Here's the latest installment of the health care reform law primer before the weekend. To refresh your memories, we are in Subtitle C of Title I. Last time, we wrapped up Part I on health insurance market reforms. Part II contains other miscellaneous provisions.
Preservation of Right to Maintain Existing Coverage
This is the section that pertains to "grandfathered" health plans. It begins by stating that nothing in the law requires an individual to terminate coverage under a group health plan or policy in which he was enrolled on March 23, 2010 (the date the president signed the law.) The next provision states that an individual may continue his current coverage even if it renews after the law's effective date. If the plan's terms allowed family members to enroll before the law's effective date, those family members may still enroll after that date. New employees may also enroll in the plan after the law's effective date. Coverage maintained under a collective bargaining agreement can continue without change until the agreement expires.
Any standards or requirements that states adopt to comply with the law have to be applied uniformly to all health plans in each insurance market where the standards apply.
All of these provisions on health insurance market reforms and continuation of coverage take effect for plan years beginning on or after January 1, 2014.
Let's move on to Title I (Quality, Affordable Health Care For All Americans), Subtitle D, titled Available Coverage Choices for All Americans. Part I deals with establishment of qualified health plans. What is a qualified health plan? I'm so glad you asked...
Qualified Health Plan Definition
A qualified health plan:
- Has a certification (which could be a "seal of approval") from each exchange through which it is offered
- Provides the "essential health benefits package" and
- Is offered by a health insurer that is licensed and in good standing in the states where it offers coverage; agrees to offer at least one "silver level" plan and one "gold level" plan in each exchange; that agrees to charge the same rate whether the plan is sold on the exchange, directly or through an agent; and complies with applicable regulations established by the Department of Health and Human Services and the exchanges.
The next subsection defines several terms, including "health plan," "health insurance coverage and issuer," and "group health plan." These refer to definitions in the federal Public Health Service Act.
The next section describes the essential health benefits package, and it really deserves its own blog post. Therefore, I'm closing this post on a cliffhanger (of sorts.) Tune in next time to find out what benefits the law requires health plans to offer.
Thanks for the info!
I hope everyone would get to read this so that they could avoid the fraud ones. Health care plans helps people in their medical needs. But before they could offer their services they should first passed the requirements and standards that the states necessitate for uniformity and for anti-fraud. My mom’s lucky because she had the best Medicare plan that helps her with her medication and regular check-up.
Posted by: Medicare Insurance Quote | February 01, 2011 at 12:29 AM