Navigating Federal Healthcare Reform Part III - A Summer Series

Department of Financial Services, Consumer eViews Volume 7 Number 26

June 25, 2010

Sean Shaw, Insurance Consumer Advocate

Navigating the Patient Protection and Affordable Care Act can be a difficult task without guidance. In the two previous installments of this series, the Office of the Insurance Consumer Advocate provided consumers with information regarding benefits that became immediately available upon passage of the reforms, and what changes consumers can expect in future years.

Consumers should be aware that on September 23, 2010, numerous provisions will take effect. Many of these provisions will ensure that consumers retain coverage and remain covered regardless of their circumstances.

Some of the benefits that will be enacted on the first policy anniversary on or after September 23, 2010, are as follows:

• Children under age 19 with pre-existing medical conditions will no longer be denied coverage by employer plans or new plans in the individual market.
• Health plans will be prohibited from dropping insureds' coverage when they become ill except in the case of fraud or intentional misrepresentation on the application.
• Lifetime limits on coverage will be eliminated and annual limits will be restricted in order to ensure consumers have access to needed care.
• New private plans will be required to cover preventative services. Insurers are prohibited from applying co-payments or deductibles for these services.
• A new independent appeals process will be created to ensure that consumers in new plans have access to an effective internal and external appeals process.
• Employer health plans will be prohibited from establishing any eligibility rules for healthcare coverage that discriminates in favor of higher wage employees.
• Health plans will be required to allow young people to remain on their parents’ health plans up until their 26th birthday, provided that they do not have access to coverage on their own.

Consumers should contact their insurer or employer to obtain any additional information regarding changes to their specific policy.

As additional changes become effective, the Office of the Insurance Consumer Advocate (ICA) will generate advisories regarding their effect on consumers. More information regarding the PPACA can be found on the website of the ICA: http://www.myfloridacfo.com/ica/federalhealthcare.asp.

Consumers who have further questions regarding the Patient Protection and Affordable Care Act, should contact the Division of Consumer Services within the Department of Financial Services online at http://www.myfloridacfo.com/Consumers/ or by phone at 1-877-MY-FL-CFO (1-877-693-5236), toll-free in Florida, and (850) 413-3089 from out of state.

The Insurance Consumer Advocate is appointed by Florida Chief Financial Officer Alex Sink and is committed to finding solutions to insurance issues facing Floridians, calling attention to questionable insurance practices, promoting a viable insurance market responsive to the needs of Florida’s diverse population and assuring that rates are fair and justified.