A frontline team member at your 18-person coffee roastery comes to you last week with a $1,200 unexpected bill from a radiologist who read their CT scan during a visit to an in-network urgent care clinic. They assumed all care at the in-network location would be covered, and had no idea the radiology team was out of network. This resource helps you explain core No Surprises Act (NSA) rules to staff clearly, and includes a ready-to-use checklist to make sure your required employee notices about the NSA are complete and compliant.
NSA Employee-Notice Checklist (Required for All Group Health Plans)
✅ Post the federal standard NSA notice in a common physical break area (or digital employee hub for remote/hybrid teams)
✅ Include a one-paragraph summary of NSA protections in your annual open enrollment materials for all covered staff and dependents
✅ Add a line to your employee benefits FAQ noting that staff can file a disputed surprise bill complaint directly with your plan carrier or the U.S. Department of Health and Human Services
✅ Confirm your plan carrier includes NSA cost-sharing disclosures on all Explanation of Benefits (EOBs) for eligible out-of-network care
✅ Keep a digital copy of the standard federal NSA notice on file for 3 years for audit purposes
✅ Avoid adding unapproved claims about NSA coverage (e.g., “all out-of-network bills are covered”) that do not match federal guidance
Two options people mix up
Most staff confusion about the NSA stems from mixing up two distinct coverage frameworks that apply to medical care. Distinguishing these two scenarios is the first step to answering staff questions accurately, without overpromising protections that do not exist.
- **Standard in-network cost sharing**: This applies to all care you schedule with providers and facilities that are part of your health plan’s network. You are responsible for your pre-determined deductible, copay, and coinsurance amounts as listed in your Summary of Benefits and Coverage (SBC). The NSA does not reduce or eliminate these required costs, and does not change standard network rules for care you choose to schedule in advance.
- **Surprise out-of-network billing protections**: This applies to care where you could not reasonably choose an in-network provider, even if you sought care at an in-network facility or needed emergency care. The NSA caps your cost sharing for these services at the in-network rate, and bars providers from sending you “balance bills” for the difference between their out-of-network rate and the amount your plan pays.
Comparison table
The table below breaks down common care scenarios to clarify what the NSA does and does not cover, so you can share consistent information with your team.
| Care scenario | Pre-NSA rules | NSA rules | Your cost responsibility |
|---|---|---|---|
| Scheduled primary care visit with an in-network provider at an in-network clinic | You pay in-network copay/coinsurance after deductible | No change from pre-NSA rules | Full in-network cost sharing as listed in your SBC |
| Scheduled surgery at an in-network hospital, where the anesthesiology team is out of network and you did not sign a written consent to pay extra | You could be billed the full difference between the anesthesiologist’s out-of-network rate and your plan’s payment | You can only be charged the in-network cost-sharing amount for these services | In-network copay/coinsurance only, no extra balance bills |
| Emergency room visit for a suspected broken bone at an out-of-network hospital 30 minutes from your home | You could be billed full out-of-network cost sharing plus balance bills | You can only be charged the in-network cost-sharing amount for emergency care, regardless of facility network status | In-network emergency cost sharing as listed in your SBC, no extra balance bills |
| Scheduled appointment with an out-of-network physical therapist you chose specifically, with full knowledge they are not in your plan’s network | You pay full out-of-network cost sharing plus any balance bills the provider sends | No change from pre-NSA rules | Full out-of-network cost sharing plus any allowed balance bills, per your plan terms |
Illustrative example
Illustrative example: A covered employee has a health plan with a $1,500 individual deductible and 20% coinsurance for in-network outpatient surgery. They schedule a knee arthroscopy at an in-network ambulatory surgery center, and confirm the center and operating surgeon are in network ahead of time. They do not receive any notice that other providers working at the center are out of network, and do not sign any consent forms agreeing to pay extra for out-of-network care. After the procedure, they receive a bill for $700 from an out-of-network pathologist who examined tissue removed during the surgery, plus an EOB from their plan noting they applied the $700 charge to their out-of-network deductible, which has a separate $3,000 limit. Under the NSA, this is a prohibited surprise bill. The employee can contact their plan carrier to have the charge reprocessed at the in-network rate, applied to their in-network deductible, and only pay 20% of the plan’s allowed in-network rate for the pathology service. The pathologist is barred from sending them a balance bill for the remaining difference between their out-of-network rate and the plan’s payment.
Limits and exceptions
The NSA does not cover every out-of-network medical bill, so it is important to share these clear limits with staff to avoid unmet expectations. First, the NSA does not apply to short-term limited duration insurance plans, health care sharing ministries, or excepted benefits like standalone dental or vision plans, so staff enrolled in those plans do not have these protections. Second, if you explicitly choose to receive care from an out-of-network provider for a non-emergency service, and sign a standard written consent form acknowledging you will pay out-of-network costs, the NSA protections do not apply to that service. This consent form must include clear disclosures about the estimated cost of the out-of-network service, and cannot be included as a blanket term in standard intake paperwork, so if a staff member is asked to sign a form that says they agree to pay all out-of-network charges for all providers at a facility, they can ask for a separate, service-specific consent form for any out-of-network providers that will be involved in their care. Third, the NSA does not cap the total amount you pay for in-network care, including deductibles, copays, and coinsurance, up to your plan’s annual out-of-pocket maximum. Fourth, some states have additional surprise billing protections that apply to fully insured group plans, so staff can check their state insurance department website for more details. If a staff member receives a surprise bill they believe is prohibited under the NSA, they should first contact their plan carrier to dispute the charge, then reach out to the U.S. Department of Labor or Department of Health and Human Services if the dispute is not resolved.
Bottom line
Sharing clear, accurate information about the NSA with staff helps reduce confusion and frustration around unexpected medical bills, and the checklist earlier in this resource can help you meet federal notice requirements without extra administrative work. You can direct staff with specific questions about their coverage to your plan’s customer service team, or share the federal government’s public NSA consumer resources for additional guidance.
This content is for educational purposes only and does not constitute insurance, tax, legal, or medical advice. All employers should verify their plan’s specific NSA compliance requirements with their licensed health insurance broker or plan carrier, and direct staff to review their official Summary of Benefits and Coverage for details about their specific plan’s cost sharing and protections.
Important note: This page is educational and is not insurance, tax, legal, or medical advice. Confirm current rules in your plan documents or with a licensed professional.