Health Care Reform Bill Facts

Health Care Reform Bill Facts

Part V

Health insurance plan changes that impact individuals and employers (both fully insured and self-funded plans unless otherwise noted) over the next few years:

High-Level Overview Health Reform Law: Key Provisions for Large Employers Group health plan changes

Under the new law, employers/employees have the right to keep the coverage they had as of March 23, 2010 and are exempt from many reforms. These group health plans are considered “grandfathered plans.” Collectively bargained plans that were ratifi ed before the date of

enactment are grandfathered until the date that the last collective bargaining agreement related to coverage ends.

Changes that impact large employers (both fully insured and self-funded health insurance plans unless otherwise noted) over the next few years:

IMMEDIATELY:

• Federal rate review. The Department of Health and Human Services (HHS) will establish a process for federal review of fully insured health insurance premium rate increases.

IN 90 DAYS:

• Reinsurance for early retirees. A temporary reinsurance program will be established for employers providing health insurance coverage to early retirees over age 55 who are not eligible for Medicare. The federal government will provide $5 billion to fund the program. Participating employers or insurers will be reimbursed 80 percent of retiree claims between $15,000 and $90,000.

The program will be effective through 2013.

IN SIX MONTHS:

For new health insurance plans or plans renewed six months after the law’s enactment date (includes “grandfathered plans”):

• Lifetime and annual limits. Health Insurance Plans may not impose lifetime limits on the dollar value of essential benefits. Annual limits will be restricted (to be determined by HHS).
• Rescissions. No rescissions are permitted, except in cases of fraud or intentional misrepresentation.
• Coverage for adult children. Children may stay on their parents’ health insurance policies until age 26 if coverage isn’t available through their work, regardless of their marital status. Any employer contribution toward the premium is a tax deductible business expense for the employer and not taxable income for the member.
• Pre-existing conditions. Health Insurance Plans may no longer impose pre-existing conditions exclusions for children under 19.

For new health insurance plans or plans renewed six months after the law’s enactment date (does not include “grandfathered plans”):

• Preventive services. New health insurance policies must cover the full cost of preventive care as recommended by the U.S. Preventive Services Task Force, recommended immunizations, preventive care for infants, children and adolescents, and additional preventive care for women.
• Appeals. New minimum requirements for internal and external health insurance claim appeals processes.
• Patient protections. Health Insurance Plans that require or provide for a primary care provider (PCP) designation must allow each member to designate any in-network PCP, or pediatrician for children, accepting new patients. Plans may no longer require an authorization or referral to an Ob-Gyn. Prior authorization or increased cost-sharing for emergency services is also prohibited.
• Nondiscrimination rules. Nondiscrimination rules that apply to self-funded health insurance plans are expanded to fully insured health insurance plans. Plans cannot base an employee’s eligibility or continued eligibility on hourly or annual salary.

Not to be used for implementation purposes

IMPORTANT: This document is designed to provide a general overview of the new health reform law. It does NOT attempt to cover all of the law’s provisions and should NOT be used as the legal advice for implementation activities. We encourage you to seek any professional advice, including legal counsel, regarding how the new requirements will affect your specific plan.

This summary provided by Humana One Health Insurance and Humana Small Business Health Insurance.

Health Care Reform Summary

Health Care Reform Summary

Part I.

Health insurance plan changes that impact individuals and employers (both fully insured and self-funded plans unless otherwise noted) over the next few years:

IMMEDIATELY:

• Federal rate review. The Department of Health and Human Services (HHS) will establish a process for federal review of fully insured premium rate increases.

IN 90 DAYS:

• Internet portal. By July 1, an Internet portal will be created for consumers and small businesses to shop for health Insurance.

• High-risk pool. $5 billion has been appropriated to create a temporary high-risk insurance pool to help adults with pre-existing conditions get coverage if they have been uninsured for six months. The program will be effective through 2013.

• Reinsurance for early retirees. A temporary reinsurance program will be established for employers providing coverage to early retirees over age 55 who are not eligible for Medicare. The federal government will provide $5 billion to fund the program. Participating employers or insurers will be reimbursed 80 percent of retiree claims between $15,000 and $90,000. The program will be effective through 2013.

IN SIX MONTHS:

Effective for new private health insurence plans or health insurance plans renewed six months after the enactment date unless otherwise noted (includes “grandfathered plans”):

• Lifetime and annual limits. Plans may not impose lifetime limits on the dollar value of essential benefits. Annual limits will be restricted (to be determined by HHS).
• Rescissions. No rescissions are permitted, except in cases of fraud or intentional misrepresentation.
• Health Insurance Coverage for adult children. Children may stay on their parents’ policies until age 26 if health insurance coverage isn’t available through their work, regardless of their marital status. Any employer contribution toward the insurance premium is a tax-deductible business expense for the employer and not taxable income for the employee.
• Pre-existing conditions. Health Insurance Plans may no longer impose pre-existing condition exclusions for children under 19.

Effective for new small business group health insurance plans or health insurance plans renewed six months after the enactment date (does not include “grandfathered plans”):

• Preventive services. New health insurance policies must cover the full cost of preventive care as recommended by the U.S. Preventive Services Task Force, recommended immunizations, preventive care for infants, children and adolescents, and additional preventive care for women
• Appeals. New minimum requirements for internal and external health insurance claims appeals processes.
• Patient protections. Plans that require or provide for a primary care provider (PCP) designation must allow each member to designate any in-network PCP, or pediatrician for children, accepting new patients. Plans may no longer require an authorization or referral to an Ob-Gyn. Prior authorization or increased cost-sharing for emergency services is also prohibited.
• Nondiscrimination rules. Nondiscrimination rules that apply to self-funded health insurance plans are expanded to group fully insured health insurance plans. Plans cannot base an employee’s eligibility or continued eligibility on hourly or annual salary.

This summary provided by Humana One Health Insurance and Humana Small Business Health Insurance.