Not every health insurance policy was immediately affected as the law was designed to take effect with the new effective date of the policy after September 23. Most policies begin a new plan each calendar year on January 1. This is when the majority of health insurance policies will be affected by the new provisions.
Changes Under Health Care Reform
Some of the changes that will begin to take place as new policies become effective include free preventative care, elimination of lifetime limits and children with preexisting diseases can no longer be denied coverage.
Some Exceptions for Grandfathered Plans
A few grandfathered plans that existed before the reform act was passed on March 23 and remain essentially unchanged won’t be required to include all of the provisions at this time. Check with your employer or insurance company to clarify which changes your plan will include and when.
Preventative Care
Free preventative care will be mandated in new health plans and plans that change significantly. This includes such care as flu shots and mammograms. In some instances diet counseling for at risk adults with chronic diseases will be included. Free means that patients will not be required to pay out-of-pocket for co-pays, co-insurance and deductibles for this care.
Out of Network Emergency Care
Another significant change is that if you are treated in an emergency room that is outside of your insurance plan’s network, you will not be charged additional fees. Or if the ER is in your network, but the ER physician is not a member of your plan’s network, you won’t be charged additional fees.
Primary Care Practitioners
Women can select an ob-gyn as their primary physician and children can have their pediatrician designated as their primary physician. This eliminates the need for referrals to these practitioners as required by some health insurance plans.
Limits and Caps Change
The elimination of lifetime limits or caps on policies issued or renewed after September 23rd will ensure that the very sick are not denied insurance coverage when they most need it. These caps have left millions of Americans with medical bills exceeding $1 million.
Annual limits will not be allowed to be below $750,000, and by 2014 will also be eliminated entirely. An exception to this offers employers and insurance companies an opportunity to offer “mini-med” policies with lower benefits to help employees afford insurance if premiums become too high to afford. Premiums are expected to see no more than 1-2% increase, but will vary from plan to plan.
Pre-existing Clauses End for Children
Pre-existing diseases can no longer be a reason to deny coverage for children, and adult children can be covered under their parent’s policy until age 26. Insurance companies fearing the pre-existing clause will lead to unpredictable costs, will be allowed to stop selling child-only policies in some states. For the majority of Americans this will be a non-issue as most children are covered under their parent’s policies.
Rescind for Fraud
Additionally, the law now prohibits insurance companies from canceling policies retroactively for people who become ill and run up high bills. Insurance companies will still be able to rescind policies in matters of fraudulent information or intentional misrepresentation.
Kathy Quan - Kathy Quan RN BSN has been a home health/hospice nurse for over 30 years. She has authored five books and writes for several online ...
