Contents of "Obamacare" - Part 2 - Essential Health Benefits/Wellness Programs/Nondiscrimination

Administrative Simplification. Pages 60 through 80 of the Act, arguably entitled “Administrative Simplifications” make revisions to the Health Insurance Portability and Accountability Act (HIPAA) to set up operating rules for electronic and other health care transactions. The section requires the filing of numerous reports by health plans and government agencies by specific deadlines. Health Insurance Market Reforms. Part I of Subtitle C of the Act deals with reforms such as the prohibition of pre-existing exclusions, the effects of age and tobacco use on the rating of an insurance plan, regulations for open enrollment periods, and guaranteed renewability of coverage for participants. Prohibition of Discrimination against Individual Participants and Beneficiaries. Section 2705 of the law prohibits discrimination due to health status, a physical medical condition, a mental medical condition, claims experience, receipt of health care, medical history, genetic information, evidence of insurability, disability, etc. Wellness programs. The law allows employers to offer lower rates to employees that participate in wellness programs . The Secretary of Health and Human Services is to establish a “demonstration” wellness program in ten states. Prohibition of Waiting Periods: No insurer may install a waiting period of greater than 90 days per the law. Preservation of the Right to Maintain Existing Coverage. The law expressly allows everyone to keep their existing coverage in place at the time the law was enacted and allows any health plans in place under union negotiations to remain in place until their natural expiration. Establishment of Covered Health Plans. Subtitle D of the law, entitled “Available Coverage Choices for All Americans”, calls for the establishment of “covered health plans” under the law and provides a detailed definition of such. Essential Health Benefits. A qualified health plan must provide the following: ambulatory (“one-day”) patient services, emergency services, hospitalization, maternity and newborn care, “mental health and substance use disorder services, including behavioral health treatment”, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness and chronic disease management, and pediatric services including oral and vision care. The Department of Labor will conduct a survey and provide the results to the Secretary of Health and Human Services (HHS) and HHS shall issue a proposed list of covered benefits for public review and comment. Limitation of Deductibles. The law puts a ceiling on the deductible at $2,000 for a single individual plan and $4,000 for all others. Four levels of plans: The law defines four levels of plans based upon the percentage of actual health care costs that they cover: bronze (60%), silver (70%), gold (80%) and platinum (90%). WE ARE NOW TO PAGE 118 OF THIS 2,409 PAGE ACT. NEXT: DOES THE LAW MANDATE THE COVERAGE OF ABORTIONS?