Additional Health Care Reform Provisions Kick In Today

Dean Mudgett, 802-828-4872
Thu, 09/23/2010

Changes take effect on policies renewing after Sept. 23, 2010

On Sept. 23, the next round of provisions in the Patient Protection and Affordable Care Act (PPACA) will begin to go into effect. Many of these provisions provide new or expanded options and consumer protections for health insurance coverage.

The Provisions
The changes beginning Sept. 23 include expanded coverage and new consumer protections. If they are not spelled out in the documentation you receive from your insurance provider or employer, talk with your employer’s plan administrator or your health insurance company about how these protections will apply to your coverage and what new options you may have.

Effective Date
If you have health insurance coverage through an employer, these new benefits and protections will be added to your policy at the next policy renewal after Sept. 23. If you purchased an individual health insurance policy on your own, the effective date is a bit more complicated. If your insurer has specified a "policy year" for your coverage, the new provisions will become effective on that date. Otherwise, the new benefits and protections will be added on the date when annual deductibles and annual limits reset each year. If your policy does not have an annual deductible or annual limit, these changes will become effective on Jan. 1, 2011. If you have questions about when these provisions will become effective for your policy, contact your insurance company.

Grandfathered Plans
You may be hearing a lot about what are referred to as “grandfathered plans.” These are health plans in which either a group or an individual was enrolled in prior to March 23, 2010, when President Obama signed the PPACA into law. Grandfathered plans are exempt from most changes required by the PPACA. However, if the plan significantly reduces benefits or increases deductibles, copayments, and/or an employee‘s share of premium contributions, it will lose its grandfathered status and its exemptions. This could make a difference in what provision you see at renewal time.

Coverage Changes
The Vermont Department of Banking, Insurance, Securities & Health Care Administration wants Vermonters whose health insurances policies are up for renewal after September 23 to be aware of three significant changes:

Preventive Health Services - A wide range of preventive care including immunizations, well baby and child screenings, and well women exams must be covered without cost-sharing under all non-grandfathered plans. For an exact list of what preventive services are available without cost-sharing, contact your insurance company.

Adult Dependent Coverage – Plans that cover dependent children must extend coverage until the child’s 26th birthday. This applies to all types of plans, however before 2014, group health plans will be required to cover adult children only if the adult child is not eligible for employer-sponsored coverage. Adult children cannot be charged more than any other dependent.

Preexisting Condition Exclusions – Beginning Sept. 23, 2010, children under 19 years of age cannot be denied coverage or benefits based on medical status or past illnesses. This applies to all plans except grandfathered individual plans

For More Information
If you are confused about health insurance and what is available to you and your family, the National Association of Insurance Commissioner’s Insure U consumer education program is a great resource for tips and information about health insurance options. Visit Insure U’s website at www.insureuonline.org.

You can also get more information about the new health reform changes from BISHCA’s Division of Health Care Administration by visiting our website at www.dfr.vermont.gov or by calling a Consumer Services Specialist toll-free at 1-800-631-7788.