By Julia Day, MSW
Contributions from Bryon MacDonald
Disability Benefits 101 Information Services
California Work Incentives Initiative, World Institute on Disability
September 23, 2010
September 23, 2010 is the six-month anniversary of the new health care reform law, The Affordable Care Act (ACA) of 2010(1). The ACA will lead to significant changes in our nation’s health care system, including extending health care coverage to many more Americans.
The changes in the new law do not all happen right away, but will take effect over many years, through 2020. This is a summary of the major changes that start on September 23, 2010:
Rescission Outlawed
Insurance companies aren’t allowed to drop people’s coverage when they get sick (this is known as “rescission”).
New Coverage Options for Children
Insurance companies aren’t allowed to deny coverage to children under 19 because of pre-existing conditions.
Children can stay on (or be added to) their parents’ insurance policies until they turn 26, if they can’t get insurance through a job. This applies to insurance plans that provide dependent coverage. Open enrollment starts on September 23, 2010, and is required by law to continue for at least 30 days.
Ban on Lifetime Coverage Limits
For new individual insurance and all group plans, insurance companies aren’t allowed to put caps on the amount they will spend on lifetime coverage costs on “essential benefits”. Essential benefits include hospital stays, doctor visits, and prescription drugs.
Annual limits are restricted in all group plans and new individual plans, until 2014, when annual limits are banned completely.
More Preventive Services Covered by Private Health Coverage
All new group and individual plans will have to cover certain recommended preventive services, like cancer and diabetes screenings. Insurance companies will be required to offer these services free to the patient - without deductible, coinsurance, or copayment charges.
Consumers Can Appeal Insurance Company Decision
For new plans there will be a way for consumers to appeal the decisions that their insurance company makes, including claims that are denied.
People will have the right to appeal decisions through the insurance company’s own internal review process, which has to meet certain standards of fairness.
If a person goes through the insurance company’s appeals process and is still denied, for the first time, the law says they will be able to appeal decisions to an independent outside decision-maker.
Sources:
Patient Protection and Affordable Care Act (Public Law 111-148)
Kaiser Family Foundation
The New York Times
Speaker of the House
HealthReform.Gov
HealthCare.Gov
Centers for Medicare & Medicaid Services
Departments of Health and Human Services
McClatchy Newspapers
The National Council on Independent Living
California HealthCare Foundation
California Health Advocates
Congressional Budget Office
House Committees on Ways and Means, Energy and Commerce, and Education and Labor
Additional Information:
For additional information and updates on health care reform:www.HealthCare.Gov.
(1) In March of 2010, U.S. Congress finished passing the Patient Protection and Affordable Care Act (H.R. 3590) and the Health Care and Education Reconciliation Act of 2010 (H.R. 4872). Soon after, President Obama signed these pieces of legislation into law, creating Public Law 111-148 (the Patient Protection and Affordable Care Act) and Public Law 111-152 (the Health Care and Education Reconciliation Act of 2010). Together, these are commonly known as the Affordable Care Act (ACA) of 2010.
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