Unlimited Benefit Limits-Preventive Services

Unlimited Benefit Limits-Preventive Services

However you want to frame it, nuggets, chunks or hunks (this sounds like a great ice cream cone) of the Patient Protection and Affordable Care Act that President Obama signed into law on March 23, 2010 are beginning to trickle out.  Yes, this bill is intended to expand coverage options for 32 million people, including some changes that positively affect children and families. Several of those key changes are set to take place in October of this year.  Here is a little taste of those changes that we can all agree is better for everyone.

Insurance plans can also no longer impose lifetime caps or restrictive annual limits on coverage, nor rescind coverage when a person becomes sick.  Some current policies have a 1 million or 2 million dollar cap amount.  Can you imagine explaining to your 6 year old son who needs to have an operation that the insurance company will not cover any more services?  I can’t imagine going through and now hopefully no one will either.

New insurance plans must also provide free preventive services to all enrollees. Consumers will be able to receive preventive medical services that are recommended from the US Preventive Services Task Force without co-pays or deductibles as long as the service is provided in network. For children, this includes vaccinations for influenza, diphtheria and tetanus, screenings for hearing and vision impairment and autism.

So, what are the next steps?  Individuals, employers and insurers should review their current health plan designs to ensure compliance with these interim final rules.  Plans, policies, summary plan descriptions, certificates and contracts for health insurance should be amended by the effective date to provide for the new requirements.

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