The Departments of Health and Human Services, Labor and Treasury issued regulations on June 22 to implement five of the insurance market reform provisions included in the Patient Protection and Affordable Care Act (PPACA). During the unveiling of the new rules at the White House, President Obama specifically warned the insurance industry not to use the new rules and PPACA “as an opportunity to enact unjustifiable rate increases.”

However, he praised insurers for implementing many of the law’s initial consumer-protection provisions early, such as extending coverage to dependents up to age 26. In a nod to insurance companies, HHS Secretary Kathleen Sebelius said, "We need to be in this together...the underlying cost drivers are certainly not all isolated with insurance companies."

NAHU is still completing a detailed analysis of the rules, and will distribute that to you next week. However, HHS has already released a fact sheet on the scope of the new regulation.

The five areas addressed by the new rules, which the Obama administration is billing as a new “Patient’s Bill of Rights,” include:

• the prohibition against preexisting condition exclusions
• the prohibition against lifetime health insurance coverage limits
• the restriction of annual coverage limits
• the limitation on rescissions
• the provisions guaranteeing direct access to certain types of providers and access to out-of-network emergency care.

Most of these requirements are scheduled to go into effect for plan years starting after September 23, 2010. The preexisting condition requirements are only effective for children this year; the remainder of the preexisting condition requirements take effect on January 1, 2014, and the annual limit provisions are phased in. The prohibition on lifetime coverage limits and the limits on rescissions apply to all plans, including those who elect to maintain their grandfathered status, and the limits on preexisting condition exclusions and on annual dollar limits apply to grandfathered group plans. The other provisions do not apply to grandfathered plans.

Courtesy:  NAHU's Washington Update

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