September 30, 2016

Business Brief

Healthcare Reform Is Officially Here

Just in case the date slipped your mind, the first wave of healthcare reform regulations became effective September 23, 2010. Here’s a quick refresher course on the new rules.

First, a caveat: If your company offers a calendar year plan, the changes have taken effect January 1.

A brief rundown of the new rules:

  • Plans can’t deny coverage due to a pre-existing condition to children under age 19. A similar provision for adults will become effective in 2014.
  • Insurers can’t rescind an employee’s coverage for virtually any reason, except when the worker has engaged in fraud.
  • Lifetime dollar limits on coverage are now prohibited.
  • OB/GYNs and pediatricians get primary care physician status. That eliminates the need for patients to get prior authorization from the insurance carrier.
  • No more prior authorizations for emergency room services.
  • Dependents must be covered until age 26. And those dependents no longer have to be students, or disabled; they can even be married.
  • Employers are on the hook for preventive care. Companies can’t impose co-pays or deductibles on such things as mammograms, colonoscopies and other measures designed to catch serious conditions early.
  • Insurers are required to set up a more patient-friendly claims appeals process. And while a claim is being appealed, the insurer can’t hold up payments on subsequent claims.

For the official word on the new requirements, check out www.healthcare.gov.

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