We are frequently asked “how does the recently passed federal legislation (the Patient Protection and Affordable Care Act (PPACA)) affect my health care insurance in 2010?”
The following lists changes that may affect your healthcare coverage this year:
1) The elimination of lifetime dollar limits on essential medical benefits is now prohibited. Most carriers will enact this change on policies that renew on or after September 23, 2010.
2) Rescissions and cancellations of coverage are prohibited, except for fraud or material misrepresentation of material fact.
3) Plans that offer coverage to children on their parents’ plan are required to make that coverage available until the adult child reaches the age of 26, even if the young adult no longer lives with his or her parents, is not a dependent on a parent’s tax return, or is no longer a student.
4) A new appeals process requires plans to have an internal process that allows enrollees to review their files; to present evidence and testimony as part of the appeals process; and to receive continued coverage pending the outcome of the appeals process.
5) Plans that cover emergency services are required to provide such coverage without the need for prior authorization, regardless of the participating status of the provider, at the in-network cost sharing level.
6) Prohibition on pre-existing condition exclusion for children who are under the age of 19.
To know exactly how the PPACA affects you and your family, please contact your insurance agent for further clarification.