The Affordable Care Act put into law many requirements on health insurer practices and the policies they sell that are designed to protect the consumer and make buying and using their health plans much easier. Health care consumers and their representatives have been clamoring for many of these changes Below is a brief summary of those changes and requirements.
- No lifetime or annual limits on essential benefits. The ACA ensures that all health plans offer a comprehensive package of items and services known as essential health benefits. They are:
- Ambulatory patient services, such as doctor visits and outpatient services; emergency services; hospitalization; maternity and newborn care; mental health and substance abuse services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.
- Rescissions, which are retroactive cancellations of insurance, may occur only for fraud or intentional misrepresentation of material fact. As of September 23, 2010, Acts 2010, No. 484 included this provision in state law.
- Coverage of preventive health services, such as a wide range of immunizations for children as well as adults, specific preventive services for women, children and depression.
- Extension of adult dependent coverage to age 26. As of September 23, 2010, Louisiana has included this provision in state law.
- Health insurers seeking to increase their rates by 10 percent or more must submit their requests to state or federal reviewers to determine whether they are reasonable or not.
- Plans are no longer allowed to exclude coverage for pre-existing conditions or to adjust your premiums based upon your health status or health status factors, except for tobacco usage.
- Plans are required to offer coverage to all persons seeking coverage during the open annual enrollment period, and are generally required to renew that coverage at the option of the insured.
- Plans are subject to limits on out-of-pocket expenses, which means there is a maximum amount of money that you will be required to pay during each plan year. Once that out-of-pocket limit is met, your plan must cover the remainder of your covered services during the plan year. An out-of-pocket expense includes deductibles, coinsurance, co-payments, and other charges. The out-of-pocket expense limit for the 2014 plan year is $6,350 for an individual and $12,700 for a family plan. In later years, the maximum limit may be adjusted for inflation.