So much confusion has swirled around the new Health Care legistlation that was passed last year that I thought it best to highlight exactly what it means to the average policy holder.
Insurers must allow parents to keep an adult child up to age 26 on their health plan and those young adults can't be charged more than any other dependent. BUT, if your child has an offer of coverage from an employer, he/she might not be able to be added to your plan.
Insurers can't charge co-pays or deductibles for preventive services such as breast cancer screening and cholesterol tests. But: "Grandfathered" plans - those that don't make major changes from the previous plan year -- don't have to follow this requirement.
Insurers must cover children up to age 19 with a preexisting medical condition. New individual plans and all group plans can't refuse to cover a child. But: they can charge a higher premium for a child with preexisting conditions.
No additional payments can be required for out-of-network emergency room care. Insurers cannot require higher co-payments or deductibles if you have a medical emergency and seek treatment at an emergency room that's not in your health insurance plan.
But: Once again, "grandfathered" plans are exempted.
Annual limits on coverage will be going away.
But: First, they'll be raised to $750,000 for all employer plans and new individual plans, rising to $1.25 million after Sept. 23 of 2011 and then to $2 million the following September. Your existing plan may already have a high dollar limit.
Insurers cannot cancel coverage once you get sick, a practice known as "rescission."
But: If you committed outright fraud and intentionally hid something, your insurer can refuse to pay.
Consumers get direct access to physicians: You - not your insurance company - decide which primary physician, gynecologist, obstetrician and pediatrician you see among your plan's list of approved providers.
But: The usual obstacles remain, like whether the doctor is taking new patients or has an appointment available.
All plans, even "grandfathered" plans, will be prohibited from setting dollar limits on lifetime coverage. No "But" on this one.
I hope you have found this helpful. If you have specific questions regarding your current coverage, please call or email me.