Health-Care Reform Provisions Kicking In

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I've been hearing a lot about the six-month anniversary of health-care reform, and I know that a few parts of the new law are supposed to take effect then. What is changing?

September 23 marks the six-month anniversary of the landmark health-care-reform law, when several key provisions kick in. Despite the hoopla, most consumers won't notice changes in their health-insurance coverage until the beginning of the next plan year (generally January 1 for most people who get their insurance at work). Here's what to expect if you have employer-based coverage. The rules and deadlines are slightly different if you buy your insurance on your own. I'll cover changes that affect individual policies in my next column.

New coverage for kids big and small. One of the biggest changes in the new health-care-reform law is that parents can keep their adult children on their policies up to age 26 (or add them back on to the policy if they had dropped off because they were too old). The rule takes effect in the plan year that starts on or after September 23 (which is January 1 for most employer policies). See Keeping Adult Children Insured for more information about this rule.

Even though coverage won't begin until January 1, 2011, most families who want to take advantage of this new provision have to act soon: You'll need to add your child to your policy during open-enrollment season this fall. See Health Insurance Changes for 2011 for more information about open-enrollment decisions.

If you already have family coverage for younger children, adding an adult child to your policy probably won't cost you extra. But if your employer charges separately for each dependent, it might be cheaper for your adult child to get his own policy. Healthy adults in their twenties can usually buy a policy in most states for less than $100 a month. You can shop for a policy through eHealthInsurance.com , get a list of policies available in your area at www.healthcare.gov , or find a local agent at www.nahu.org .

Younger children also get new protections under the new law. Insurers are prohibited from denying coverage to children under age 19 because of a preexisting medical condition, which applies to most plans on January 1.

Free preventive-care benefits. Many people will no longer have to pay co-payments, coinsurance or meet deductibles for routine preventative care. Depending on your age, this rule may apply to blood-pressure, diabetes and cholesterol tests, mammograms and colonoscopies, flu shots, routine vaccines, and well-baby and well-child visits. While free preventative-care benefits will be available in many employer-based plans beginning January 1, there are exceptions.

For example, these benefits may not apply if you have a "grandfathered" plan. Some existing health plans that have not made major changes to their costs and benefits since health-care-reform was enacted are not subject to some of the consumer protections that new plans or non-grandfathered plans must follow. Ask your insurer whether your plan is considered to be "grandfathered" -- the key word to use to find out whether some of these new provisions will apply to you."

Lifetime-coverage limits disappear. Health plans will no longer be allowed to impose a lifetime dollar limit on most benefits. In the past, seriously ill patients with health-insurance coverage could be on the hook for enormous medical bills once they exhausted their benefits. Annual limits will be phased out gradually between now and 2014. For plan years starting between Sept. 23, 2010, and Sept. 23, 2011, employer plans can't impose annual coverage limits of less than $750,000 (the limit rises to $1.25 million for plan years starting after Sept. 23, 2011).

For more information about health-care reform, see our special report, Health-Care Reform: What It Means to You .



The views and opinions expressed herein are the views and opinions of the author and do not necessarily reflect those of The NASDAQ OMX Group, Inc.



This article appears in: Personal Finance , Insurance

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