Implementation of Obamacare rolls on today, as the administration released some details on the coming end of pre-existing conditions, the minimum benefit standards insurance plans will meet, and wellness programs in employer-sponsored insurance. Now the public gets to weigh in and provide feedback.
BREAKING: HHS releases proposed ACA insurance regulations | Modern Healthcare
BREAKING: HHS releases proposed ACA insurance regulations | Modern Healthcare
Starting in 2014, the Patient Protection and Affordable Care Act will make it illegal for health insurance companies to discriminate against people who have pre-existing conditions, which HHS estimates affect some 129 million nonelderly Americans. In the proposed rule, health insurance issuers would generally be barred from denying coverage for such conditions, and individuals would have new special enrollment opportunities in the individual market when they have certain losses of other coverage. Under the regulation, insurance companies will be permitted to vary premiums within limits based on age, tobacco use, family size and geography. Health insurance companies will no longer be able to use factors such as pre-existing conditions, health status, claims history, gender and occupation as reasons to increase premiums.
HHS also issued a proposed rule that maps out health insurance issuer standards related to essential health benefits (PDF) and the determination of actuarial value. The Affordable Care Act requires that health plans in the individual and small-group marketsboth inside and outside the health insurance exchangesinclude a core package of essential services. Essential health benefits must include products and services in 10 categories, such as emergency services, hospitalization, maternity and newborn care, prescription drugs, mental health and substance-abuse disorder services, and pediatric services that include oral and vision care. The proposed rule prohibits benefit designs that could discriminate against potential or current enrollees, and includes special standards for health plans related to benefits that are not typically covered by individual or small-group plans, such as habilitative services.
HHS, along with the Labor and Treasury departments, also released proposed rules related to employment-based wellness programs. The regulations Tuesday outlined amended standards for nondiscriminatory health-contingent wellness programs that usually require individuals to meet certain health-related standards in order to qualify for a reward.