The Department of Health and Human Services (HHS) has released three new proposed regulations regarding the Patient Protection and Affordable Care Act’s (PPACA) essential health benefit requirements, the new rating rules for individual and small group market policies and new requirements for employer-based wellness programs.
In accordance with the Patient Protection and Affordable Care Act (PPACA), group health plans and health insurance issuers will begin issuing Summary of Benefits and Coverage (SBCs), starting September 23, 2012. According to Human and Health Services (HHS), this document explains “simple and consistent information about health plan benefits and coverage. People will receive the summary and glossary when shopping for coverage, enrolling in coverage, at each new plan year and within seven business days of requesting a copy from their health insurance issuer or group health plan.”
Starting August 1, 2012, women are getting greater control over their health care and adding eight new prevention-related health care services without paying more out of their pocket. Many insurance companies did not cover these preventative services for women at all under their health plans, as some women had to pay deductibles or copays for the care they needed to stay healthy. The new rules in the health care law requiring coverage of these services take effect at the next renewal date –on or after Aug. 1, 2012- for most health insurance plans.
On June 28, 2012, the US Supreme Court ruled that the Affordable Care Act’s (ACA) individual mandate is a constitutional exercise of Congress’s power to impose taxes. Due to the Court’s decision, compliance efforts likely will continue with major provisions of the ACA becoming effective in 2013 and 2014. According to Chief Justice Roberts, “The Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax. Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.”
An estimated 10.7 million American women use oral contraceptives, the leading method of contraceptive in the United States. The Patient Protection and Affordable Care Act now requires coverage of FDA-approved contraceptive methods for women at 100 percent, without charging a copayment, coinsurance or deductible, when filled at a network pharmacy. HHS commissioned an Institute of Medicine study to review what preventive services are necessary for women’s health and well being and should be considered in the development of comprehensive guidelines for preventive services for women.
HHS issued two rules on August 1st addressing the preventive care requirements in the Patient Protection and Affordable Care Act (PPACA). The first is a proposed rule, which would require new health insurance plans to cover women’s preventive services without charging a co-payment, co-insurance or deductibles for plan years starting on or after August 1, 2012. The requirement will not apply to grandfathered plans that were in effect before the law was enacted on March 23, 2010.
The first “unintended consequence” of the Patient Protection and Affordable Care Act (PPACA) addressed in Part 1 of the blog described how routine physical exams were not specifically listed as a preventive service under health reform so insurance companies do not have to cover this service. The second “unintended consequence” of health reform addressed in Part 2 of the blog revealed how most insurance companies are not offering individual insurance policies to children under 19 since they are prohibited from applying pre-existing conditions exclusions. The third and final “unintended consequence” of health reform that I will discuss relates to dependent children under the age of 26 staying on their parents’ plans.
The first “unintended consequence” of the Patient Protection and Affordable Care Act (PPACA) addressed in Part 1 of our blog described how routine physical exams were not specifically listed as a preventive service under health reform so insurance companies do not have to cover this service. Today, we will discuss the second “unintended consequence” of health reform, which addresses how new individual insurance policies are prohibited from applying pre-existing conditions exclusions for children under 19.
Wikipedia states that the law of unintended consequences is a warning that an intervention in a complex system always creates unanticipated and often undesirable outcomes. Unfortunately, health reform has “unintended consequences” written all over it. Three specific examples include: preventive care, no pre-existing conditions for children under 19, and dependent children under the age of 26 staying on parents’ plans. I’ll focus on the first topic today: preventive care.
On May 31, 2011, the U.S. Department of Health and Human Services (HHS) announced that premiums will be reduced and eligibility requirements will be eased when enrolling in the federally administrated Pre-Existing Condition Insurance Plan (PCIP).