New Insurance Rules Start September 23

Horizons in Hemophilia, September 2010

By Jeff Cornett, RN, MSN, Director of Training, Research, and Advocacy

The Affordable Care Act (“the Health Reform Law”) offers many benefits to people with bleeding disorders.  Some of the new insurance changes start this month.  It is important to understand that these changes go into effect for health plan years beginning on or after September 23, 2010.  What is a health plan year?  It is the period of coverage for your health insurance plan.  For example, Hemophilia of Georgia’s health plan year for its employees starts on September 1.  Since this is before September 23, these changes will go not go into effect for the agency’s plan until September 1, 2011.  The State Health Benefit Plan for state employees in Georgia begins on January 1, so these changes will go into effect for them on January 1, 2011.  Your employer's Human Resources Department can tell you when your group health insurance plan year begins.

Here are changes to be aware of:

Extending coverage for young adults
Under the new law, young people can stay on their parents’ health insurance until they turn 26 years old.  The only exception is if a young person can get health insurance through his or her own employer.  Some insurance companies began offering this option a few months ago.  It does not matter if a young person is married or doesn’t live with the parents.  They can still stay on the insurance.  Young people who are not currently on a parent’s plan can sign back up as long as they are under age 26.  Your employer is supposed to notify you of the special open enrollment period for dependents.  Ask your employer when this period will begin.

Prohibiting denial of coverage of children based on pre-existing conditions
The Affordable Care Act set new rules to prevent health insurance companies from denying coverage to children under the age of 19 due to a pre-existing condition (such as a bleeding disorder).

Free preventive care
All new insurance plans must cover certain preventive services such as immunizations, mammograms, and colonoscopies without charging a deductible, co-pay, or coinsurance.  You can see a list of covered services at https://www.healthcare.gov/law/about/provisions/services/lists.html.

Eliminating lifetime caps on insurance coverage and regulating annual limits
The bleeding disorder community worked hard to get this change put into the Affordable Care Act.  Under the new law, insurance companies can’t limit the amount they will pay for essential health benefits over a person’s lifetime.  Previously, many people had lifetime caps of $1 million or $2 million.  It was not unusual for a person with severe hemophilia to reach this limit early in life.  The new law also places restrictions on the use of annual limits – the maximum amount a health insurance company will pay in a year.  In 2014, putting annual dollar limits on essential benefits like hospital stays will be banned for new plans in the individual market and all group plans.

Prohibiting insurance companies from cancelling health insurance policies when you get sick
One of the worst practices of the health insurance companies, called rescission, is now banned.  Before the Affordable Care Act, companies could look for a mistake in a person’s application for health insurance.  If they found an error, they could refuse to pay for care when the insured person became ill. They can’t do this anymore.

Other benefits of the Affordable Care Act have started or are starting soon, including tax credits for small businesses who offer health insurance to employees.  You can find out about all of the changes at the new government website, www.healthcare.gov.

If you are covered by TRICARE, the dependent health coverage for the military, these changes do not currently apply to your insurance.  You can read more about this issue at https://healthyfuturega.org/archives/1090#more-1090.