The health care reform legislation passed this year introduced sweeping changes to health insurance. But many of those changes do not go into effect for several years. A few key reforms, however, have just become law. Effective September 23, 2010, several key features of the reform legislation went into effect.
[In Pictures: Top 10 Cities with the Most Debt]
These new rules generally apply to policies issued after March 23, 2010. And they apply to both employee-sponsored health insurance and individual health policies.
Here's a quick summary of the new health care protections:
Under the new law, health care insurers will no longer be able to do the following:
Deny coverage to children with pre-existing conditions: For children younger than age 19, health plans can no longer limit or deny coverage simply because the child has a pre-existing health condition. This provision does not mean that such coverage will be inexpensive, but at least coverage will be available.
Impose lifetime limits or caps on health coverage: Some insurance policies place lifetime spending caps on coverage. Once the limit is reached, there is no more health coverage available. Under the new law, health plans can no longer set a lifetime dollar limit on benefits, which can be particularly important for those with expensive medical conditions.
Cancel a policy without proving fraud: Currently, health plans can and will cancel coverage retroactively if you failed to accurately disclose required information on the insurance application. Under the new law, the insurance carrier must prove that the information was left off the application by reason of fraud before canceling the policy.
[Visit the U.S. News My Money blog for the best money advice from around the web.]
Deny health claims without giving you a chance to appeal the decision: For new health plans, you can now have the right to ask the insurance company to reconsider any denial of coverage. And if they still deny the claim, you have the right to appeal the decision to an independent reviewer.
In addition to the above restrictions, new health insurance plans must provide the following:
Free preventative health services: New health plans are now required to offer access to preventive services such as screenings, vaccinations and counseling at no charge, including no copayment, co-insurance, or any deductible. Depending on your age, preventative services may include blood pressure, diabetes, and cholesterol tests; many cancer screenings; routine vaccinations; flu and pneumonia shots; and regular well-baby and well-child visits, from birth to age 21.
Young adults can stay on parent’s plan until age 26: Most health plans can remove children from coverage at age 19. Under the new rules, the age is extended to 25 if they don’t already have coverage through their job. The new rule applies even if the child does not live at home or is married.
Choose a primary care doctor and pediatrician: With new health plans, you can now choose the pediatrician or primary care doctor or you want from your health plan’s provider network. You can also see an OB-GYN doctor without getting a referral from your primary care physician.
[Visit the U.S. News Personal Finance site for more insight and money management tips.]
Use the nearest emergency room without penalty: Under existing plans, you can often pay significantly more if you visit an emergency room that is not in your insurance company’s provider network. With new health plans, you won’t be required to get prior approval before seeking emergency room services from a facility that is outside of your plan’s network. In addition, you won’t have to pay higher copayments.
You can find more information on these new rules at HealthCare.gov.