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Benefits Law
Alert
AGENCIES ISSUE INTERIM FINAL REGULATIONS FOR NEW
PATIENT'S BILL OF RIGHTS UNDER HEALTH CARE REFORM LEGISLATION
by Kristi Gauthier
The Departments of Health and Human Services, Treasury,
and Labor have issued interim final regulations to execute a new
"Patient's Bill of Rights" under the recently enacted
Patient Protection and Affordable Care Act (the "Affordable Care
Act").
The following provisions in the Patient's Bill of
Rights, aimed at extending coverage and reducing patient costs, take
effect for plan years beginning on or after September 23, 2010
(January 1, 2011 for a calendar year plan):
· No
pre-existing condition exclusions for children under the age of 19.
This prohibition includes both benefit limitations and outright
coverage denials (applies to all health plans except for
grandfathered individual policies, and will be extended to also cover
all adults over 19 in 2014);
· No arbitrary rescission of insurance
coverage, except in cases of fraud or intentional misrepresentation
of material facts. Where insurers and plans rescind coverage, they
must provide at least 30 days advance notice and time to appeal
(applies to all individual and group health plans without exception);
· No lifetime limits on coverage (applies to all individual and group
health plans without exception);
· No restricted annual dollar limits on
coverage. The
rules will phase out the use of annual dollar limits over the next
three years until the Affordable Care Act bans them for most plans in
2014. Group health plans and all new individual market plans
issued or renewed beginning September 23, 2010, will be allowed to
set annual limits no lower than $750,000. This minimum limit
will be raised to $1.25 million beginning September 23, 2011, and to
$2 million beginning on September 23, 2012. Employers and
insurers seeking to delay complying with these rules may obtain
permission from the government if their current annual limits are
necessary to prevent a significant loss of coverage or increase in
premiums (applies to all health plans except grandfathered individual
policies);
· No limitation on patient choices for
primary care physicians, including pediatricians (applies to all individual and group
health plans unless grandfathered);
· No referral requirements for OB-GYN care (applies to all individual and group
health plans unless grandfathered); and
· No higher cost-sharing charges for
emergency services obtained outside a plan's network (applies to all individual and group
health plans unless grandfathered)
The agencies are accepting comments until August 27,
2010, when these interim final regulations become effective.
If you have any questions please contact: Edward C. Hammond at
(248) 988-1821 - ehammond@clarkhill.com
, John P. Schneider at (616) 608-1108 - jschneider@clarkhill.com
or Kristi R. Gauthier at (248) 988-5854 - kgauthier@clarkhill.com.
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