David M. Gilston Insurance Agency, Inc.

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).

The DOL, HHS, and IRS jointly issued another set of FAQs (Part IV) regarding implementation of the market reform provisions of the Affordable Care Act. For simplicity, only the questions are included below. You may view the government’s response here or access FAQs Part I, Part II and Part III.

There have been a few articles published regarding the fact that the baby boomers, those individuals ages 50 to 64, may have the most to gain from the new health care law. An article from CQ HealthBeat (12/15, Norman, subscription required) states that this particular age group is feeling the pinch of the economy and has the highest rates of unemployment. The article goes further to say that the creation of a new high risk pool with no pre-existing limitations, elimination of annual limits and lifetime maximums, and coverage for preventive services will benefit this age group significantly.

The Obama administration predicted that hundreds of thousands of people would enroll in the Pre-existing Conditions Insurance Plan (PCIP), but the actual enrollment only totaled 8,011 as reported November 5, 2010. As a result, the Department of Health and Human Services (HHS) announced the federally-administered PCIP program will expand the one option offered in 2010 to three options in 2011: the Standard Plan, the Extended Plan and the Health Savings Account eligible plan. In addition, families will be able to enroll their eligible children age 0-18 in PCIP at child-only rates.

Who has a question about reform? Who better to answer that question than the government? While I’m sure there are mixed responses to the second question, it’s certainly worth your while to browse through the FAQs below.

The HHS, DOL, and IRS recently issued these FAQs on the implementation of health care reform as Part II and Part III. (Part I was issued on September 20th, 2010.) For simplicity, only the questions are included below. To view the government’s response and learn what this could mean to if you have a similar situation, please visit their website.

Ways and Means health panel Chair Pete Stark (D-Calif.) said, “Plain and simple, insurance companies can’t be trusted.” This comment was Stark’s response to the announcement that most insurance companies will no longer sell new individual policies for children under 19 as health reform now prohibits pre-existing conditions exclusions.

While I understand that this is a sensitive and important topic, I am still amazed at how much negative press insurance companies are receiving for 3 reasons.