Patient’s Protection and Affordable Care Act Mandates What changes went into effect for policies beginning or renewing after September 23, 2010
Although most health insurance plans are
subject to the new mandates there are still
some that are not. To avoid embarrassment and
fiscal frustration, read your policy in its entirety
before you start insisting on your rights.
Adult Children to Age 26
Most health insurance plans implemented this change earlier in the year but those that did not are required to cover all adult children until they are age 26
Keep in mind, this provision does not begin until your plan renews after September 23. That may not be until January 1, 2011 if you are on a group plan.
Also, be advised that if your child has a bona fide offer of health insurance from their employer they may not be able to stay on your plan, even if it is less expensive.
No Preventive Care Co-Pays
Doctors are not allowed to collect a co-pay from you for preventive care if you have certain types of health insurance. They are to bill 100% of their fee directly to your health insurance company.
No Preventive Care Deductibles
Hospitals , labs and imaging centers are not allowed to charge a deductible before providing certain preventive testing, like mammograms for women over 50 and colonoscopies for men over 50.
Guaranteed Issue for Juveniles
Children under the age of 19 are guaranteed to be approved for health insurance if they apply, regardless of any pre-existing health issues.
Health insurance companies are not allowed to cancel a policy unless they can prove it was obtained by fraud.
Direct Access To Physicians
Insurance companies cannot dictate what doctor you see provided the doctor you elect is willing to grant you an appointment
No “Out of Network” Emergency Room Payments
If you elect to use an Emergency Room and it is a true emergency, insurance companies are no longer allowed to charge you more for using a hospital that is not contracted with them than they would one that has agreed to a payment schedule.
Begin Annual Limit Phase Out
This is one of the most confusing parts of the bill. Annual limits are not eliminated immediately. They are phased out over a couple of year.
For the next year insurance companies may limit benefits in a year to $750,000.
The following year the limit is raised to $1,250,000.
The following year the limit is raised to $2,000,000.
No Lifetime Limits
Although some plans may still have annual limits, new plans or plans renewing after September, 23, 2010 are not allowed to have any lifetime limits.
Assuming your plan is based on a calendar year, it is possible for an individual to use up their annual benefit prior to December 31 but they will begin again on January 1.
These next 3 elements of the PPACA were implemented earlier in 2010
High Risk Pools
Many state already had a high risk pool with more generous benefits than what was offered by HHS.
Those that did not or were unwilling to set up such a plan were required to opt in to the federal program for people who have pre-existing medical issues and have gone without health insurance for at least 6 months.
Earlier this year a series of grants were made available through HHS to reimburse select employers for some of the cost of health insurance for people over the age of 50 who have retired buy are not eligible for Medicare.
Small Business Tax Credits
Many employers with fewer than 25 employees may be eligible for partial tax credits for their costs in offering group health insurance.
Be advised the qualifications for the tax credit are rather complex. Small business owners should seek guidance from a tax expert before assuming they will participate in the tax credit.