Sweeping Reform in the Insurance Market Is Changing Your Health Care
Getting quality care and staying healthy is easier for your employees with improvements to health plan benefits for new health insurance products.
The following reforms do not apply to grandfathered plans. However, beginning January 1, 2016, small businesses are no longer allowed to be enrolled in grandfathered or noncompliant plans that do not include the following:
Improved Preventive Care
Many preventive care services, such as screenings, vaccinations and counseling, are now covered without a copayment, co-insurance or deductible. For a complete list of all preventive services covered under the health care law, click here.
Easier Access to Emergency Services
Group health plans and insurers will now cover emergency services without prior authorization and in-network requirements. Click here to learn more.
Real Physician Selection
New provisions under the law permit you to choose any available participating primary-care provider as your doctor and to choose any available participating pediatrician as your child’s primary-care doctor. Health plans are also prohibited from requiring a referral from a primary-care provider before you can seek coverage for obstetrical or gynecological (OB-GYN) care from a participating OB-GYN specialist. Click here to learn more.
insurance company accountability
Increased Accountability Is Improving Coverage
New provisions protect your employees by making insurance companies more accountable.
Insurance Companies Will Have an Incentive to Keep People Healthy
The law allows everyone – regardless of whether they have a pre-existing condition – to purchase a private health insurance policy and will keep them from paying more if they have been ill. This gives health insurance companies a strong financial incentive to keep their customers healthy through purchasing high-quality effective medical care. In the past, insurance companies had a financial incentive to avoid selling policies to people who had been or might become sick.
Excluding Children Under Age 19 Because of Pre-Existing Conditions Is Already Not Allowed
Group health plans and insurers are already prohibited from imposing pre-existing condition exclusions for children under age 19.
Dependent Coverage Is Extended to Age 26
Group health plans that provide dependent health coverage now extend that coverage to children up to age 26.
Health Coverage Cancellation Is Not Allowed
Group health plans and insurers are prohibited from rescinding or canceling health coverage except in the case of fraud or intentional misrepresentation of material fact.
People With Pre-Existing Conditions Are Covered, Too
Insurance companies are no longer allowed to reject customers based on pre-existing conditions.
There Is No Limit On Lifetime Benefits
Group health plans and insurers are prohibited from imposing a lifetime dollar limit on essential health benefits. As of 2014, these annual dollar limits are prohibited for all essential health benefits.