Affordable Care Act Makes Improvements
July 19, 2015
Pre-Existing Condition Insurance Plan
July 19, 2015

Key Health Plan Mandates

Insurance companies have often left patients without coverage when they needed it the most, causing them to put off needed care, compromising their health and driving up the cost of care when they finally do get it. Too often, insurance companies put insurance company bureaucrats between you and your doctor. New tougher insurance standards are intended to put consumers back in charge of their health insurance coverage and to make many major abuses a thing of the past.    

    These key health plan mandates are about to go into effect:  

1. Health plans may not impose lifetime dollar limits on essential benefits. The Department of Health & Human Services has not yet released definitions of what it considers “essential benefits” to be, but Anthem Blue Cross has published a list of services they believe will be affected.

2. Health plans may not rescind coverage except in cases of fraud and abuse. Insurers seeking to rescind coverage must provide 30 days advanced notice to give policy holders a chance to appeal. There are no exceptions to this ruling.

3. Health plans must provide preventive care services without cost-sharing. The preventive care services will include higher cost services such as colonoscopies, mammograms, and MRIs.

 4. Health plans must provide the option for dependents to be covered by their parent’s plan up to age 26 whether enrolled in a college or not, and whether living at home or not, and whether married or not. Children and spouses of married dependents will not covered.

 5. Health plans may not deny coverage for children under the age of 19 because of pre-existing health conditions. This mandate will apply to all types of policies, except for individual policies that have been “grandfathered”.

 6. Health plans may not discriminate coverage eligibility or benefits in favor of highly compensated individuals.

 7. Health plans will be required to report quality data, pending federal guidelines.

 8. Health plans must implement internal claims appeals and an external review processes.

Insurance companies have often left patients without coverage when they needed it the most, causing them to put off needed care, compromising their health and driving up the cost of care when they finally do get it. Too often, insurance companies put insurance company bureaucrats between you and your doctor. New tougher insurance standards are intended to put consumers back in charge of their health insurance coverage and to make many major abuses a thing of the past.    

    These key health plan mandates are about to go into effect:  

1. Health plans may not impose lifetime dollar limits on essential benefits. The Department of Health & Human Services has not yet released definitions of what it considers “essential benefits” to be, but Anthem Blue Cross has published a list of services they believe will be affected.

2. Health plans may not rescind coverage except in cases of fraud and abuse. Insurers seeking to rescind coverage must provide 30 days advanced notice to give policy holders a chance to appeal. There are no exceptions to this ruling.

3. Health plans must provide preventive care services without cost-sharing. The preventive care services will include higher cost services such as colonoscopies, mammograms, and MRIs.

 4. Health plans must provide the option for dependents to be covered by their parent’s plan up to age 26 whether enrolled in a college or not, and whether living at home or not, and whether married or not. Children and spouses of married dependents will not covered.

 5. Health plans may not deny coverage for children under the age of 19 because of pre-existing health conditions. This mandate will apply to all types of policies, except for individual policies that have been “grandfathered”.

 6. Health plans may not discriminate coverage eligibility or benefits in favor of highly compensated individuals.

 7. Health plans will be required to report quality data, pending federal guidelines.

 8. Health plans must implement internal claims appeals and an external review processes.

Brian Schroeder
Brian Schroeder
Brian J Schroeder – Independent Broker - (925) 513-7778