Photo: Lower Columbia College
Today marks the beginning of the earliest provisions of the new health care reform signed into law by President Obama on March 23. If you’re a little hazy about all of the provisions created by that law, check out 26 quick facts about the changes the health care industry. For now, here’s a look at the new consumer protections that begin today.
No pre-existing condition exclusions for children below the age of 19 - Before today, children who developed or were born with a costly condition could be denied coverage by insurers. In addition to being less likely to receive crucial care for their condition, children in this category are much less likely to receive crucial vaccines and other preventative care.
The new law prohibits companies from denying coverage or services. For example, a company can no longer deny chemotherapy coverage because a child developed cancer before they were covered.
Insurers can no longer rescind coverage arbitrarily – Before today, insurers would routinely revoke coverage retroactively due to illness or unintentional paperwork errors on the part of employers. New regulations prohibit insurers from revoking coverage except in cases of fraud or intentional misrepresentation.
Insurers who want to cancel coverage must give 30 days notice to make time to appeal. There are no exceptions to this policy.
There are no longer any lifetime limits on coverage – Particularly for those who suffer from costly conditions from an early age, lifetime limits have the potential to rescind coverage exactly when a patient is most in need of care. No more, as of today.
Today begins the phase out of annual limits on the amount of care paid for by insurers – As of right now, no plan issued or renewed can set an annual limit below $750,000. This limit will rise to $1.25 million on year from today, and to $2 million two years from now. On January 1, 2014, all annual coverage limits will be prohibited.
Insurers are now required to accept any licensed, available primary care provider – Parents, for example, can choose any pediatrician to be their children’s primary care provider. Also, insurers are barred from requiring referrals for OBGYN care.
No longer can insurers limit you to a restrictive network of facilities, including those used for emergency care – Insurers are now barred from restricting access to emergency care or requiring approval for emergency care access, with the exception of a few plans that are grandfathered in.
These changers are likely to effect the cost of health for most Americans in the following four ways:
- Many experts expect a reduction in the “hidden tax” on insured Americans. The reasoning is that in the current system, the uninsured frequently receive emergency care that runs up costs that are never collected. This results in a markup for insured Americans, which should soon see itself reduced.
- By insuring high-risk risk individuals have insurance, fewer children should require expensive, avoidable hospital stays.
- Unexpected high medical costs contributed, in one way or another, to about half of the over half a million personal bankruptcies in the US in 2007. Many of these costs will now be borne by insurers, now that lifetime bans, annual bans, and pre-existing conditions are regulated.
- No longer will families be subject to “job lock” due to worries about losing health care. Now that pre-existing conditions are regulated, a parent needn’t worry about losing their children’s health care coverage when considering a better paying job. Also, with healthier children, parents will be less likely to use sick time to care for their children. That means a more active and vibrant economy.
There you have it, the care and financial benefits coming your way today – a host of regulations that result in fewer limitations on care. Now, you need no longer worry about health care running out or being rescinded when it could most hurt your livelihood.
Published or updated April 5, 2013.