By Sunee Mickle,
Director of Government Relations,
Blue Cross and Blue Shield of Kansas
Federal Health Care Reform Edition
On March 23 President Obama signed H.R. 3590, Patient Protection and Affordable Care Act, into law. This historic legislation encompasses the U.S. Senate proposal for health care reform which was passed by the U.S. House of Representatives, 219-212.
The Patient Protection and Affordable Care Act encompasses many changes to private health insurance, Medicaid and Medicare. In the next few days, we expect the Senate to pass H.R. 4872, Health Care and Education Reconciliation Act, which will modify certain provisions in the Patient Protection and Affordable Care Act. We are working diligently to understand every detail in the 2,000-plus pages of legislation to assist our members. Below is a preview of the legislative reforms that will impact your private health insurance coverage with Blue Cross and Blue Shield of Kansas in coming months.
Health Plan Benefit Changes*
We know that many Kansans are wondering how these new reform laws will affect them. Most of the changes to health insurance and health care delivery will not take place until 2014 and beyond.
Some of the changes will occur this year, however. Contracts with anniversaries beginning on and after Oct. 1, 2010, will include the following changes:
- There will no longer be a lifetime maximum benefit limit.
- There will no longer be an annual limit on "essential health benefits" as defined by the U.S. Department of Health and Human Services.
- Dependents will be eligible for coverage to age 26.
- There will be no pre-existing condition exclusions for children under 19.
- Insurers will only be allowed rescind a member’s coverage in cases of fraud or intentional misrepresentation of a material fact, and only with prior notice to the policyholder.
- Certain preventive services will be covered without any cost-sharing.
- Internal and external appeals processes will be expanded.
Changes After 2010
Beginning in 2014, individual health insurance policies will be available guaranteed issue. This coordinates with the implementation of state-run insurance exchanges (websites) and premium subsidies. Group health insurance policies are currently guaranteed issue.
There are many other provisions that will take effect after 2010, and more details about how those legislative items will affect your coverage will be made available as it becomes available.
*Taken from the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act.