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Below are a list of key points that have gone into effect. The new coverages will increase the premium for everyone but may benefit % of policy holders.
YOUR HEALTH COVERAGE CANNOT BE ARBITRARILY CANCELLED IF YOU BECOME SICK
Under the new law, health plans are now prohibited from rescinding coverage except in cases involving fraud or an intentional misrepresentation of facts.
YOUR CHILD CANNOT BE DENIED COVERAGE DUE TO A PRE-EXISTING CONDITION
The new law prohibits insurance plans both from denying coverage and limiting benefits for children based on a pre-existing condition. This protection applies to all health plans, except “grandfathered” plans in the individual market. These protections will be extended to Americans of all ages starting in 2014.
YOUR CHILD UP TO AGE 26 CAN STAY ON YOUR HEALTH PLAN
Under the new law, insurance companies are required to allow young people up to their 26th birthday to remain on their parents’ insurance plan, at the parent’s choice. This provision applies to all health plans.
YOUR HEALTH PLAN CANNOT PUT A LIFETIME LIMIT ON YOUR HEALTH COVERAGE
Millions of Americans who suffer from costly medical conditions are in danger of having their health insurance coverage vanish when the costs of their treatment hit lifetime limits. These limits can cause the loss of coverage at the very moment when patients need it most.
YOUR HEALTH PLAN’S ANNUAL LIMITS ARE PHASED OUT OVER THREE YEARS
The new law phases out the use of annual limits over the next three years. For plan years beginning on September 23, 2010, the minimum level for the annual limit will be set at $750,000. This minimum is raised to $1.25 million in a year and $2 million in two years. In 2014, all annual limits are prohibited. The protection applies to all plans, except “grandfathered” plans in the individual market.
If you are purchasing a new plan, you will have the following additional protections:
YOU HAVE THE RIGHT TO KEY PREVENTIVE SERVICES WITHOUT DEDUCTIBLE OR CO-PAYMENTS
Under the new law, insurance companies must cover recommended preventive services, including mammograms, colonoscopies, immunizations, and pre-natal and new baby care, without charging deductibles, co-payments or co-insurance.
YOU HAVE THE RIGHT TO BOTH AN INTERNAL AND EXTERNAL APPEAL
The new law guarantees the right to an “internal appeal.” Also, insurance companies will be prohibited from denying coverage for needed care without a chance to appeal to an independent third party.
YOU HAVE THE RIGHT TO CHOOSE YOUR OWN DOCTOR
The new law: 1) guarantees you get to choose your primary care doctor; 2) allows you to choose a pediatrician as your child’s primary care doctor; and 3) gives women the right to see an OB-GYN without having to obtain a referral first.
YOU HAVE THE RIGHT TO ACCESS TO OUT-OF-NETWORK EMERGENCY ROOM CARE AT IN-NETWORK COST-SHARING RATES
