Obama Administration issues first health reform regs

June 23, 2010

The Obama Administration today issued the first regulations implementing what will be known as the “Patients’ Bill of Rights” — requiring health insurance companies to follow new rules on benefits for consumers with insurance coverage.

The regulations give children better access to insurance, give everyone with benefits more flexibility in choosing a doctor, and begin to phase out the ability of insurance companies to place annual or lifetime caps on the value of benefits.

The regulations begin the implementation of the health reform bill passed earlier this year. Most of the new rules take effect Sept. 23. The highlights:

–Insurance companies will be banned from excluding coverage for children under age 19 based on pre-existing medical conditions. By 2014, this rule will apply to all Americans. In the meantime, adults will get access to an expanded high-risk pool if they are denied coverage.

–Limits on rescinding coverage. Insurance companies and health plans will be prohibited from rescinding coverage except in cases of fraud or intentional misrepresentation on an application. Currently insurers can and do revoke coverage, even retroactively, for people who make unintentional errors on their application.

–No lifetime limits on coverage. The regulations prohibit the capping of lifetime benefits on all policies issued or renewed after Sept. 23, 2010.

–Phase out of annual limits. Annual caps on benefits will be phased out over three years, until 2014, when most such limits will be banned. Coverage issued or renewed beginning Sept. 23 will be allowed to set limits no lower than $750,000. The minimum will be raised to $1.25 million in 2011 and $2 million in 2012. The limits apply to all employer-based plans and all new individual market plans.

–Choice of doctors. The rules require insurers to let members choose any primary care doctor that is part of the plan’s network and has space available. Insurers will also be prohibited from requiring a referral for OB-GYN care.

–Emergency rooms. Insurers will be prohibited from requiring prior approval for emergency room visits and imposing higher cost-sharing on visits to ERs that are out-of-network.

To see more on the new rules and health reform in general, see this White House fact sheet.

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