The Department of Health and Human Services (HHS) on June 28 published a Final Rule in the Federal Register implementing provisions of the Patient Protection and Affordable Care Act (PPACA). The provisions were dubbed "The Patient’s Bill of Rights" by the agency.
This Final Rule takes effect Sept. 23, but it breaks little ground from the sweeping PPACA legislation other than to clarify certain provisions and mandates.
The Bill of Rights establishes that children 19 and younger cannot be denied either coverage or treatment for pre-existing conditions; health coverage once in place cannot be rescinded except in cases of applicant fraud; no lifetime limit can be set on health insurance payments; annual caps on insurance expenditures will be phased out completely by 2014; patients are free to choose their primary-care physician without restriction; and extra fees for out-of-network emergency services are barred.
Though some provisions do not apply to grandfathered policies, most take effect on Sept. 23, or on Jan. 1, 2011, when annual plan policies commencing on that date kick in.
The acceptable annual limits on health insurance expenditures (aka "essential health benefits," a term that is yet to be defined) were clarified from PPACA as being $750,000 as of Sept. 23, 2010, $1.2 million as of Sept. 23, 2011, and $2 million as of Sept. 23, 2012, for both group and individual plans. After Jan. 1, 2014, the cap is dropped and outlays become open-ended.
As of 2014, all exclusions and pre-emptions based on pre-existing conditions are outlawed.
Employers, you can easily keep your workforces informed of these new benefits and protections by acquiring and posting Personnel Concepts’ Health Care Reform Employment Information Poster. Get your copy today.