By Sept. 23, a wave of health reform provisions will take effect. But, according to a new phone survey from the National Association of Insurance Commissioners, most consumers don't know exactly what's coming.
NAIC's survey found when asked to choose from four dates for which the first health care reform provisions officially take effect, only 14 percent of respondents correctly identified Sept. 23, 2010.
And when asked about the provisions that will take effect on Sept. 23, most respondents were only in tune to things that affect children. Specifically, 72 percent knew that children with pre-existing conditions may not be excluded from coverage and 70 percent understood that individuals up to age 26 may be covered under their parents' insurance.
"Our survey findings are a clear indicator that most Americans are not aware of how soon some of the early health care changes may impact them," said NAIC President and West Virginia Insurance Commissioner Jane L. Cline, in a statement. "It's essential for consumers to understand what to expect and when to consult their state insurance departments for more information."
The survey also found there's confusion surrounding health plan mandates. Roughly half the respondents think employers with 50 or fewer employees have to provide health coverage by law, when in fact those smaller companies have escaped the mandate. In fact, more than 16 million small business employees work in firms that will be eligible for tax credits under the Affordable Care Act to help offset premium costs, according to The Commonwealth Fund.
And again, roughly half of the respondents mistakenly thought all health insurance plans must cover preventive care and checkups without co-payment, when in fact, only new health plans must cover these services; This provision doesn't apply to plans that are considered grandfathered - those in effect on or before March 23, 2010 - unless those plans lose their grandfather status [see related: Survey: most health plans will lose grandfather status]
However, those qualifying for Medicare will receive new preventive care benefits that will include annual visits free of co-payments, but this is not mandated for all health insurance plans, according to NAIC.
"The results show that while most consumers are well attuned to provisions specifically affecting their children's health care, they do not grasp the overall reform framework," said Cline. "It's promising to see this, but we feel it necessary for consumers to fully understand the changes and get informed about what to expect."
What about transitional plans (bought between March 23, 2010 and Sept. 23 2010)?
- Added protection from having insurance cancelled: An insurance company can't rescind your policy except in cases of intentional misrepresentations or fraud. If your insurer tries to rescind your coverage, it must give you 30 days notice so that you have time to appeal the rescission.
- No pre-existing condition exclusions for children: If you have children under the age of 19 with pre-existing medical conditions, you can add them to your family health insurance plan, and their application for coverage cannot be denied as a result of a pre-existing condition.
- Extended coverage for adult children: Adult children may qualify to remain on their parents' health plan until age 26.
- Lifetime coverage limits: No lifetime limits on the dollar value of those health benefits deemed to be essential by the Department of Health and Human Services.
Mark your calendar for Sept. 23, 2010:
- Dependents (children) will be permitted to remain on their parents' insurance plan until their 26th birthday, and regulations implemented under the Act include dependents that no longer live with their parents, are not a dependent on a parent's tax return, are no longer a student, or are married.
- Insurers are prohibited from excluding pre-existing medical conditions (except in grandfathered individual health insurance plans) for children under the age of 19.
- Insurers are prohibited from charging co-payments or deductibles for Level A or Level B preventive care and medical screenings on all new insurance plans.
- Individuals affected by the Medicare Part D coverage gap will receive a $250 rebate, and 50 percent of the gap will be eliminated in 2011.The gap will be eliminated by 2020.
- Insurers' abilities to enforce annual spending caps will be restricted, and completely prohibited by 2014.
- Insurers are prohibited from dropping policyholders when they get sick
- Insurers are required to reveal details about administrative and executive expenditures
- Insurers are required to implement an appeals process for coverage determination and claims on all new plans.
- Indoor tanningservices are subjected to a 10 percent service tax.
- Enhanced methods of fraud detection are implemented.
- Medicare is expanded to small, rural hospitals and facilities.
- Non-profit Blue Cross insurers are required to maintain a loss ratio (money spent on procedures over money incoming) of 85 percent or higher to take advantage of IRS tax benefits.
- Companies which provide early retiree benefits for individuals aged 55 to 64 are eligible to participate in a temporary program which reduces premium costs.
- A new website installed by the Secretary of Health and Human Services will provide consumer insurance information for individuals and small businesses in all states.
- A temporary credit program is established to encourage private investment in new therapies for disease treatment and prevention.
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