Recently, some interim final rule regulations were released on health care reform dealing with pre-existing conditions.*
- Implementation of pre-existing condition stipulations for children up to age 19 will begin with plan years (or “policy” years on individual insurance products) after September 23, 2010.
- A prohibition on pre-existing condition exclusions – including a prohibition of the denial of coverage related to a pre-existing condition starts January 2014. However, health insurance plans must begin this provision earlier for children below the age of 19. This regulation applies to plan years or policy years beginning on or after September 23, 2010.
Other Interim Rulings
- Rescissions – must be made based on “…an act, practice or omission that constitutes fraud, or unless the individual makes an intentional misrepresentation of material fact.”
- Lifetime Annual Limits – “essential health benefits” (still being defined) should no longer include annual or lifetime dollar limits at the plan (aggregate) level. This does not apply to vision and dental coverage.
- Patient Protections – Health plans must allow members in “primary care physician plans” to choose any available in-network PCP, this includes participating pediatricians. Insurers must permit individuals to access care from in-network OB/GYN specialists without a requirement for pre-authorization or a referral. Insurers must cover out-of-network ER services. Co-pays and coinsurance levels must not be in excess of in-network ER services. Plan participants may still be “balance billed” by non-network providers.
Here is a link to the Federal Register documentation on these updates:
http://www.dol.gov/federalregister/PdfDisplay.aspx?DocId=23983
Learn more about the cost of compliance. There is a hidden cost in your health plan premiums associated with government compliance and it is in the billions of dollars. Learn more from Christopher Conover’s article, “Health Care Regulation: A $169 Billion Hidden Tax.”
*The information presented here is for informational purposes only. It is not intended as legal advice. This information should not be relied upon for compliance or used in the place of competent legal, tax, accounting or other professional advice. Thanks!