Our Human Resources Blog

Yesterday, September 23^rd, we hit the six month anniversary of the Healthcare Reform Act.  It is also the day that a series of health reform provisions impacting employer based health plans begin to take effect- “Patient Protection and Affordable Care Act(PPACA)

 Below are a few of the highlights of the major changes. (Note for calendar year plans, changes take effect on January 1, 2011)

• Dependent Coverage: Group health plans with dependent child coverage must make available coverage for the enrollee’s adult children who are younger than age 26, regardless of whether or not the dependent is a full-time student, disabled, or married.
• No Lifetime Limits: Lifetime or annual benefit limits cannot be imposed by group health plans.
• Children and Pre-existing Conditions: Health insurers may not drop a child’s coverage for a pre-existing condition up to age 19. (This change is coming for adults, too, but not until 2014)
• Prohibition on Rescissions of Coverage: Health insurance issuers in the group and individual market may not rescind an enrollee’s coverage, except where an individual has engaged in fraud or made an intentional misrepresentation of fact as prohibited under the terms of the plan.
• Preventive Care Services:  All plans are required to cover, without cost sharing, preventive services and immunizations that are recommended by the U.S. Preventive Services Task Force and the Centers for Disease Control (CDC). Also required to be covered, without cost sharing, are certain child preventive services recommended by the Health Resources and Services Administration.
• Expanding Patient Provider Choices: Health insurance plans must allow enrollees to select any participating primary care provider available, including a pediatrician for children, and to cover emergency services provided at a hospital emergency department regardless of the hospital’s participation in the plan preferred provider network and without prior authorization requirements. Female enrollees must be able to obtain obstetrical/gynecological specialist services without a referral from another primary care provider. (Not applicable to grandfathered plans.)

Although opponents of PPACA hope to repeal the law, these efforts could take years. Employers should be aware of the changes and work closely with their benefit professionals to ensure their plans are up to date.