✓ Q1 If self or level funded, has the employer performed their Mental Health Parity QTL & NQTL comparative analysis ? Yes
✓ Q2 If self or level funded, Has the TPA provided 2 separate Machine-Readable Files of required healthcare costs? No
✓ Q3 If self or level funded, does the employer or their TPA provide an online, self-service, searchable tool that provides information on the cost-share for items and services covered by the health plan? Yes
Q4
If self or level funded, has the employer submitted the required Prescription Drug Data Collection (RxDC) reporting to CMS, or are plans in place to complete annually by the June 1st deadline? Yes No Not Sure
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✓ Q5 Does the employer apply the in-network cost share when a participant receives out-of-network emergency services, some non-emergency services at an in-network facility, and/or air ambulance? (i.e.- no balance billing)? No
✓ Q6 Is the employer providing participants with the No Surprises Act notice as required? Not Sure
✓ Q7 If self or level funded, who will submit the online Gag Clause Prohibition Compliance Attestation (GCPCA) annually by 12/31? Employer