Health reform provisions kick in

On September 23, some provisions of the healthcare reform act became active.

The provisions include:

  • Under the new law, insurance companies will be prohibited from imposing lifetime dollar limits on essential benefits, like hospital stays.
  • Health plans must permit adult children to remain on their parents' plans until age 26
  • Health plans can no longer refuse to cover a child, up to age 19, because of a pre-existing health condition.
  • Plans can't impose annual coverage limits of less than $750,000 for "essential" health benefits.
  • All new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance.
  • Plans must allow women to see an OB-GYN without a referral.
  • Plans can no longer require higher co-payments for out-of-network emergency services.
  • In the past, insurance companies could search for an error, or other technical mistake, on a customer’s application and use this error to deny payment for services when he or she got sick. The new law makes this illegal.
  • Plans must provide consumers with a way to appeal coverage determinations or claims to their insurance company, and establishes an external review process.

(Sources: http://www.healthcare.gov/law/introduction/index.html, Accessed October 4, 2010; The Washington Post, http://www.washingtonpost.com, September 14, 2010)