Health Care Reform
(Updated on 10/29/2010)
The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 were recently enacted into law as part of the health care reform agenda.
The new law includes a large number of health insurance and health care changes which will take place over the next several years. To help you better understand what this means to you, we've put together some key information and resources. Because this new law includes a large number of requirements which require some clarification from regulation, we will share new information as it becomes available.
Key Information About Selected Requirements
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Extension of Adult Dependent Coverage
Effective September 23, 2010, all health plans that provide dependent coverage must extend coverage to married and single adult children up to age 26 who do not have access to employer-based coverage. (Effective January 1, 2010, Wisconsin law requires health insurance policies to provide coverage to single adult children up to age 27, subject to eligibility requirements. This change is effective for Unity members at their group's or their individual renewal date.)
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Early Retiree Reinsurance Program
This program provides reimbursement to sponsors of participating employment-based plans for a portion of the costs of health benefits for early retirees and their spouses, surviving spouses and dependents.
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Tax Credit for Employee Health Insurance Expenses of Small Employers
This offers a tax credit to certain small employers that provide health insurance coverage to their employees.
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Grandfathered Plans
Grandfathered health plan coverage means that coverage provided by a group health plan in which an individual was enrolled on March 23, 2010 (for as long as the plan maintains this status under the rules). A group health plan that provided coverage on March 23, 2010 is also a grandfathered plan with respect to new employees (whether newly hired or newly enrolled) and their families who enroll after March 23, 2010.
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Appeals/Grievance Process
An insurer offering group or individual health insurance coverage must continue to comply with Wisconsin's internal appeal and external review standards. (There is no change from current Wisconsin law.)
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Coverage for Emergency Services
Health plans that provide coverage for emergency services must do so without requiring prior authorization regardless of whether the provider is a participating provider. (There is no change from current Wisconsin law.)
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Removal of Pre-Existing Condition Limitations for Enrollees Under 19 Years Old
Beginning September 23, 2010, health plans are prohibited from imposing pre-existing condition exclusions on children under 19 for the first plan year or policy year.
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Coverage of Preventive Health Services without Cost-Sharing
Under the regulations, beginning July 14, 2010 plans must cover without copay, coinsurance or deductible certain preventive services when delivered by in-network providers. (Grandfathered plans are exempt for as long as they remain grandfathered.)
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Lifetime Limits on Coverage/ Annual Limits on Coverage
The Patient's Bill of Rights prevents health plans from placing lifetime caps on coverage (beginning September 23, 2010), and restricts new plans' use of annual limits.
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Additional Resources
Please Note: Information on other requirements will be added as it becomes available.
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