By Karyn Oyler, SPHR

As each HR professional tries to sort through the flood of information, articles, websites and seminars regarding the new Health Care Reform Act it can get rather confusing. Since there is so much information about each portion of the bill, it is too much for everyone to absorb all at once.

Personally…I think understanding the legislation form a big picture standpoint is a good place to start and then with a timeline of when each item is rolled out, we can drill down into the sections on an as needed basis. As the old saying goes…”How do you eat an elephant??? One bite at a time.”

As always…I like to provide everyone with the sources of my information. The best website I have found for information regarding the new law is the government website www.healthcare.gov. This is a very comprehensive website that will be able to answer many of your questions regarding the new law and what to do next. For a big picture overview of what the law can do for you, click on the “Information for You” tab and review each item. For a timeline of rollout dates and details on each provision, click on the “Understanding the New Law” tab. Here you will find a very user friendly timeline so you can easily see when each provision goes into effect. For details on each provision, click on the “Provisions” tab and select the provision you would like to learn more about. It is a very useful site.

September 23, 2010

Last Thursday on September 23rd, several new provisions of the Health Care Reform Act went into effect. According to the Healthcare.gov website, here are the 7 provisions that went into effect last week and a brief description of each one. Follow the links to learn more details about each provision.

• Extended Coverage for Young Adults
o Effective for health plan years beginning on or after September 23, 2010
o Under the new law, young adults will be allowed to stay on their parent’s plan until they turn 26 years old. (In the case of existing group health plans, this right does not apply if the young adult is offered insurance at work.) Some insurers began implementing this practice early. Check with your insurance company or employer to see if you qualify.
o For additional information, click http://www.healthcare.gov/law/provisions/youngadult/index.html

• Providing Free Preventative Care
o Effective for health plan years beginning on or after September 23, 2010.
o All new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance.
o For additional information, click http://www.healthcare.gov/law/provisions/preventive/index.html

• Prohibiting Insurance Companies from Rescinding Coverage
o Effective for health plan years beginning on or after September 23, 2010
o In the past, insurance companies could search for an error, or other technical mistake, on a customer’s application and use this error to deny payment for services when he or she got sick. The new law makes this illegal. After media reports cited incidents of breast cancer patients losing coverage, insurance companies agreed to end this practice immediately.
o For additional information, click http://www.healthcare.gov/law/provisions/Curbing%20Insurance%20Cancellations/cancellations.html

• Appealing Insurance Company Decisions
o Effective for new plans beginning on or after September 23, 2010
o The law provides consumers with a way to appeal coverage determinations or claims to their insurance company, and establishes an external review process.
o For additional information, click http://www.healthcare.gov/law/provisions/appealing/appealinghealthplandecisions.html

• Eliminating Lifetime Limits on Insurance Coverage
o Effective for health plan years beginning on or after September 23, 2010
o Under the new law, insurance companies will be prohibited from imposing lifetime dollar limits on essential benefits, like hospital stays.
o For additional information, click http://www.healthcare.gov/law/provisions/limits/limits.html

• Regulating Annual Limits on Coverage
o Effective for health plan years beginning on or after September 23, 2010
o Under the new law, insurance companies’ use of annual dollar limits on the amount of insurance coverage a patient may receive will be restricted for new plans in the individual market and all group plans. In 2014, the use of annual dollar limits on essential benefits like hospital stays will be banned for new plans in the individual market and all group plans.
o For additional information, click http://www.healthcare.gov/law/provisions/limits/limits.html

• Prohibiting Denying Coverage of Children Based on Pre-Existing Conditions
o Effective for health plan years beginning on or after September 23, 2010 for new plans and existing group plans
o The new law includes new rules to prevent insurance companies from denying coverage to children under the age of 19 due to a pre-existing condition.
o For additional information, click http://www.healthcare.gov/law/provisions/ChildrensPCIP/childrenspcip.html

Another great resource is the www.shrm.org website. They have established a special “Health Care Reform” page. To see this page, visit http://www.shrm.org/hrdisciplines/benefits/Articles/Pages/HealthCareReform.aspx. Here you will find articles and resources to help guide you through the rollout process. Click here to see SHRM’s own timeline for the rollout: http://www2.shrm.org/HC_Timeline/scroller3.html.

If you have any additional resources that you would like to share with the group, please feel free to email me at karynoyler@yahoo.com. I will be happy to gather the information/resource and pass it on to the rest of the organization.