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May 5, 2010
Health Insurance Reform & You
The Patient Protection and Affordable Care Act (PPACA), which was signed into law on March 23, 2010, will ultimately touch almost every
American. The provisions of the law will be phased in over the next 10 years with the most significant changes taking place in 2014. At
this early stage, it is very difficult to predict what changes are in store for each of us. That is because there are numerous federal
and state entities that must issue regulations, which will explain to insurance companies and others involved, how the law should be implemented.
PPACA will make dramatic changes in the insurance marketplace. The new law will require all health insurance policies to contain new benefits. It
will require that health insurers rate health plans in new ways. Many health industry suppliers will be called upon to pay new taxes to cover the
uninsured, thereby increasing their costs. The new reform legislation did not contain provisions that would control medical costs, which are the
primary drivers of premium costs. These facts taken together mean that for most Americans, the cost of health insurance will rise. By 2014, many
Americans will be eligible for government subsidies, which will help to offset those increases. In the meantime, those with private insurance should
expect there to be some increase in cost as reform provisions are implemented.
That being said, Arkansas Blue Cross and Blue Shield and its family of companies are committed to doing all we legally can to hold costs down to
helping our customers understand how they will be affected. With the understanding that the final rules are not in place, described below are the
changes we believe will be required by the new law over the next 18 months based on the kind of policy you have and when you enrolled in it. Until
we better understand the requirements, which will come with the issuance of regulations, we are not able to accurately price the changes.
If you have employer group coverage enrolled before March 23, 2010 (at least one person was enrolled):
Policies, which were in place on the day the law was passed, are considered “grandfathered” plans. The new requirements for these plans are more
limited than for those sold after the law was enacted. Changes that members enrolled in grandfathered employer group plans can expect over the
next six to 18 months may include:
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New rules around pre-existing health conditions for children which may mean that children who are insured under their parent’s health
plan do not have to meet any pre-existing condition waiting periods even if the parents are required to do so as a result of some condition
of their enrollment. (Late enrollment, no prior creditable coverage, etc.)
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Dependents can continue coverage under a parent’s plan until their 26th birthday. Dependents are eligible regardless of student or marital
status. Dependents also are eligible regardless of whether they are claimed as a dependent on their parent’s tax return. (More information
on Dependent Coverage.)
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Lifetime dollar limits will be removed on “essential benefits.” The rules and guidelines outlining what benefits are considered essential
have not been defined by the government. On most Arkansas Blue Cross plans, the lifetime maximum benefit is currently $5,000,000This lifetime
benefit would become unlimited.
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The dollar limits for some benefits in place today may be adjusted by the law. The benefits to which this regulation applies have not been determined.
If you have an individual or family policy in place March 23, 2010 (in which you were enrolled):
Policies, which were in place on the day the law was passed, are considered “grandfathered” plans. The new requirements for these plans are more
limited than for those sold after the law was enacted. Changes that members enrolled in grandfathered plans can expect over the next six to 18 months
may include:
-
Dependents can continue coverage under a parent’s plan until their 26th birthday. Dependents are eligible regardless of student or marital
status. Dependents also are eligible regardless of whether they are claimed as a dependent on their parent’s tax return. (View more
information on Dependent Coverage.)
-
Lifetime dollar limits will be removed on “essential benefits.” The rules and guidelines outlining what benefits are considered essential
have not been defined by the government. On most Arkansas Blue Cross plans, the lifetime maximum benefit is currently $5,000,000. This
lifetime benefit would become unlimited.
If you are enrolled in an employer group plan effective April 1, 2010, or after:
For more recently effective health plans, a number of changes apply over the next six to 18 months. These changes may include:
-
New rules around pre-existing health conditions for children which may mean that children who are insured under their parent’s health plan do not
have to meet any pre-existing condition waiting periods even if the parents are required to do so as a result of some condition of their
enrollment. (Late enrollment, no prior creditable coverage, etc.)
-
Dependents can continue coverage under a parent’s plan until their 26th birthday. Dependents are eligible regardless of student or marital
status. Dependents also are eligible regardless of whether they are claimed as a dependent on their parent’s tax return. (View more
information on Dependent Coverage.)
-
Lifetime dollar limits will be removed on “essential benefits.” The rules and guidelines outlining what benefits are considered essential have
not been defined by the government. On most Arkansas Blue Cross plans, the lifetime maximum benefit is currently $5,000,000. This lifetime
benefit would become unlimited.
-
The dollar limits for some benefits in place today may be adjusted by law. The benefits to which this regulation applies have not been determined.
-
Emergency services must be covered at the in-network coinsurance or copayment level even if you receive the services at an out-of-network
facility. (This benefit is already offered by Arkansas Blue Cross and Health Advantage.)
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Access to any in-network primary care physician or pediatrician who is accepting new patients. (Already available.)
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Direct access for women to obstetricians/gynecologists without a referral.
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Preventive services identified by the US Preventive Services Task Force will be covered with no member cost-sharing (copayments,
deductibles or coinsurance.) The services that will be covered have not yet been identified.
If you were enrolled in a family or individual policy on April 1, 2010, or after:
For more recently effective health plans, a number of changes apply over the next six to 18 months. These changes may include:
-
New rules around pre-existing health conditions for children which may mean that children who are insured under their parent’s health plan
do not have to meet any pre-existing condition waiting periods even if the parents are required to do so.
-
Dependents can continue coverage under a parent’s plan until their 26th birthday. Dependents are eligible regardless of student or marital
status. Dependents also are eligible regardless of whether they are claimed as a dependent on their parent’s tax return. (View more
information on Dependent Coverage.)
-
Lifetime dollar limits will be removed on “essential benefits.” The rules and guidelines outlining what benefits are considered essential have
not been defined by the government. On most Arkansas Blue Cross plans, the lifetime maximum benefit is currently $5,000,000. This lifetime benefit
would become unlimited.
-
The dollar limits for some benefits in place today may be adjusted by law. The benefits to which this regulation applies have not been determined.
-
Emergency services must be covered at the in-network coinsurance or copayment level even if you receive the services at an out-of-network facility. (Arkansas Blue Cross already offers this benefit.)
-
Access to any in-network primary care physician or pediatrician who is accepting new patients. (Already available.)
-
Preventive services identified by the US Preventive Services Task Force will be covered with no member cost-sharing (copayments, deductibles or
coinsurance.) The services that will be covered have not yet been identified.
-
Direct access for women to obstetricians/gynecologists without a referral will be included in all policies. In addition to the new requirements
described above, PPACA includes additional regulations that may impact members. These provisions include:
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New appeals processes will be established.
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The federal Department of Health and Human Services will create a Web Site to facilitate consumer and small group health plan shopping.
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State ombudsman programs will be established.
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Over the counter drugs not prescribed by a physician can no longer be reimbursed from a flexible spending account or HRA.
These are the changes you can expect in the next six to 18 months. As regulations are clarified, Arkansas Blue Cross will notify you of
those provisions that impact your policy. Most importantly, we will keep you informed of the impact these changes may have on your rates.
The most substantial changes will be implemented in 2014. Those provisions will change where and how you buy insurance, how it is priced and how you
pay for it. As regulations are issued, Arkansas Blue Cross will you with as much information as possible to help explain health insurance reform and
its impact on the health care industry. Please visit our Web Sites or contact us with any questions you may have.
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