Archive for July, 2013

California Health Reform Rollout to Continue into 2014

July 25th, 2013

If you live in the state of California, you’ve probably heard word of the federal health reform – known officially as the Affordable Care Act – that has been put in place. Many of these changes have already occurred, while others will be implemented on intermittent dates for the rest of 2013 and well into 2014.

Perhaps the biggest change is the introduction of Covered California, the new health insurance marketplace designed to ensure that buyers are getting health insurance policies that meet federal standards for quality and create a competitive landscape for insurance providers. If desired, consumers can still purchase their policies through brokers and directly through licensed carriers; however, the government will be providing subsidies to qualifying patrons through the marketplace.

For customers who wish to use the Covered California marketplace, the open enrollment will begin on October 1, 2013 and end on March 31, 2014. This is the time period during which the buyers can obtain their California family health insurance for the 2014 year.

No matter how you choose to purchase your health insurance, you’ve likely seen and will continue to see the changes in healthcare benefits that have been implemented. For one, the age cutoff for coverage for dependents is now 26 years old, regardless of their current residency, education, employment, or marital status. Furthermore, no enrollees with pre-existing conditions can be denied if they are under the age of 19. While formerly there was a limit on the amount of dollars spent in a lifetime – and sometimes, annually – in healthcare on a specific enrollee, that provision has been lifted. Women’s preventative health services will now be free of charge under the new act as well. Finally, patients have more rights to choose their primary care provider; there is no longer a necessity for a referral for an OB/GYN, no increased copay for out-of-network emergency care, and no need for authorization for emergency visits.

In tandem with the changes to provisions will be the enforcement of new rules. For one, health insurance providers must continue to provide care during time when an appeal is still pending. Under the New Rescission rules, a person cannot have their healthcare rescinded once enrolled under an Individual and Family plan unless they have intentionally misrepresented their facts. Those enrolled in small group health plans will also notice that the Medical Loss Ratio, or MLR, has changed – no more than 80% (85% for large groups) of revenue can be spent on medical costs; if this number is exceeded, the covered person will be entitled to a rebate.

Finally, and perhaps most importantly, all covered persons will receive standard documentation that thoroughly outlines their policies to avoid confusion and insufficient coverage for costs.

Though the healthcare changes got mixed reviews from the public, the changes are put in place and should benefit the customer overall.