Key health reforms start Thursday; consumers to see new benefits when plans renew

Beginning Sept. 23, most health plans must include several new consumer protections outlined in the Federal Affordable Care Act. Consumers will see the new benefits when their plan renews.

Beginning Sept. 23, most health plans must include several new consumer protections outlined in the Federal Affordable Care Act. Consumers will see the new benefits when their plan renews.

“Six months after health reform was signed into law, many new programs are well underway,” said Insurance Commissioner Mike Kreidler. “The key reforms kicking-in this week are designed to break down barriers to health coverage. Our office has worked closely with the health plans over the last several months to ensure their plans meet the requirements of the new federal law.”

Beginning Thursday (Sept. 23), any health plan sold after March 23, 2010 cannot:

• Charge out-of-pocket costs, including co-pays, deductibles and co-insurance, for preventive services.

• Cap lifetime benefits.

• Cancel or rescind a policy, except in the case of fraud or misrepresentation.

• Refuse to cover a child’s pre-existing condition.

• If the health plan includes a cap on essential benefits, it can’t be less than $750,000.

• And young adults can be covered on their parents’ plan until the age of 26, unless they get a job that offers health insurance.

However, there are some exceptions. Health plans sold before March 23, 2010, when the law was signed, are considered “grandfathered” and are exempt from some of these new protections.

For example, grandfathered individual health plans still can charge out-of-pocket costs for preventive services, cap lifetime benefits, and refuse to cover an enrolled child’s pre-existing condition. Grandfathered group plans (plans purchased by employers for their employees) still can charge out-of-pocket costs for preventive services.

Plans lose their grandfathered status if they significantly reduce benefits or increase deductibles, copayments, and/or an employee’s share of the premium.

Other federal reforms already underway include:

• A new, temporary health insurance program for people with pre-existing conditions who’ve been uninsured for at least six months.

• $250 checks for seniors with Medicare’s prescription drug benefit who hit the coverage gap or “donut hole.”

• Employers can apply for federal funds to help cover their retirees’ health care costs.

• Small businesses that pay for their employees’ health insurance may qualify for a new tax credit on their 2010 returns.