The Patient Protection and Affordable Care Act (PPACA) was signed into law on March 23, 2010, and will have significant impacts on individuals and business. This is the largest piece of legislation that has passed since Congress enacted Medicare/Medicaid in 1965. Although the law is complex and different parts of it take effect at various times over the next several years, certain important provisions go into effect September 23, 2010, and the law will provide access to health insurance to a great number of presently uninsured Americans.
Some of the changes we will see:
★ Insurers will not be allowed to rescind health insurance coverage except where the insurer can show fraud or misrepresentation of a material fact by the insured (for example, the insured lied on an application about her/his health). It is still unclear what legal standard will apply to fraud determinations.
★ Group health plans and health insurers offering either group or individual coverage must eliminate lifetime limits and annual limits on the dollar value of benefits for participants and beneficiaries, starting September 23, 2010. (For plan years prior to 2014, group plans or health insurers may establish restricted limits, without significant impact on premiums).
★ PPACA will require insurers to pay for certain preventive care measures, such as vaccinations, annual check-ups, and breast cancer screenings, without charging co-pays.
★ PPACA sets minimum standards for appeals processes for denied claims, with which all health insurers must comply. The law lays out these standards, which include both internal and external review processes, notice to enrollees in a ‘culturally and linguistically appropriate manner’, and an opportunity to the enrollee to present evidence and testimony in support of her/his appeal. The external review process must include consumer protection standards laid out in the National Association of Insurance Commissioners’ Uniform External Review Model Act.
★ The insurer should provide notice to non-English speakers in their primary language.
★ Effective September 23, 2010, insurers cannot exclude children under age 19 with pre-existing conditions, from their family’s policy. Insurers must rescind pre-ex condition exclusions which may exist in current policies.
★ By 2014, insurers will no longer be able to deny coverage on the basis of pre-existing conditions. In the meantime, a high-risk insurance pool is available for people with pre-existing conditions to sign up within 90 days of PPACA’s enactment.
It’s important to keep informed about this new federal legislation and how it will be implemented and potentially impact you. We will periodically report here on new developments, and you can always check out the Wikipedia article on the subject.