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.