Despite the fact that full reform would not occur immediately, it is likely that Healthcare Reform will provide some help to many Americans who need it right away.
Large chunks of any new health reform law are not designed to go into effect until 2013 or later – but both the House and the Senate bills provide some immediate help for those who currently lack healthcare coverage. Here is a summary of key provisions in the bills.
High risk pool for the uninsured –
Both bills create a temporary High Risk Pool Program to make insurance available to uninsured people with pre-existing conditions. For more details, click here.
Immediate reforms to help people who already have (or have access to) health insurance.
Provisions under both bills –
Limitation on rescissions. Insurance companies will be prohibited from rescinding policies unless there is clear evidence that the covered person has committed fraud.
Elimination of lifetime limits. No lifetime benefits limits for plan years beginning during the first year after enactment. (For effective dates, click here.)
Coverage of adult children. Plans that provide dependent coverage must cover adult children up to 26 years old in the Senate bill, under 27 in the House bill.
Possible limitation on premium price increases. A procedure will be put into place to monitor and require justification for premium price increases.
Limitations on exclusions for pre-existing conditions. Both bills place limits on such exclusions. For details, click here.
Provisions under House bill only –
Domestic violence. The House bill only would prohibit group and individual plans from imposing a pre-existing condition requirement because of domestic violence…. (see more)
COBRA. Under the House bill, people who have COBRA continuation coverage in effect as of the date of enactment will see the 18-month duration limitation lifted…. (see more)
Disabled children. The House bill states that group and individual plans that offer surgical benefits must provide coverage for outpatient and inpatient diagnosis and treatment of congenital or developmental deformity, disease, or injury for children under 21….(see more)
Provisions under Senate bill only –
Requirement that insurers spend a high percentage of premiums on subscribers’ health care.
Note: This section of the bill has changed. See updated post here.
The Senate bill requires health insurers to file annual reports showing the percentage of total premium revenue spent on (a) direct healthcare services for subscribers, (b) activities to improve healthcare quality, and (c) all other costs, except state taxes and licensing and regulatory fees.
Expenses detailed in (c) above cannot exceed 20% of premium revenue for group insurance or 25% of premium revenue for individual insurance….(see more)
Coverage of preventive health services
The Senate bill provides that group and individual health plans must cover, and may not impose cost-sharing requirements on, certain preventive health services, including….(see more)
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Tags: health reform, healthcare reform, house bill, senate bill