September 23, 2010, a key date under this year’s federal health care reform legislation, is just around the corner. What does this mean for you? It means that your health plan must be in compliance with the following health care reforms, beginning on the first day of your plan’s next plan year:
· Adult child coverage to age 26
· Restrictions on annual limits on essential health benefits
· No lifetime limits
· No retroactive cancellation of coverage, absent fraud or misrepresentation
· No pre-existing condition exclusions for participants under age 19
If you have a calendar year plan, that means these reforms go into effect on January 1, 2011.
If your plan is not grandfathered, you must also comply with the following reforms by the first day of your next plan year (January 1, 2011 for calendar year plans):
· No cost-sharing on preventive care
· Medical retention standards
· Nondiscrimination rules for insured plans
· Enhanced claims and appeals procedures
· Patient protections, including the right to choose primary care provider, no referral or preauthorization on OB-GYN care, uniform payment for emergency services regardless of whether they are in-network or out-of-network
For all employers participating in the Vigilant Group Benefits Trust, these reforms will go into effect on January 1, regardless of when your participation in the Trust renews. Have questions about how health care reform applies to your plans? Contact Vigilant.