In your most recent column, you talked about how the
provisions of the health-care-reform law that
took effect on September 23
would affect people with health-insurance coverage through their
employers. How will these new rules affect people who buy health
insurance on their own?
Many of the changes in health-insurance coverage for individuals
are similar to those for people who are covered through their
employer, but the timeline is different. Employer-provided plans
have a standard open-enrollment period and renewal date, and most
of the changes in employer plans will take effect on January 1. But
the renewal schedule for individual plans varies depending on when
you bought the policy. The changes will take effect whenever the
individual plan renews after September 23 -- which could be very
soon or many months from now. Ask your insurer when your policy
renews.
A few of the new consumer protections will be a bit different,
too, because of existing rules about who can be rejected under
individual policies. Most employer policies have always provided
coverage for employees and their families regardless of their
health. But when you buy a policy on your own, the insurer can
still reject you or charge a higher rate based on your medical
condition -- a process called underwriting. (Starting in 2014,
insurers will no longer be allowed to reject anyone because of
their health.)
For example, the rules about offering dependent coverage to
children up to age 26 are more complicated if you have an
individual policy. With employer policies, you can now add any
child up to age 26 to your coverage, regardless of their health or
previous coverage, as long as they don't have a job that offers
health insurance. But if you have an individual policy, the insurer
is required to offer dependent coverage to children, regardless of
their health, only if they had been covered by your policy in the
past, says Brian Mast, vice-president of communications for
eHealthInsurance.com. "If they were never on your policy, you may
still be able to add them," says Mast. "But health reform does not
require
the insurance company to let them on a plan without
underwriting."
But depending on their age, your kids may be protected by
another rule that takes effect for plan years starting after
September 23, when insurers can no longer exclude children under
age 19 from coverage because of a preexisting condition. This rule
applies to new plans and to
nongrandfathered
plans -- plans that have made significant changes to their premiums
and benefits since health-care reform was enacted. But it does not
apply to
grandfathered
plans -- those that have remained essentially the same since
health-care reform was enacted on March 23, 2010. Grandfathered
plans can still require medical underwriting, even for children
under age 19. Ask your insurer whether your plan is considered to
be grandfathered.
If you'd like to add a young adult to your policy, check the
time frame -- your plan is required to give you written notice of a
30-day period during which you can add eligible children up to age
26 to your policy. And find out how much the insurer charges to
cover the child. If the insurer charges an extra premium for each
dependent, compare the cost to having your child buy his or her own
policy. Healthy twentysomethings can usually buy policies for less
than $100 per month in most states.
If your policy is not grandfathered, insurers are also required
to provide coverage for certain preventive services without
deductibles or co-payments for plan years starting after September
23. See my
Health-Care Reform Provisions Kicking In
column for details. Policies that are considered to be
grandfathered, however, are not required to provide these free
benefits.
A few key benefits apply to all individual policies when they
are issued or renewed after September 23, regardless of whether
they are considered to be grandfathered. Policies are no longer
allowed to impose lifetime dollar limits on most benefits. And if
you lost your health coverage because you exceeded your policy's
lifetime-coverage limit -- but still qualify for the plan -- your
insurer must notify you that you're eligible to re-enroll in the
same plan, says Mast. If the same plan is no longer offered, you
may apply to enroll in a new plan with unlimited lifetime coverage.
Also, insurers cannot drop you because you get sick; they can only
rescind your coverage if you committed fraud or made an intentional
misrepresentation to the insurer.