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September 21, 2010
How health insurance reform may affect you
If you have:
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A young adult living at home?
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A child with a pre-existing health condition?
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Been wondering what other benefits have changed?
This information is for you.
In the past few months, we’ve learned more about how health insurance reform, or the Patient Protection and Affordable Care Act (PPACA), will affect you, our member. As promised, we are sharing this information so you can make informed decisions about your health insurance coverage.
The provisions discussed in this article are for fully insured group health plans for people under age 65. They do not pertain to self-insured health plans. Please contact your human resources administrator if you are unsure if you have a self-insured or fully insured health plan.
Please review the following information and remember that it may be different depending on whether you have an individual or family medical insurance policy or if you have fully insured coverage through an employer.
Good news for parents of adult children under age 26
Most young adults up to the age of 26 now can have dependent coverage under their parents’ health plans.
If you have a fully insured plan through an employer (small business or large corporation) —
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Many young adults who were enrolled on their parents’ policies as of May 2010 were previously informed that they may remain on those policies until the age of 26. This allowed young adults graduating from college or high school in May to remain on their parents’ plans even if they were no longer students.
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For those who were not covered by their parents’ plans at that time (or did not receive notification from the employer sponsor to remain enrolled) but are still 25 years of age or younger, an open enrollment period will be held 30 days before each employer group health plan’s renewal date to allow parents to add dependents. Your human resources department or the employee who deals with your company’s health plan can provide you with the renewal date for your company plan.
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In some situations, adult dependents who are eligible for coverage under their own employer’s health plan may not be able to enroll for coverage as a dependent.
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If you work for an employer with fewer than 50 employees (considered a small employer group under the new federal law), your dependent must answer the medical questions on the application.
More information on the pre-existing health condition requirements and guaranteed issue
What is a pre-existing health condition?
A pre-existing condition is any health condition that existed before you applied for health insurance coverage or enrolled in a health plan.
What is “guaranteed issue”?
It means that a health insurance company will accept anyone who applies for coverage (and pays the premium).
How has health insurance reform affected pre-existing health conditions requirements? And does Arkansas Blue Cross guarantee coverage for those age 18 and younger?
If you have a fully insured plan through an employer (small business or large corporation) —
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Your insurance plan will remove the pre-existing condition requirements for individuals age 18 and younger at your group’s health plan’s renewal date, beginning in October.
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There always has been guaranteed issue on group policies. Everyone is covered at the time of enrollment.
What are the rules on lifetime limits?
If you have a fully insured plan through an employer (small business or large corporation) —
The lifetime dollar limit benefit is now unlimited. On most plans, the lifetime maximum benefit previously ranged from $1 million up to $5 million.
What are the rules on annual dollar maximums?
If you have a fully insured plan through an employer (small business or large corporation) —
There will be changes in your current benefits for ambulance, home health and durable medical equipment. These changes will be described in detail in your Certificate of Coverage or Evidence of Coverage policy, which will be provided to you when you renew your coverage.
We’re working to keep you informed
Changes to your benefits are based on our current understanding of PPACA. These changes have been made in good faith based on the interim final regulations released by the U.S. Department of Health and Human Services. Many of the regulations remain in a “comment” period; therefore, other changes could be coming. We will continue to keep you up to date. As your health insurance company, it’s our responsibility to help you understand the changes in your coverage. And, it’s our privilege to serve you.
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