When can you be asked to waive your protections from balance billing: Health care providers, including hospitals and air ambulance providers, can never require you to give up your protections from balance billing. If you have coverage through a self-funded group health plan, in some limited situations, a provider can ask you to consent to waive your balance billing protections, but you are never required to give your consent. Please contact your employer or health plan for more information. When balance billing isn’t allowed, you also have the following protections:  You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out- of-network providers and facilities directly.  Your health plan generally must: • Cover emergency services without requiring you to get approval for services in advance (prior authorization). • Cover emergency services by out-of-network providers. • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits. • Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit. If you believe you’ve been wrongly billed, you may file a complaint with the federal government at www.cms.gov/nosurprises/consumers or by calling 1-800-985-3059; and/or file a complaint with the Washington State Office of the Insurance Commissioner at www.insurance.wa.gov/file-complaint-or- check-your-complaint-status, or by calling 1-800-562-6900. Visit www.cms.gov/nosurprises for more information about your rights under federal law. Visit the Office of the Insurance Commissioner Balance Billing Protection Act website at www.insurance.wa.gov/what-consumers-need-know-about-surprise-or-balance-billing for more information about your rights under Washington state law. WABBPANSA0124 2