Affordable Care Act Major Coverage & Administrative Changes
Tools from the Carriers
Oxford Health Plans -
Dependent (Adult Child) Coverage to 26
Medicare Advantage and Prescription Drug Benefit Programs Final Rule
Pre-
Aetna
Empire -
Health Care Reform Overview -
Sample Employer Disclosure Template
Introduction to Health Care Reform Video
Navigating the Next Phase of Health Care Reform
Children's Pre-
Under the Affordable Care Act, health plans cannot limit or deny benefits or deny
coverage for a child younger than age 19 simply because the child has a “pre-
Lifetime & Annual Limits source: healthcare.gov
The Affordable Care Act prohibits health plans from putting a lifetime dollar limit on most benefits you receive. The law also restricts and phases out the annual dollar limits a health plan can place on most of your benefits — and does away with these limits entirely in 2014.
Young Adult Coverage source: healthcare.gov
Under the Affordable Care Act, if your plan covers children, you can now add or keep your children on your health insurance policy until they turn 26 years old.
What This Means for You
Before the health care law, insurance companies could remove enrolled children usually
at age 19, sometimes older for full-
Your children can join or remain on your plan even if they are:
- married
- not living with you
- attending school
- not financially dependent on you
- eligible to enroll in their employer’s plan
There is one temporary exception. Until 2014, “grandfathered” group plans do not have to offer dependent coverage up to age 26 if a young adult is eligible for group coverage outside their parent’s plan.
Some Important Details
- Your plan is required to provide a 30-
day period — no later than the first day of your plan’s next “ plan year” or “policy year” that begins on or after September 23, 2010 — to allow you to enroll your adult child. Your plan must notify you of this enrollment opportunity in writing. - If you enroll your adult child during this 30-
day enrollment period, your plan must cover your adult child from the first day of that plan year or policy year.
65 or Older source: healthcare.gov
The Affordable Care Act strengthens Medicare, offers eligible seniors a range of
preventive services with no cost-
If you have Medicare, you are eligible for a number of cost-
Eligible seniors who are in the coverage gap known as the “donut hole” automatically receive a discount on prescription drugs in 2011 and beyond.
Flexible Spending Account Changes source: healthcare.gov
As of January 1, 2011, the costs of over-
Note: Flexible Spending Accounts are sometimes called Flexible Spending Arrangements. Health Reimbursement Accounts are sometimes called Health Reimbursement Arrangements.
For More Information
Posted on: December 2, 2010
Appealing Health Plan Decisions
The Affordable Care Act ensures your right to appeal health insurance plan decisions-
Your state may have a health care Consumer Assistance Program that can help you file an appeal or request a review.
Administrative Simplification source: healthcare.gov
The Affordable Care Act accelerates adoption of standard “operating rules” for health
insurance plan administration. Operating rules are the business rules and guidelines
for electronic transactions with health insurance plans, and the current non-
By establishing uniform operating rules, the Affordable Care Act ensures that small businesses, health plans, physicians, hospitals, and patients are all speaking the same language. Benefits include:
- Improved coordination of care for the patient
- Increased payment accuracy and timeliness
- Reduced administrative cost and hassle factor for small businesses
- Payment transparency
The Affordable Care Act requires standard operating rules for eligibility and claims status to be adopted by July1, 2011 and fully implemented by January 1, 2013.
Doctor Choice & ER Access source: healthcare.gov
The Affordable Care Act helps preserve your choice of doctors by guaranteeing that
you can choose the primary care doctor or pediatrician you want from your health
plan’s provider network. It guarantees that you can see an OB-
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Insurance & Employee Benefits
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