PPACA Updates on Pre-Ex, Annual Limits, Patient Protections, and Preventive Care

We continue to share new information regarding PPACA. This week the Health and Human Services (HHS) released interim rules regarding the following:

Pre-Existing Conditions – Beginning January 1st, 2011, as your health insurance contract renews, there will be no pre-existing condition limitations for children under the age of 19.

Annual Limits – if your health insurance policy has an annual cap, for example, a 1 million or 5 million dollar limit, this will be eliminated at your 2011 renewal. We are still awaiting future guidance on internal caps. Most group health insurance policies have annual limits on physical, occupation and speech therapy. We are not sure how these benefits will change.

Patient Protections – No referrals to see an OBGYN regardless of the type of health insurance contract. Emergency Room visits will no longer need pre-authorization and the bill limits out-of-network cost sharing.

Preventive Care- effective with your 2011 health insurance renewal, preventive services will be paid at 100% with no copays or deductibles.

Burman S. Clark

Burman S. Clark, RHU, CSA is the President of Muneris Benefits and a licensed insurance broker and consultant. His independent practice and focuses on employee benefits, individual life, disability, medical, and senior products. Burman has traveled extensively and provided guidance to large employer associations with regards to the Affordable Care Act.