What’s in the Patient Protection and Affordable Care Act for you?

Here’s a list, provided by the Illinois Department of Insurance, of some of the changes coming soon under health care reform legislation:

Immediate changes:
— Tax credits for small businesses providing health coverage for employees.
— Beginning of a phased-in closure of the coverage gap in Medicare Part D prescription drug plans.
— Health insurers must post justification for premium increases on their Web sites.

Within 90 days of enactment:
— A high-risk health insurance pool administered by the state will be available to cover people with pre-existing health conditions.
— Employers will be allowed to reduce health care costs through a temporary reinsurance program for early retirees below Medicare age. Participating employers will get help paying for higher claims incurred by retired employees.

Six months after enactment:
Some new restrictions kick in for new policies (some of which won’t apply to those written before March 23) including:
— Insurance companies won’t be allowed to drop coverage for an individual due to prior health claims, except in instances of fraud.
— All health insurance plans will be required to cover preventive services such as screenings and immunizations without cost to policy holders.
— No lifetime dollar limits on coverage.
— Young adults up to age 26 can remain covered under their parents’ health plans.
— Consistent with Illinois law, insurance companies will be prohibited from requiring prior authorization for emergency health care or visiting a hospital emergency room outside the provider network. Nor can the insurer charge a higher co-payment for an out-of-network emergency room visit.
— Also consistent with Illinois law, women can see in-network gynecologists and obstetricians without a prior authorization or referral from a primary care provider.
— Insurers must post on their Web sites the percentage of premium dollars they spend on health care.

Starting Jan. 1, 2011:
— Health insurance companies will have to meet standards for how much of their premium income they spend on health care and rebate excess premium dollars to policy holders.
 

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