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Coverage of Preventive Health Care Required under Reform bill


March 24, 2010

By Marcus Wilip

In my ongoing quest to read the entire Patient Protection and Affordable Care Act page-by-page to see exactly what is inside. I have come across one of my favorite topics: Preventive Treatment.  I give you…

SEC. 2713. COVERAGE OF PREVENTIVE HEALTH SERVICES.

Basically this section says the insurance companies cannot “impose any cost sharing requirements” for certain preventive treatment. Meaning that insurance companies will have to foot-the-entire-bill for preventive treatment in the future if this bill stands. This is a huge provision and it is rarely, if ever, mentioned by the mainstream media.

Currently many health insurance plans require patients to pay for physicals, OBGYN visits and their related diagnostic tests until the member first satisfies their calender year deductible. That means that today most people pay for most preventive work with money out-of-pocket. Some insurance plans on the market today will request a doctor visit co-pay of say $40 but will not cover the related preventive lab work. It is rare to find a plan that has no doctor visit co-pay and covers all related diagnostic testing. The only examples I can think of are very expensive comprehensive HMOs and some of the high deductible HSA plans.

The tests that are covered under the new bill are designed to match the current recommendations of the United States Preventive Services Task Force. Unfortunately this site is a mess and it is unclear exactly what it covered and what is not.

Immunization are also required to be covered at no cost as long as they are recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention 

When will Coverage of Preventive Health Services take place?

It is unclear when health insurance companies will have to offer full reimbursement of these preventive services.. The document says the minimum shall not be less than 1 year. Ok, so we know it won’t happen for at least a year. But what is the maximum time before this will be implemented on all health insurance plans. I haven’t figured that one out yet. If I do come across it I’ll post it up here.

Fun fact of the day: There is no such word as preventative. It’s preventive. Now you to can feel smug and correct others who mispronounce the word.

My next post:
How this confusing to read bill will force health insurance companies to explain their benefits is a simple and standard way.  Sounds like fun!

 




Comments for Coverage of Preventive Health Care Required under Reform bill

By Douglas Thompson on April 21, 2010

Health Care Reform Act-intent for Change

For many years, America’s health brokers have been offering health insurance to individuals, small businesses and large businesses for decades, yet the enrollment statistics have revealed a steady decrease on an annual basis.  The number of uninsured Americans is estimated to be as high as 30 million, and the Health Care Reform Act offers a solution.  Not only will there be a higher enrollment number for America’s health brokers, but as of 2014, it will be required by law for every American to obtain health insurance.  Every single American will be impacted by the New Health Reform Bill, making it one of the most important measures of the 21st Century.
Businesses
The main focus will be on businesses of 50 or more employees, in which they will be required to offer individual health plans, as well as family plans to all employees or face some stiff fines from the government.  The amount comes to $2000 per uninsured employee, though there are exemptions to this fine.  If you as an employer assist an individual with acquiring a personal health insurance plan through an open market called an exchange, then it would result in no fines.  This only applies to an individual who makes a certain amount under the Federal Poverty Level, and the premiums are over 8% of his annual income.
America’s health brokers can rest easy in the fact that there will be expanded coverage, though there may be more competition.  With the rise in individuals who will have health insurance, there may not be as large of a risk as one may assume.  Though the new bill will require America’s health brokers to enroll individuals with pre-existing conditions, there will also be a new population of young individuals who will be insured with fewer health problems.
It is understood that larger companies already provide a group insurance plan (HMO, PPO) that covers all areas of needs for the population of employees.  These policies will change very little, but there may be some changes in where the funding for the new health care plan will come.  It is proposed that those making a certain amount of money, both individuals and couples, will be taxed at a higher percentage than others.  This will provide money that can be used for the exchange and making sure that all individuals will be offered an affordable health plan.
There are still a few years before the plan goes into full effect, though some of the measures will be enforced immediately.  There will be plenty of time to sort out the details and iron out the difficulties.  As for the plan, anyone who does not have health insurance as of January 1, 2014, will be penalized a certain amount of money, and this amount could become worse if health insurance is continuously neglected.  There has never been a better opportunity for America’s health brokers in terms of acquiring a new customer base-a broader customer base.  Also, there has never been a better time in history for individuals being provided with the resources for the necessary medical treatment.  This is a very unique time, with history in the making.  Finally, there will be health care for all.


By Douglas Thompson on April 22, 2010

A Government proposal for Change-Health Care Reform Act

March 2010 may stand out as a monumental month for change with the Obama Administration-Americans can look forward to changes in the current health care system through the passing of the Health Care Reform Act.  Though there are many details that need to be ironed out, there are many changes that have been established. 

There are two factors that will have the largest impact for Americans and America’s health brokers:
1)  The fact that as of 2014, it is required by law for employers to offer affordable health insurance plans to all employees. 
2)  As of 2014, all Americans will be required to acquire health insurance.

Employers-For businesses over 100 employees, there may not be many changes.  The difference may be that part-time employees will be offered aid with a percentage of hours in relation to full-time employment.  This will offer benefits to those who do not have that same opportunity currently as a part-time employee.  With businesses under 100 employees, there will be opportunities for credits from the government to offer aid with those employees.  A percentage will be paid, based on payroll that will pool to help those who acquire insurance through an exchange, where many of America’s health brokers will provide different affordable insurance plans for all individuals. 
What is the incentive for employers to offer insurance? 
Employers will face a fine of up to $2000 per employee for not providing insurance coverage to an individual employee.  These fines can be diverted if the employer offers an alternative means to acquire insurance (which would require assistance through the exchange).
Individuals-As of 2014, all Americans (with the exception of certain special case individuals) will be required to carry some form of insurance.  Insurance will either be offered through employment or affordable insurance can be purchased through the exchange.  America’s Health brokers will offer many new plans and opportunities to acquire cheap health insurance.
What is the incentive for individuals to acquire insurance?
According to the law, there will be a penalty assessed to all Americans who fail to acquire health insurance by the year 2014.  The fine will be originally set at $695 per person, per year.  This will hopefully be enough to encourage those who are not insured to carry some form of low cost health insurance. 
America’s health brokers will be seeing some changes that could affect them.  Pre-existing conditions will no longer be applicable in denying insurance to children.  As of 2014, America’s health brokers cannot deny health insurance to anyone due to a pre-existing condition.  There are other factors that will change certain policies and conditions. 
The Health Care Reform Bill is an opportunity to reorganize the condition of care that is offered in the United States.  There are many issues that riddle the care of many Americans, so hopefully this will provide solutions to some of the larger issues.  One key aspect is the fact that all Americans will have the opportunity to have health care.  This will be advantageous in many aspects:  Prescription medications, preventative care, and treatment.



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