Sep 24, 2010

September 23, 2010: Big day for PPACA implementation

Posted by: Neal

September 23 marks the six-month anniversary of the enactment of health reform. As a result, some key changes take effect.

The following changes take place for all health plans:

  • Lifetime limits. Plans may not impose lifetime dollar-limits on essential benefits.

  • Rescissions. No rescissions are permitted, except in cases of fraud or intentional misrepresentation.

  • Coverage for adult children. Children may stay on their parents' policies until age 26 if coverage isn't available through their work, regardless of their marital status.

  • Pre-existing conditions. Group plans and new individual plans may not impose pre-existing condition exclusions for children under 19 (does not apply to grandfathered individual plans).

The following changes take place for all new plans and plans renewed six months after the law's enactment date (except grandfathered plans):

  • Preventive services. New policies must cover the full cost of preventive care – no cost-sharing – as recommended by the U.S. Preventive Services Task Force; recommended immunizations, preventive care for infants, children and adolescents; and additional preventive care for women.
  • Appeals. New minimum requirements go into effect for internal and external claims appeals processes.
  • Patient protections. Plans that require or provide for a primary care provider (PCP) designation must allow each member to designate any in-network PCP, or pediatrician for children, accepting new patients. Plans may no longer require an authorization or referral to an Ob-Gyn. Prior authorization for emergency services is also prohibited – and no additional cost sharing for out-of-network emergency room services.

  • Annual limits. Annual limits are restricted by Health and Human Services.

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