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On September 23rd, the new health care law:
Ends pre-existing condition exclusions for children under 19. As of September 23rd, insurance companies can no longer deny coverage to children based on a pre-existing condition or institute benefit limitations.
Bans arbitrary rescissions of insurance policy. Insurance companies can no longer drop your coverage when you get sick and need it most. Under the new regulations insurers and plans are prohibited from rescinding coverage--for individuals and groups of people--except in cases of fraud.
Gets rid of lifetime limits. No longer can insurance companies stop paying for your care once you hit your lifetime 'cap' on coverage. Currently, once you reach your policy's lifetime limit, the policy is revoked, leaving you with 100% of the cost of all future medical expenses. This new regulation prohibits lifetime limits in all health plans and insurance polices issued or renewed on or after September 23rd.
Restricts annual limits. Annual limits are less common than lifetime limits, but follow the same general idea. The new rules will phase out the use of annual dollar limits over the next three years until 2014 when the Affordable Care Act bans them for most plans.
Institutes a new appeals process. Plans issued on or after September 23rd must include streamlined guidelines for an internal appeals process. They must also include an external process for appeals, so that if the insurance company denies a claim the policy holder can take it to an external reviewer not employed by the insurance company. These regulations include provisions mandating there is an expedited process for emergency cases and that the insurance company picks up the lion's share of the cost for external reviews.
Allows young adults up to the age of 26 to stay on their parent's plan. Young adults will now able to be put onto their parent's plan as a dependent on open enrollment periods after September 23rd. The person needs to be under the age of 26, but doesn't need to be filed as a dependent on tax statuses, or be a student; they can also be married and still be eligible for coverage. They only need to be the legal child of the parent looking to add them to their plan.
Mandates free preventive care. All plans offered on or after September 23rd must give policy holders free preventive care benefits including coverage with no-cost sharing for all preventive services labeled A or B by the U.S. Preventive Services Tax Force, which include: annual check-ups, mammograms, colonoscopies, diabetes screening, depression screening, STD screenings, and other preventive care screenings and tests. It also includes vaccinations for children, autism screenings for children, hearing and vision screenings and other additional screenings for children.
Creates small business tax credits. The first round of small business tax credits are available this year to qualifying businesses. Tax credits of up to 35% of premiums will be available to firms that choose to offer health care coverage. There is also up to 25% tax credits available to small non profits that offer health insurance.
Issues a rebate check to seniors in the 'donut hole.' This year seniors stuck in the donut hole in Medicare Part D will receive a $250 check to help with the costs. Effective next year, the donut hole will begin to shrink every year until it is closed in 2020. Also, seniors will receive a 50% discount on brand name drugs and 7% on generics next year if they hit the donut hole.
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