Senate Bill 415 Summary

• Establishes a "benchmark amount" for out-of-network and emergency health care services calculated as the lesser of 100% of Medicare payment rates, the provider's actual charges, or the median contracted rate in the insurer's network, with annual recalculation required.

• Prohibits health care providers from balance billing patients beyond the benchmark amount unless no in-network providers are reasonably available without unreasonable delay, as determined by the insurer.

• Requires written disclosures to patients before treatment at participating facilities and before emergency services at nonparticipating facilities, informing them of potential non-contracted providers, benchmark amount protections, and limitations on consumer protections.

• Applies benchmark protections to out-of-network services, emergency care, and situations where patients receive services from non-participating providers without prior knowledge or proper written consent and explanation.

• Designates repeated failure to comply with billing and collection requirements as unfair and deceptive trade practices actionable under North Carolina law, effective October 1, 2021.