National Health Care Reform – 5 Important Provisions that Start this Year

Are you prepared for the next round of National Health Care implementations?

While Virginia’s lawsuit is expected to be heard in October, and a lawsuit by 20 other States is headed toward the Supreme Court, the National Health Insurance Reform legislation remains law. Montana, which is not part of any legal wrangling, has been scrambling to meet the requirements. Because the parts of the legislation under dispute won’t go into effect for a couple of years, these disputes are not likely to impact near term changes. Some of these go into effect this year.

The timeline published by Montana Commissioner of Securities and Insurance, Monica J. Lindeen lists several provisions that will radically alter the insurance landscape beginning next month.

1. Montana Affordable Care Plan – this plan pays the difference between a normal premium and a premium that is higher because of an existing condition. This program started in July and will continue until insurance companies are required to ignore pre-existing conditions as a basis to deny coverage. (more information at www.mthealth.org)
2. Preventative Care – Starting September 23rd, any insurance plan purchased after March 23rd, 2010 must eliminate any cost-sharing provisions for preventative care when they are renewed. New services are not added, but charges for treatment of a preventive nature must be dropped. This means no co-pay or deductable for these services. List of covered items.
3. Dependent Coverage – Starting Oct 1st, dependents up to the age of 26 must be allowed coverage on comprehensive insurance plans. This isn’t a free benefit, but will stipulate that dependents can be added with an appropriate premium.
4. No Rescission – Insurers now have the ability to rescind a policy based on a pre-existing condition or for other contractual reasons. This will be disallowed after Sept 23, 2010 except in cases of fraud.
5. Lifetime Benefits – the law prohibits lifetime benefit limits. There may still be annual limits and for 2011 the ceiling can be set as low as $750,000, but this amount is raised every year up to $2 million by 2014.

Evolving Rules

Some of the practical rules necessary to clarify how the Health Care Reform Legislation will be implemented have yet to be written. Some are still suggestions—such as recommending third party review of rescissions. Both Montana and other states are struggling to meet the requirements of the act without having everything in place and without the money to do it.

For more information, the White House has an overview and the Montana Commissioner of Securities and Insurance has published more detailed information here.

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