New Regulations Provide More Insight to Health Care Reform

August 13th, 2010

The Departments of Labor, Treasury and Health and Human Services recently issued regulations to implement a new Patient’s Bill of Rights as part of the Health Care Reform Act.  The major initial provisions include the following:

INSURANCE FOR UNINSURED AMERICANS WITH PRE-EXISTING CONDITIONS

Beginning July 1, 2010, a Pre-Existing Condition Insurance Plan will provide new coverage options to individuals who have been uninsured for at least six months because of a pre-existing condition. States have the option of running this new program in their state. If a state chooses not to do so, then the individual can utilize the Federal programs.  This program serves as a bridge to 2014, when all discrimination against pre-existing conditions will be prohibited.  To learn more about the plan for a particular state, visit the Department of Health and Human Services website.

EXPANDING COVERAGE FOR EARLY RETIREES

Too often, Americans who retire without employer-sponsored insurance and before they are eligible for Medicare see their life savings disappear because of high rates in the individual market. To preserve employer coverage for early retirees until more affordable coverage is available through the new Exchanges required to be established by 2014, the new law creates a $5 billion program to provide needed financial help for employment-based plans to continue to provide valuable coverage to people who retire between the ages of 55 and 65, as well as their spouses and dependents.

The program provides reimbursement to sponsors of participating employment-based plans for a portion of the cost of health benefits for early retirees and their spouses, surviving spouses, and dependents. The Secretary will reimburse sponsors for certain claims between $15,000 and $90,000 (with those amounts being indexed for plan years starting on or after October 1, 2011).

Employers wishing to participate in the program can obtain additional information on the Department of Health Services website.

PROVIDING FREE PREVENTIVE CARE

Effective for health plan years beginning on or after September 23, 2010, all new plans must cover certain preventive services, such as mammograms and colonoscopies, without charging a deductible, co-pay or coinsurance.

PRE-EXISTING CONDITION EXCLUSIONS FOR CHILDREN UNDER AGE 19

Effective for health plan years beginning on or after September 23, 2010, for new plans and existing group plans, the new law includes rules to prevent insurance companies from denying coverage to children under the age of 19 due to a pre-existing condition. This limit applies to both specific coverage denials (because of a pre-existing condition) AND banning benefit limits (refusing you a policy).  This pre-existing condition will also apply to all individuals effective in 2014.

ELIMINATION OF ARBITRARY RESCISSION OF COVERAGE

Effective for health plan years beginning on or after September 23, 2010, insurance companies may no longer retroactively cancel a policy due to sickness or because of an “unintentional” mistake on paperwork. The only exception is if the case involves fraud or intentional misrepresentation of the facts.

LIFETIME LIMITS ARE PHASED OUT

Effective for all policies issued after September 23, 2010 and those renewing after this date, there can no longer be lifetime limits placed on health care plans.

ANNUAL DOLLAR LIMITS

There is a phase-out of annual dollar expenditure limits on health plans over the next three years until 2014 when the Affordable Care Act bans them for most plans.  Thus, plans issued or renewed beginning September 23, 2010 will be allowed to set annual limits no lower than the amounts shown in the following table:

Beginning

Minimum Limit

September 23, 2010
$750,000
September 23, 2011
$1.25 Million
September 23, 2012
$2 Million
January 1, 2014
Not Allowed

If you have additional questions, please give this office a call.

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