Under the new health care reform law, group health plans must now conform to standards of coverage. Here are three of the biggest changes that affect who qualifies, coverage limits and essential benefits.
Pre-existing Conditions – One of the most important provisions of health care reform is that an individual cannot be excluded from a plan on the basis of a pre-existing medical condition. Plan members may also not be charged more because of a pre-existing condition, nor can they be refused treatment due to health status. While this aspect of the law opens up coverage more equally and to more people, it also puts more emphasis on the importance of prevention and wellness as part of a quality health plan.
Lifetime Dollar Limits – Somewhat tied to the limits removed for those with pre-existing conditions, the lifetime dollar limits previously imposed by some insurance companies are also a thing of the past. This is another benefit for those who require long term care or are dealing with chronic health issues. It’s also another instance of how an effective and affordable health plan can be viewed as a tremendous benefit to a prospective employee.
Essential Health Benefits – Along with the removal of many limitations on health coverage, the Affordable Care Act also requires that certain essential health benefits be a part of any health insurance plan. The components that make up the essential benefits cover a range of treatments: hospitalization and emergency services, newborn care & maternity, mental health and substance treatment, disease management, wellness and prevention, pediatric care and prescription drug coverage, just to name a few. For a full list and explanation of the essential health benefits, visit this resource from healthcare.gov.