Beginning today, most health plans sold after March 23, 2010 must include several new benefits when they renew. These provisions, outlined in the federal Affordable Care Act, are designed to increase access to health care. Under the new reforms, plans cannot:
Charge out-of-pocket costs, including co-pays, deductibles and co-insurance, for preventive services.
Cap lifetime benefits.
Cancel or rescind a policy, except in the case of fraud or misrepresentation.
Refuse to cover a child’s pre-existing condition.
If the health plan includes a cap on essential benefits, it can’t be less than $750,000.
And young adults can be covered on their parents’ plan until the age of 26, unless they get a job that offers health insurance.
However, there are some exceptions. Health plans sold before March 23, 2010, when the law was signed, are considered “grandfathered” and are exempt from some of these new protections.
For example, grandfathered individual health plans still can charge out-of-pocket costs for preventive services, cap lifetime benefits, and refuse to cover an enrolled child’s pre-existing condition. Grandfathered group plans (plans purchased by employers for their employees) still can charge out-of-pocket costs for preventive services.
Plans lose their grandfathered status if they significantly reduce benefits or increase deductibles, copayments, and/or an employee’s share of the premium.
Learn more about the fall reform here or see a general timeline of health reform.