Here’s some imprtant information for all of us on new health insurance key reform changes.
FOR THOSE PRIVATELY INSURED
NO DISCRIMINATON AGAINST CHILDREN WITH PRE‐EXISTING CONDITIONS—Prohibits all employer plans and
new plans in the individual market from denying coverage to children with pre‐existing conditions. Effective
for plan years beginning on or after September 23, 2010.
NO RESCISSIONS—Bans all health plans from dropping people from coverage when they get sick. Effective for
plan years beginning on or after September 23, 2010.
NO LIFETIME LIMITS ON COVERAGE—Prohibits all health plans from placing lifetime caps on coverage.
Effective for plan years beginning on or after September 23, 2010.
TIGHTLY REGULATES ANNUAL LIMITS ON COVERAGE—Tightly restricts the use of annual limits by all
employer plans and new plans in the individual market, to ensure access to needed care. Effective for plan
years beginning on or after September 23, 2010.
FREE PREVENTIVE CARE UNDER NEW PLANS—Requires new private plans to cover preventive services with
no co‐payments and with preventive services being exempt from deductibles. Effective for plan years
beginning on or after September 23, 2010.
NEW, INDEPENDENT APPEALS PROCESS FOR NEW PLANS—Ensures consumers in new plans have access to an
effective internal and external appeals process to appeal decisions. Effective for plan years beginning on or
after September 23, 2010.
MORE FOR YOUR PREMIUM DOLLAR—Requires all health plans to put more of your premiums into your care,
and less into profits, CEO pay, etc. This medical loss ratio requires plans in the individual market to spend 80
percent of premiums on medical services, and plans in the large group market to spend 85 percent. Insurers
that don’t meet these thresholds must provide rebates to policyholders. Effective on January 1, 2011.
NO DISCRIMINATION BASED ON SALARY—Prohibits new employer health plans from establishing any
eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage
employees. Effective for plan years beginning on or after September 23, 2010.
FOR THOSE UNINSURED
IMMEDIATE HELP FOR THE UNINSURED WITH PRE‐EXISTING CONDITIONS (INTERIM HIGH‐RISK POOL)—
Provides immediate access to insurance for Americans who are uninsured because of a pre‐existing condition ‐
through a temporary high‐risk pool – until the Exchanges are up and running in 2014. Effective on July 1, 2010.
EXTENDING COVERAGE FOR YOUNG PEOPLE UP TO 26TH BIRTHDAY THROUGH PARENTS’ INSURANCE –
Requires plans to allow young people up to their 26th birthday to remain on their parents’ insurance policy, at
the parents’ choice. Effective for plan years beginning on or after September 23, 2010.