Health-care protections to take effect

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By N.C. Aizenman
Washington Post Staff Writer
Friday, September 24, 2010

Thursday marked six months since the nation's health-care overhaul bill was signed into law, and a number of consumer protections provided by the legislation took effect.

For all plans - including individual and group policies as well as those sponsored by employers - insurers will no longer be permitted to:

l Deny coverage to children with preexisting conditions.

This will not necessarily prevent insurers from charging higher premiums in such cases. But it will mean they can no longer refuse to sell policies for children who are sick. They also cannot temporarily or permanently exclude coverage of medical bills arising from a child's preexisting condition. An important caveat: This rule does not apply to plans purchased before the legislation was adopted on March 23. But Americans of all ages will be able to receive these protections after 2014.

l Put lifetime limits on benefits.

Another caveat: A plan can still put a lifetime dollar limit on spending for health services that the government does not deem essential.

l Cancel a policy retroactively without proving fraud.

This addresses a practice known as recission, by which insurers could cancel coverage just as a person got sick, on the grounds that they or their employer had provided inaccurate information when they originally applied for coverage. Now insurers will have to prove that the error was more than just an honest mistake. As with many of the other rules, this one applies to "plan years" or "policy years" that begin on or after Sept. 23.

People enrolled in job-related health plans or individual insurance policies created after March 23 will receive some additional benefits. However, for policies that have renewable "plan years," the protections will take effect only after the renewal date. For example, if a worker is covered by an employer's plan that renews on Jan. 1, these benefits will not start until then. The benefits include:

l The right to appeal the denial of a claim.

The insured now have the right to demand that their health plans reconsider decisions to deny them payment for a test or treatment. This includes the right to appeal to an independent reviewer.

l Free preventive services, such as screenings, vaccinations and counseling.

l The right of young adults to stay on a parent's plan until age 26.

l The choice of primary care doctor, obstetrician/gynecologist and pediatrician within a provider's network.

l The right to use the nearest emergency room without penalty.


© 2010 The Washington Post Company

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