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Calculator for the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act

New Jersey has a law, the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act (the “Act”), to help protect you from surprise bills, including bills for emergency services from doctors, hospitals and other health care professionals who are not in your health plan’s network (also called out-of-network providers).

The questions and answers below can help you understand out-of-network care, surprise bills and how the Act can help you.

  • Any estimates or examples provided by the carrier for out-of-network costs do not take into account the amounts that the covered person may have already paid for their cost-sharing liability that accumulate toward the Maximum Out-of-Pocket (MOOP) benefit.
  • Out-of-network arbitration is only eligible for services with respect to services provided by a provider that is licensed or certified in New Jersey.