For Immediate Release: September 22, 2010
Additional Healthcare Reform Provisions Go Into Effect Sept. 23
RALEIGH -- On Sept. 23, the next round of provisions of the federal health care reform bill, also called the Affordable Care Act, will go into effect. Many of these provisions provide new or expanded benefits that serve as consumer protections for health insurance coverage.
"The good news for consumers is that they will begin seeing increased health insurance benefits that weren't offered before," said Commissioner Wayne Goodwin. "Further, consumers will begin seeing an increased level of transparency, including plain-language explanations and definitions from insurance companies. I hope this increased transparency will help consumers have a better understanding of their health insurance coverage."
For new health insurance plans with plan years beginning on or after Sept. 23, the Affordable Care Act makes the following changes:
- Annual and Lifetime Limits - At the new plan year, plans may not contain lifetime limits on essential benefits. This provision applies to all plans. Annual limits will be phased out through 2014 for all plans, except grandfathered individual plans. Check with your insurance company to see if this applies to your policy before you renew.
- Rescissions - Rescission is when an insurance company retroactively cancels your policy. The Affordable Care Act bans rescissions except in cases of fraud or intentional misrepresentation of material fact. You must be notified prior to the cancellation, and you will be able to have the decision reviewed under your policies internal appeal/grievance procedures. This provision applies to all types of health insurance plans.
- Preventive Health Services - A wide range of preventive care including immunizations, well baby and child screenings, and well women exams must be covered without cost-sharing under all non-grandfathered plans. For an exact list of what preventive services are available without cost-sharing, contact your insurance company.
- Adult Dependent Coverage - Plans that cover dependent children must extend coverage until the child's 26th birthday. This applies to both individual and group health plans, however before 2014, group health plans will be required to cover adult children only if the adult child is not eligible for employer-sponsored coverage. Adult children cannot be charged more than any other dependent.
- Preexisting Condition Exclusions - Beginning Sept. 23, 2010, children under 19 years of age cannot be denied coverage or benefits based on medical status or past illnesses. This applies to all plans except grandfathered individual plans.
The Affordable Care Act also eliminates pre-existing condition exclusions for everyone starting in 2014. Until 2014, each state will have a federal high risk pool that provides insurance coverage for people with pre-existing conditions. In North Carolina, Inclusive Health administers the federal high risk pool alongside the existing state high risk pool. For more information, consumers should contact Inclusive Health at 866-665-2117 or www.inclusivehealth.org.
There are also increased provisions included in the Affordable Care Act that help consumers when they must appeal a claim denial; North Carolina already has a program that helps consumers appeal their health insurance denials. The Department's Healthcare Review Program provides consumer counseling for working through insurance company internal appeals as well as coordinates external appeals by independent experts. Consumers who receive a health insurance claim denial should call the Healthcare Review Program at 877-885-0231.
The Affordable Care Act does not require people to change their existing coverage and/or find new coverage if they are satisfied with their current health insurance policy. If a health insurance plan existed as of March 23, 2010 - the date the Affordable Care Act was enacted - the plan is known as a "grandfathered plan." Grandfathered plans are exempt from most changes required by the Affordable Care Act. However, if the plan significantly reduces benefits or increases deductibles, copayments, and/or an employee's share of premium contributions, it will lose its grandfathered status and its exemptions.
For more information about the Affordable Care Act, visit www.ncdoi.com/healthcarereform or www.healthcare.gov.