the amount of participant cost sharing, the accrued amounts already met and the amount the plan is responsible for paying (yes, just like EOBs are supposed to already)
- Disclaimers that this is only an estimate