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Tag Archives: Preexisting condition exclusions
‘Bill of rights’ brings hope, but also frustration
The regulations in the Patient Protection and Affordable Care Act’s Patient’s Bill of Rights, which address preexisting condition exclusions, retroactive rescissions, lifetime limits, annual dollar limits and other consumer-protection mandates, aim to “put American consumers back in charge of their health coverage and care,” according to a healthreform.gov fact sheet.
However, after a week to digest the legislation’s interim final rules, EBA’s health reform panelists are left wanting more.
For Dave Lapka, president of logistics consulting company D360, the issue begins with the title.
“Interesting choice of titles: ‘Patient’s Bill of Rights.’ The definition of rights as applied in the U.S. Constitution represent things that the government can’t take away from states or citizens,” he says. “The term ‘rights’ in this application is really just a listing of minimally acceptable cost levels. It then includes the possibility of waivers, so that significant cost increases or coverage limitations don’t occur. So you might have changes or you might not — a bureaucrat will decide once the political winds are determined. If policies are ‘waive-able’ were they ever really rights?”
Lapka refers to a provision in the rules that allows for plans with an annual dollar limit, such as limited medical plans, to seek a waiver that would allow for a delay in compliance as long as the plan “can prove that its current annual limits are necessary to prevent a significant loss of coverage or increase in premiums,” according to a Hewitt overview. Continue reading
Gov’t unveils new Patient’s Bill of Rights under PPACA
Federal regulators released interim final rules implementing a new Patient’s Bill of Rights under the Patient Protection and Affordable Care Act. The guidance addresses preexisting condition exclusions, retroactive rescissions, lifetime limits and annual dollar limits.
Source: Employee Benefit News article used by permission
“These rules effectively put in place a basic set of consumer protections known over the years as the ‘Patient’s Bill of Rights.’ This is a concept introduced 15 years ago and supported by both Democrats and Republicans,” said Secretary of Health and Human Services Kathleen Sebelius in an e-mail statement.
The Federal Register will publish the rules on June 28. The new regulations, issued by the Departments of Health and Human Services, Labor and Treasury, will take effect for most plans on or after Sept. 23. For calendar year plans, the rules will take effect Jan. 1, 2011.
The interim final rules, which are nearly 200 pages, focus on PPACA provisions that apply to all health plans, including grandfathered health plans. According to consultants at Hewitt Associates, the provisions in the interim final rules adopt the following: Continue reading
