Posted Friday, February 22, 2013

Since the Patient Protection and Affordable Care Act health care reform bill was signed on March 23, 2010, there have been numerous discussions and un-ending media focus on the pros and cons of the bill. Over the course of the next few weeks, we will cover the health care reform pros and cons of the bill’s regulations, chronologically, as they were implemented:

Pros of Health Care Reform 2010

  • Health insurance plans may no longer impose lifetime limits on benefits. They can, however, impose annual limits on certain benefits.
  • Annual limits may not be imposed on ‘Essential’ benefits. The biggest impact from this provision was the removal of limits on brand-name medications and durable medical equipment. Although a plan was not mandated to cover these two items, if they do, they may not impose annual payment limitations.
  • Children may stay on their parents’ policies until age 26, regardless of student status or whether or not they are married.
  • Non-grandfathered plans, (plans that were in place prior to March 23, 2010 and have not changed benefits), must provide preventive services at no cost.
  • Pre-existing condition exclusions were eliminated for children up to age 19.

Cons of Health Care Reform 2010

  • Removal of limitations on benefits and mandated no-cost coverage has resulted in increased costs. The 2012 Kaiser Family Foundation survey reports a 97% total premium increase from 2002-2012 in employer-sponsored health insurance. Nothing is free…everything comes with a cost.
  • Criteria required to retain grandfathered plan status was not released until September 2010, yet was retroactive back to March 2010. Many groups/Individuals unknowingly lost their grandfathered status. For example, if an employer increased their plan coinsurance or reduced their contribution by more than 5%, they lost their grandfathered status and will have to comply with all future non-grandfathered plan regulations.
  • Employers are mandated to provide annual notices to employees of their grandfathered/non-grandfathered status.
  • Employers are required to provide a general notice of pre-existing condition exclusion for children.
  • Employers are required to provide an annual notice elimination of lifetime limits and special enrollment rights.
  • Employers must provide notification of eligibility for children up to age 26 to remain on parents’ policies.
  • A 10% tax on indoor UV tanning services was imposed on July 1, 2010, during the slowest months of the year for these business owners.

It is imperative to recognize the health care reform pros and cons of this bill. The implications will have a resounding impact on future generations.

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