Friday, October 30, 2009

The Final House Bill--Title I

I've begun reading the final House Bill.

Title I of the bill deals with the immediate reforms that will take place on January 1, 2010.  Here is what will happen:


Sec. 101. National high-risk pool program.  A temporary high-risk pool program would be established on January 1, 2010 to provide health benefits to individuals who have been denied coverage because of a pre-existing condition, were offered coverage that excluded pre-existing conditions or were offered coverage at a premium rate above the rate for the temporary high-risk pool program.  That means if you can not get affordable coverage now, you will be able to get it as of January 1st.

Sec. 102. Ensuring value and lower premiums.  Health insurance issuers would have to report their medical loss ratio.  If their medical loss ratio was below 85% (or a lower level as specified by the Secretary), the insurance company will have to rebate the difference to its enrollees.  This terminates when the health insurance exchange is established.

Sec. 103. Ending health insurance rescission abuse.  Insurance companies will not be allowed to rescind individual or group coverage without convincing evidence of fraud.  Individuals or groups that have their insurance rescinded will have the opportunity to challenge the rescission with a third-party review.

Sec. 104. Sunshine on price gouging by health insurance issuers.  Insurance companies will have to justify increases in premiums prior to implementation of the increases. 

Sec. 105. Requiring the option of extension of dependent coverage for uninsured young adults.  Insurance companies will have to cover children of enrollees up to age 27 who are not otherwise covered.

Sec. 106. Limitations on preexisting condition exclusions in group health plans in advance of applicability of new prohibition of preexisting condition exclusions.  Until preexisting conditions exclusions are totally prohibited, insurers will be able to exclude preexisting conditions only if they occurred within a shorter period such as 30 days (the permissible look-back period allowed varies from 9 months to 30 days depending upon section of existing law that is being amended. 

Sec. 107. Prohibiting acts of domestic violence from being treated as preexisting conditions.  An insurer will not be allowed to impose a preexisting condition exclusion on the basis of domestic violence.

Sec. 108. Ending health insurance denials and delays of necessary treatment for children with deformities.  Insurers must cover outpatient and inpatient diagnosis and treatment of an enrollee’s  minor child’s congenital and developmental deformity, disease, or injury if the child is under 21.

Sec. 109. Elimination of lifetime limits.  Insurers may no longer impose lifetime limits or caps on coverage.

Sec. 110. Prohibition against postretirement reductions of retiree health benefits by group health plans.  Insurers can not cut retiree benefits.

Sec. 111. Reinsurance program for retirees.  A temporary reinsurance program will be established to reimburse employment-based plans for 80% of the cost of providing health benefits to retirees (55 and older and not eligible for Medicare or Medicaid), eligible spouses, surving spouses and dependents if claim exceeds $15,000 up to $90,000.  Payments must be used to reduce the cost of health insurance premiums, contributions, copayments and so on.

Sec. 112. Wellness program grants.  Small employers will be provided with grants for up to 3 years and a total of $50,000 to cover 50% of the cost of wellness programs.  Wellness programs are those related to tobacco use, obesity, stress management, fitness, nutrition, substance abuse, depression, and mental health promotion.

Sec. 113. Extension of COBRA continuation coverage.  COBRA coverage is extend until the date the individual would be able to purchase insurance through the insurance exchange.

Sec. 114. State Health Access Program grants.  Grants would be made to states to help them expand their state health insurance programs to expand coverage to the uninsured.

Sec. 115. Administrative simplification.  Six months after enactment of this law the Secretary is required to submit a plan for administrative simplification (use of electronic record keeping primary) in order to reduce costs including provisions to protect the privacy of records.

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