Today marks the 6th month anniversary of the signing of the health care reform bill (Affordable Care Act).  President Obama will mark this anniversary of the law’s enactment by meeting with individuals and employers from across the United States and learning from them how the new legislation has benefited them personally or their company. These stories, along with vital information about the Affordable Care Act, will be presented in a new website provided by the White House, www.WhiteHouse.gov/HealthReform. Today, President Obama will also recognize the implementation of the new Patient’s Bill of Rights that is a part of the Affordable Care Act.

Due the complexity of the many changes the Affordable Care Act will bring to us over the next several years, many Americans are still confused as to what changes will occur and when. Below is a list of the protections provided under the Patient’s Bill of Rights, which will be take effect today, September 23, 2010. We will do our best to keep you up to date as more rules of the Affordable Care Act come into effect.

Starting September 23, 2010 Insurers Will No Longer Be Able to:

Discriminate Against Children with Pre-Existing Conditions:

For most plans, discrimination against children (under age 19) with pre-existing conditions will be banned.   In 2014, no one seeking coverage can be discriminated against because of a pre-existing condition. It is estimated that up to 72,000 uninsured children who have been denied coverage due to a pre-existing condition, are expected to gain coverage. Coverage for up to an estimated 90,000 children will no longer exclude benefits because of a pre-existing condition.   

Drop Your Coverage Without Proving Fraud:

Insurance companies can no longer stop your coverage due to an illness or a mistake on your application. Approximately 10,700 people’s coverage, that is dropped each year when they become ill or make an error on their application, will now be protected under the new law. 

Put Lifetime Limits On Benefits:

Insurance companies can no longer put a lifetime limit on the amount of coverage they provide. Up to 20,400 people who typically hit their lifetime limits on the dollar amount that can be spent on coverage, along with the nearly 102 million enrollees who have policies with lifetime limits, will no longer have to worry about hitting their benefits caps.  

The use of annual dollar limits will be restricted, and in 2014 will be banned completely.   Annual dollar limits are less common than lifetime limits – involving 8% of large employer plans, 14% of small employer plans and 19% of individual market plans. For the people with medical costs that hit these limits however, the results can be overwhelming.  The law will phase out the use of annual dollar limits over the next three years until 2014 when most plans will ban it. These restricted annual dollar limits apply to all insurance plans except for individual market plans that are grandfathered.

Deny Your Right to Appeal:  

Consumers will be guaranteed the right to appeal insurance company coverage determinations or insurance claims to an independent third party for an external review process. Up to 88 million people will benefit from the new appeals process provisions by 2013.

Starting September 23, 2010 Consumers In New Health Care Plans Will Be Able to:

Cover Young Adults on a Parent’s Plan:  

For most plans, young adults will be allowed to remain on their parent’s family policy or be added to it, until their 26th birthday, unless they are offered coverage at work. There are up to 2.4 million young adults and up to 1.8 million who are uninsured. There are almost 600,000 who purchase coverage in the individual market, that could now gain coverage through their parents. Group health plans that are grandfathered plans can limit this option to adult children that don’t have another offer of employment-based coverage.

Choose a Primary Care Doctor or Pediatrician:

If you purchase or join a new plan, you have the right to choose your own primary care doctor or pediatrician in your plan’s provider network. For most plans, you will now be able to see an OB-GYN without needing a referral. Up to 88 million people will benefit from the provision that protects primary care provider choice by 2013. These protections apply to health plans that are not grandfathered.

Use the Nearest Emergency Room Care:

If you purchase or join a new plan, those plans are banned from charging more for emergency services obtained out of network.  Insurance companies will not be able to require you to get prior approval before seeking emergency care at a hospital outside your plan’s network. Up to 88 million people will benefit from this provision. These protections apply to health plans that are not grandfathered.

Have Preventive Services Cost-free:

If you join or purchase a new plan, you will receive recommended preventive care with no out-of-pocket cost.   Services like mammograms, colonoscopies, immunizations, pre-natal and new baby care will be covered and insurance companies will be prohibited from charging deductibles, co-payments or co-insurance. Up to 88 million people will have access to preventive care with no out-of-pocket costs. If your plan is grandfathered, these benefits may not be available to you.

Click here to learn more about the “Grandfather” Clause. To read more about the above information go to www.healthcare.gov.

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