Wednesday, September 15, 2010

Reform brings stability to one family

By Michelle Andrews
updated 9/15/2010 8:32:25 AM ET

For many years, Ric and Jill Lathrop held their breath when the annual open enrollment period for their health insurance plan rolled around. Their two boys, now 12 and 14, have severe hemophilia, and each needs twice-weekly injections of a blood clotting replacement factor that costs roughly $250,000 per person per year. The couple lived in fear that their health plan would put a lifetime limit on their benefits.

In 2005, that's what happened. The Oshkosh, Wis., hospital where Ric Lathrop worked as an MRI technician instituted a $2 million lifetime cap on benefits for the entire family. Rather than wait for their benefits to run out, the Lathrop family relocated to Illinois, where Ric Lathrop got a job at a hospital in Peoria; along with the job came insurance without lifetime limits.

If that coverage had changed, the Lathrops might have had to move again . . . and maybe again. But the federal health-care overhaul makes further wandering unnecessary. Starting Sept. 23, the new law requires that when health plans renew their coverage for the coming year, they eliminate lifetime limits on coverage.

"It gives us a lot of reassurance to know our kids can have more freedom," says Jill Lathrop.

The elimination of lifetime caps on benefits is one of several provisions that will begin to take effect Sept. 23, six months after enactment of the law. Health plans don't have to implement the provisions until their next annual renewal date; since most plans begin their coverage year on Jan. 1, that's when many consumers will start to see changes.

As you sign up for coverage this fall, here's what to look for:

Extension Of young adult coverage

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Prohibition on coverage exclusions for kids with preexisting conditions

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Restriction on annual dollar coverage limits

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Additional provisions take effect on or after Sept. 23 for new plans offered by employers or purchased by individuals since March 23. These include requirements that insurers:

* Cover the full cost of preventive services that have the highest recommendation of the U.S. Preventive Services Task Force.
* Allow women to see an Ob-Gyn without a referral.
* Do not make plan members pay higher co-payments or coinsurance for out-of-network emergency services.

The federal government has a website with more detail about the provisions that take effect for plan years beginning on or after Sept. 23.


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