The most important changes will ensure that consumers are able to retain coverage and remain covered regardless of their circumstances. While the following provisions take effect next week, some policyholders may not be able to take advantage of all of these new provisions until policy renewal, which for many employees in group plans is in January. Consumers should contact their insurer or their employers’ benefit administrator to obtain any additional information regarding changes to their specific policy.
The benefits that will be effective on September 23, 2010, are as follows:
Currently, most health insurance policies have provisions stating that the maximum the insurer will pay during the life of the policy is $1 million or maybe $2 million. In addition, they have a maximum the insurer will pay in any calendar year, usually around $250,000. As of this Thursday, insurers will be prohibited from limiting the amount they will pay over the lifetime of the policy. However, until 2014, plans will still be allowed to have an annual limit on coverage payments.
All health plans will be prohibited from dropping consumers from coverage just because they get sick.
Children under the age of 19 with pre-existing medical conditions will no longer be denied coverage by employer plans or new plans in the individual market because of their pre-existing condition.
New private plans will be required to cover preventative services and neither copayments nor deductibles will apply to the cost of these services.
All new plans will have to provide consumers with two levels of appeal when the plan denies payment for medical services. The first level would be a review by the plan itself. The second level would be an independent review process in which an outside group of medical experts review the claim to determine whether the plan followed its own rules in denying the claim.
Employer health plans will be prohibited from establishing any eligibility rules for health care coverage that have the effect of discrimination in favor of higher wage employees.
Health plans will be required to allow young people to remain on their parents’ health plans up to their 26th birthday, provided that they do not have access to coverage on their own plan.
Consumers will have more freedom of choice in the selection of their physicians.
As more information is available and additional changes become effective, the Office of the Insurance Consumer Advocate will generate advisories regarding their effect on consumers. More information regarding the PPACA can be found on the website of the Insurance Consumer Advocate: http://www.myfloridacfo.com/ica/federalhealthcare.asp