Disability & Benefits: Health Care Reform Changes for 2010
Earlier this year Congress passed and the President signed into law a massive Health Care Reform, named the Patient Protection and Affordable Care Act. (PPACA) Its implementation will create major changes in how healthcare is delivered and how health insurance is purchased.
Transitional High Risk Insurance Pool – Effective July 1, 2010, persons who are not able to purchase health insurance due to a pre-existing condition will have the opportunity to purchase “affordable” coverage through high risk insurance pools operated by the states and funded by the federal government. Rates charged will be based on the average charge for health insurance by private insurers for similar coverage in the individual health market in that geographical area.
To be eligible for the coverage this year, a person:
* Must have a pre-existing condition that makes them otherwise uninsurable; and,
* Must have been uninsured for at least six months prior to applying.
* A person meeting these two criteria will be able to obtain coverage regardless of their health.
As of May 3, 2010, 30 states have indicated they will operate their own high risk pools. Persons living in states which do not operate such a pool will be able to purchase coverage through a federal fallback high-risk pool, currently being set up. These pools will operate until insurance companies are required to accept anyone regardless of their pre-existing condition or age in 2014.
Lifetime Maximums Prohibited – Effective at the start of plan years beginning after September 23, 2010, health plans will no longer be able to place lifetime or annual limits on new or existing health plans, both group and individual. For many employers who use December 31as the end of their plan year, this would take effect on January 1, 2011.
Rescissions Prohibited – Effective September 23, 2010, insurers will be prohibited from dropping persons from coverage when they become ill. Insurance companies have announced they will implement this provision immediately as well.
Children with Pre-Existing Conditions – Effective September 23, 2010, insurance companies will no longer deny coverage to children because of a pre-existing condition. (This will not apply to adults until 2014.) Children applying for coverage under a health plan that requires medical underwriting, whether singly or with a family, cannot be denied coverage due to past medical history.
"Rates charged will be based on the average charge for health insurance by private insurers for similar coverage in the individual health market in that geographical area."
Similar coverage as I have seen so far with insurance companies who know you have a pre-existing illness does not constitute affordable coverage. It will be interesting to see when it's all said and done what the actual monthly premiums will be since those with hepc are considered high risk.
Let me tell you!!!!!!!!! I just got a letter from AETNA informing me that my insurance will go from the $480/month I now pay to $560/month starting next month... This is just for me, not my family and that is with a $5,000.00 deductible!
I'm glad to see they will have to drop the lifetime limit though... mine is 2 mil.... and at the cost of this tx, I was concerned about anything else coming up in the future.
I don't know if you heard about WellPoint/Anthem Blue Cross here in California.
They were going to raise rates for individual policy holders in California by as high as 39% at the beginning of this year. They said they had to raise rates because Angela Braly, the chief executive of WellPoint (who makes over a million a year in salary and 8 million in stock options), "the rate increases were necessary to keep the company solvent". Typical corporate doomsday scenario. If they don't get their way they will go broke due to all those ill customers they have to pay for. Gee I thought that was their business? Insuring customers who may need medical services. Of course their real business is to increase profits, period. Ms. Braly was hired for her patient advocacy expertise.
At the same time they were pleading loss of revenues WellPoint gave 39 of its executives more than $1 million each and spent more than $27 million on 103 lavish executive retreats. I guess this is what they call "belt tightening" at WellPoint.
This was when the Health Reform Bill appeared dead and they thought they could sneak the increase in under the radar. Unfortunately for WellPoint, the administration put pressure on them to justify the increase before congress. After months of PR and justifying the increase as legal it turns out that there was a technical error in some of the paper work when applying for the cost increase in California and now they have dropped their "necessity" to increase the rates by 39% to remain solvent. At least for now. While they wait for all the bad PR to blow over.
Health and Human Services Secretary Kathleen Sebelius noted last week that profits for the country’s 10 largest insurance companies outpaced inflation in the last decade 10 to one. Anthem’s parent, WellPoint, reported a $2.7 billion profit in the last quarter of 2009.
LOS ANGELES — Insurance giant Anthem Blue Cross drew public outrage and criticism by President Barack Obama as a poster child for out-of-control health care costs when it proposed raising rates for Californians by as much as 39 percent.
On Thursday, Los Angeles-based Anthem withdrew plans for the increase.
Anthem made the decision after an independent audit determined the company's justification for raising premiums was based on flawed data, state Insurance Commissioner Steve Poizner (now running for governor) said.
The decision also came one day after Anthem's parent, Wellpoint, Inc. of Indianapolis, announced its first-quarter profit soared by 51 percent.(!)
Anthem said separately it will file a new application for a rate increase with the California Department of Insurance and the Department of Managed Health Care, perhaps as early as next month. It added that any errors in its original application were inadvertent.
"The current application that was withdrawn today (Thursday) was just flawed," Poizner said during a conference call with reporters. He added that it contained mathematical errors and in some instances double counting of data.
Neither Poizner nor Anthem officials said just how big the insurance giant's next proposed increase would be.
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