Commemorating the First Anniversary of Health Care Reform
One year ago, on March 23, 2010, President Obama signed the Patient Protection and Aff ordable Care Act (PPACA). This new law was designed to expand health care access to millions of Americans, improve quality of care and reduce costs.
Cigna supports the reform goals of enhancing access, lowering cost and improving health for all Americans. We're continuing to work hard to help you understand the reform legislation and what it means for you and your family.
Here are some changes that may already affect your plan. However, every plan is different so some changes may not apply to your plan.
Many Cigna plans have already been off ering a lot of the services and benefi ts now associated with reform, including doctor choice, emergency services, preventive care, fair appeals process and cultural sensitivity.
- Preventive care services (like annual physicals) and immunizations must be covered at no cost to you.
- If you’re under 19, you cannot be denied coverage because of a pre-existing condition. This will apply to everyone in 2014.
- No more lifetime limits on the dollar amount your plan pays for essential health benefits throughout your life.
- No more annual limits on the dollar amount your plan pays for essential health benefits by 2014.
- Young adults under age 26 can stay on their parent’s health insurance. It makes no diff erence if they are students, married or have a job.
- All insurance plans must have an internal appeal and external review process that conforms to new federal requirements. Plans will work with you on your appeal in the language you choose, such as English or Spanish.
- If your plan requires or allows you to choose a primary care doctor, you can select a general practitioner, family practitioner, internal medicine specialist or pediatrician.
Women can also select an obstetrician/gynecologist.
- For true emergencies, emergency room services from any hospital must be paid at the in-network level - even for hospitals that aren't in your plan's network.
- Insurance companies cannot retroactively cancel coverage unless fraud occurs or you intentionally give false information, such as knowingly covering someone on your plan who is ineligible.
- You can no longer use your health spending account to pay for most over-the-counter drugs and medicines without a prescription. These accounts include health reimbursement accounts, health savings accounts and flexible spending accounts.
- If you use your health savings account funds for purchases that aren't eligible, you're now subject to a 20% penalty on those purchases.
- For Medicare Part D, you now pay only half of your expenses until you meet your deductible. By 2020, most of these expenses will be completely covered once you meet your deductible.
What are Essential Health Benefits?
"Essential Health Benefits" is a term used in the reform law. It describes items and services that are fundamental to your health. While these items and services have not been defined yet, they are likely to include:
- Emergency services
- Laboratory services
- Maternity and newborn care
- Mental health and substance disorder services, including behavioral health treatment
- Outpatient service
- Prescription drugs
- Rehabilitative and habilitative services*, and devices
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
The reform law calls for work to begin to standardize and simplify documents and terms. Cigna has been providing our customers simplifi ed health care documents and terms for many years.
Employers will report the full value of your health insurance on your W-2 tax form. This is for your information only and will not affect your income or taxes.
States must open new health care exchanges in time for open enrollment and coverage eff ective in 2014. Health care exchanges are virtual marketplaces that can help you compare and buy health insurance. They will mostly be online. Customers may include those buying an individual plan or small employers.
- All individuals must have at least a minimum form of health care coverage. It can either be through an employer or an individual plan. If you don't have this minimum level of coverage, you'll pay a penalty or tax.
- All exchanges must be fully up and running.
- Essential health benefi ts will be defined.
- All employers with 50 or more employees must provide affordable health insurance.
For More Information
Every health plan is diff erent. If you have questions about how health care reform aff ects your plan, please contact your employer or insurance broker.
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