Each month AssuredPartners NL will discuss a different aspect of the Affordable Care Act. Stay tuned for more updates on the second Thursday of each month. Click here for more Affordable Care Act blogs.
A major focus of the Affordable Care Act is putting American consumers in the driver’s seat when it comes to their health care. To do this, an Affordable Care Act Patients’ Bill of Rights was created. The Patients’ Bill of Rights aims to help children, and ultimately all Americans, with pre-existing conditions get health insurance coverage and keep it, protect their choice of doctors and end lifetime limits on the care received.
Americans with health care coverage starting on or after Sept. 23, 2010 are protected by certain regulations. However, if your company sponsored a health insurance plan before March 23, 2010, you may have what’s considered a “grandfathered” plan. Grandfathered plans are exempt from certain Patients’ Bill of Rights requirements. Learn more about how to determine if you have a grandfathered plan here.
The Affordable Care Act Patients’ Bill of Rights includes:
- No Pre-Existing Condition Exclusions for Children under Age 19
Insurance plans cannot deny coverage to children based on pre-existing conditions. This includes both benefit limitations and coverage denials. These protections apply to all types of insurance except for individual policies that are grandfathered and will be extended to all Americans beginning in 2014.*
- No Arbitrary Rescissions of Insurance Coverage
Under new regulations, insurers and plans are prohibited from withdrawing coverage for individuals or groups of people (except cases involving fraud or intentional misrepresentation). Now, insurers looking to rescind coverage must provide 30 days advance notice to provide time for people to appeal.*
- No Lifetime Dollar Limits on Coverage
This regulation bans the use of lifetime dollar limits in all health plans and insurance policies issued or renewed on or after Sept. 23, 2010.*
- Only Restricted Annual Dollar Limits on Coverage
Annual dollar limits on what an insurance company pays for health care will phase out in the next year until 2014, when the ACA bans annual dollar limits. Protections against annual dollar limits apply to most health plans, excluding individual market plans that are grandfathered.*
- Protecting Your Choice of Doctors
Parents can choose any available participating pediatrician to be their child’s primary care provider. Additionally, health plans cannot require female participants to get a referral from a primary care provider before she can get obstetrical or gynecological care from a specialist. These policies apply to all individual market and group health insurance plans except for grandfathered plans.*
- Removing Insurance Company Barriers to Emergency Department Services
The Affordable Care Act makes emergency services more accessible to consumers and limits the cost-sharing for emergency services received out-of-network. This policy applies to all individual market and group health plans, excluding those that are grandfathered.*
What do you think about the new Patients’ Bill of Rights? The Affordable Care Act reforms can be confusing – our team of dedicated employee benefits specialist can help your organization navigate the coming changes. Our team can review your current coverage and explore new options with you. For questions about the Affordable Care Act, contact a AssuredPartners NL representative. Check back on the second Thursday of each month as we discuss the Affordable Care Act and what it means to you.
This post is not intended to be exhaustive, nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.
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