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New health care reform rules debut Sept. 23

 

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The Affordable Care Act, part of the sweeping health care reform law, was enacted about six months ago. Now, on Sept. 23, the “Patient's Bill of Rights” gets some teeth. It articulates priorities designed to restore fairness to health insurance coverage, improve access to preventive care and promote strong relationships between patients and health care providers.

health care reformHealth care reform beginning Sept. 23, 2010:

  • No pre-existing condition exclusions for children under age 19. In the past, health insurance companies could deny coverage to sick children, either by citing benefit rules barring coverage for pre-existing conditions or by refusing to insure the child at all. The new health care reform law requires insurers to cover children of insured patients. “Grandfathered health plans” established before March 23, 2010, may continue their existing policy until 2014, at which time all health insurance discrimination based on pre-existing conditions will be prohibited.
  • No arbitrary rescissions of health insurance. Rescission is a widely criticized practice whereby insurers have been able to rescind insurance when a patient becomes sick. The rescission is based on an unintentional mistake on the initial enrollment paperwork by either the patient or employer. Health care reform eliminates this practice, except in cases of patient fraud or intentional misrepresentation. All insurers are subject to this new rule.
  • No lifetime limits on health insurance coverage. Over 100 million Americans have plans that set caps on the total amount of coverage. The caps expose patients to the risk of exhausting coverage in the midst of a costly procedure, when they need it most. For example, a leukemia patient in need of aggressive chemotherapy, a bone marrow transplant and hospital stays could exhaust the typical $1 million dollar lifetime limit in less than a year. The new provision prohibits lifetime limits on any plan issued or renewed after Sept. 23.
  • No annual limits on coverage. Similarly, annual limits will be gradually phased out beginning Sept. 23. Initially, health insurance plans will not be able to set annual limits lower than $750,000 per year. That minimum limit rises to $1.25 million next year on Sept. 23, 2011, and $2 million the following year. Beginning Jan 1, 2014, annual limits will be prohibited for most health plans.

These measures remedy some of the most controversial practices in the health industry. With the Sept. 23,  2010, effective date, the reform legislation ensures that patients who need care the most -- those recently diagnosed with or currently battling serious illness -- have the health insurance they need.

Patient choice and access to care

Also going into effect on Sept. 23, 2010, are provisions to strengthen patients' access to medical care, particularly preventive services.

  • Protecting choice of health care provider. Patients will have the option to select and keep a primary care doctor from among the insurance company's participating provider network. In addition to promoting a long-term relationship between patient and doctor, this provision encourages patients to seek preventive care, which lowers hospitalization rates and costs. The rule also prohibits insurers from requiring a referral for obstetric or gynecological care.
  • Improved access to emergency services. Health insurance companies will no longer be able to deny coverage or demand that patients pay co-insurance for the use of out-of-network emergency services. This protects patients who become ill on the road or far from a network hospital.
  • Preventive services covered. Beginning Sept. 23, all new or renewed health insurance plans must cover preventive services such as vaccinations, mammograms, colonoscopies, and nutrition counseling for obese patients. These services must be free to the patient, with no applicable deductible, co-pay or co-insurance.
  • Adult children covered to age 26. Children will have extended access to health insurance coverage under their parents' health insurance plan until age 26, unless they qualify for health insurance through their employer.

More health care reform coming

Health care reform ultimately affects all Americans, whether you have an individual or employer plan, or are uninsured. Some subscribers and employers may choose to stay with their current plans, many of which are exempt from some Sept. 23 provisions. By 2014, however, all plans will have to conform to these and other standards. Health care reform innovations still ahead include electronic health records, discount prescription drugs for seniors and state-run insurance exchanges to encourage competition.

Legislators have wasted no time putting into effect some of the Affordable Care Act's key provisions. If you or your employer subscribe to a new health insurance plan or renew a current plan, these changes will likely apply to your health insurance.

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