New PPACA Provisions Take Effect in September - But Do Your Clients Know?

So what can you do to help? The answer is simple – pick up the phone, send an email, or contact your clients in some way to let them know about the health reform provisions that begin in September. Then, if they still have questions, be prepared to answer them to the best of your knowledge, and hunt down any answers that you don’t immediately know.

To help you answer the questions that may arise, here is a list of the provisions that kick in on Sept. 23. The complete list of PPACA provisions, categorized by effective date, can be viewed on ASJ’s reform timeline.

• Dependents will be permitted to remain on their parents’ insurance plan until their 26th birthday. Under the rules, plans must cover the dependents regardless of whether the dependent lives with their parents, is a dependent for income-tax purposes, receives financial support from their parents, is no longer a student, or is married.
• Insurers are prohibited from excluding pre-existing medical conditions (except in grandfathered individual health insurance plans) for those younger than 19.
• Insurers are prohibited from charging copayments or deductibles for Level A or B preventive care and medical screenings on all new insurance plans.
• All individuals affected by the Medicare Part D coverage gap will receive a $250 rebate. The first round of checks was mailed on June 10, 2010. Fifty percent of the gap will be eliminated in 2011; the gap will be completely eliminated by 2020.
• Insurers will be restricted on their ability to enforce annual spending caps, and completely prohibited from doing so by 2014.
• Insurers are prohibited from rescissions, or dropping policyholders when they get sick.
• Insurers are required to share details about administrative and executive expenditures.
• Insurers are required to implement an appeals process for coverage determination and claims on all new plans.
• Indoor tanning services are subject to a 10 percent tax.
• Fraud detection efforts are expanded.
• Medicare is expanded to small, rural hospitals and facilities.
• Nonprofit 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 that provide early-retiree benefits for people aged 55 to 64 are eligible to participate in a temporary program that 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 will encourage private investment in new therapies for disease treatment and prevention.

Heather Trese is the associated editor of the Agent’s Sales Journal. She can be reached at 800-933-9449 ext. 225 or [email protected].