Posted on Sep 28, 2010 by Sergio Ulloa
After the passage of the Affordable Care Act six months ago in the United States, the first raft of new healthcare rules have come into effect, as of Thursday, September 23rd
While much of the healthcare law has yet to impact the US Healthcare landscape, what has gone into effect on Thursday 23rd
are important consumer protection laws known as the Patient's Bill of Rights. These provisions tend to either prevent US domestic insurance companies from engaging in certain practices, or grant additional rights to patients and insured persons.
One of the more important provisions that have come into effect is the fact that children may stay on their parent's health insurance plan until the age of 26. Young people in America are a demographic that has high numbers of uninsured individuals, with up to one third of young Americans having no health insurance. The new provision applies to all health insurance plans, allowing parents the choice of whether to keep the children on their health plan until their 26th
birthday. However, for employer-based insurance plans, children will only be extended this benefit if they are ineligible for their own employer-based coverage.
In another child related provision, American insurance companies are no longer allowed to either deny coverage to children with pre-existing medical conditions or limit the benefits offered to them, except in the cases of insurance plans that are 'grandfathered' in. Currently this provision covers children up to the age of 19, although in 2014, this provision extends to cover Americans of all ages.
Insurers in the United States are also no longer allowed to place lifetime limits on health insurance plans. Some policies in the domestic US insurance market come with coverage limits, whereby once treatment costs reach a certain ceiling, coverage by the insurer is ceased leaving the insured unprotected when they need it most. There were approximately 100 million Americans with insurance plans that had lifetime coverage limits in place, however these limits are now prohibited on all health insurance policies.
Another type of coverage limit placed on plans are annual limits, whereby once an insurer pays out for enough claims to hit the ceiling, the insurer will no longer pay out during that year. While less prevalent than lifetime limits, annual limits are still used by about 14% of small employer plans and 19% of individual plans on the US market. Under the new provisions in force, annual limits will be phased out over the next three years, except for individual plans that are 'grandfathered' in. For insurance plan years starting on or after September 23rd
, 2010, the annual limit must maintain a bare minimum of US$ 750,000 (EUR 559,800). During the second year, the minimum annual limit is raised to US$ 1.25 million (EUR 932,800), and in the third year annual limit minimum must be at least US$ 2 million (EUR 1.49 million) before all annual limits are banned in 2014.
Also made illegal is the practice where insurers may retroactively cancel your insurance coverage, also known as rescission, for a variety of potential reasons. For all health insurance plans, insurance companies are no longer able to lawfully rescind your insurance coverage, unless it is in the case of fraud or intentional misrepresentation of facts.
Furthermore, anyone buying a new insurance policy is now protected by a number of consumer-friendly provisions in the law. One of these provisions that Americans should be taking advantage of to stay healthy is that insurers must now cover Level A and Level B preventative care, without deductibles, co-insurance or co-payments. This includes immunizations, mammograms, colonoscopies, pre-natal checks and new baby care, to try and encourage Americans to be proactive about keeping themselves healthy, or at least catching serious illnesses early.
The new laws also guarantee the insured the right to both an internal and external appeal over denied claims. Previously, if an insurer declined to either cover a treatment or pay out a claim, in many cases there would be an internal mechanism within the insurance company to appeal the denial of treatment or claim payment, dubious as that might seem. The provisions now guarantee that all new insurance plans must have an internal appeal mechanism, and are now prevented from denying coverage without an opportunity for an external appeal to an independent third party.
People purchasing health insurance plans will now be able to pick their own doctor, which has previously been difficult on occasion due to American health insurance provider networks. One survey reported that three of every four obstetrics and gynecology specialists (OB/GYN) said that patients had to return to their primary physician to be referred back for follow up care. The laws now in force ensure that policyholders have the right to choose their primary physician, the right to choose a pediatrician for their child's primary care, as well as granting women the right to see an OB/GYN specialist without a referral.
Another provision which affects in-network versus out-of-network issues is that health insurance plans will not be able to make the insured pay more in cost-sharing methods for getting emergency treatment at an out of network hospital. Prior to this law coming into effect, an individual would have to pay excessively higher costs for emergency care that happened outside of their insurance company's healthcare provider network, making an accident while away from home potentially financially devastating. Insured individuals now have the ability to receive emergency care at out-of-network healthcare providers, while being charged in-network prices.
All of these provisions are now in effect, as of Thursday, 23rd
September, 2010, meaning that Americans now have much greater protections and clarifications of their rights in regards to their health insurance policies. However, this is only a small part of the Affordable Care Act which is coming into force and there will be some new developments in early 2011, and more changes to the healthcare landscape within the next four years, so it is always advisable to ensure you remain informed.