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A New Patient’s Bill of Rights
On September 23rd 2010, critical new consumer protections in the new law – a Patient’s Bill of Rights -- begin to take effect. The Patient’s Bill of Rights puts an end to some of the worst insurance company abuses, and puts consumers, not insurance companies, in control of their health care. These new protections include:
Ban on Discriminating Against Kids with Pre-Existing Conditions:
Before reform, tens of the thousands of families had been denied insurance each year for their children because of an illness or condition. Starting September 23rd, plans cannot discriminate against kids with pre-existing conditions. In 2014, no one seeking coverage can be discriminated against because of a preexisting condition. Up to 72,000 uninsured children are expected to gain coverage by banning insurers from refusing them coverage due to a pre-existing condition. Coverage for up to 90,000 children will no longer exclude benefits because of a pre-existing condition.
Ban on Insurance Companies Dropping Coverage:
Before reform, insurance companies could cancel your coverage when you got sick and needed it most because of a simple mistake on your application. Starting September 23rd, insurance companies are banned from cutting off your coverage due to an unintentional mistake on your application. Approximately 10,700 people’s coverage, whose coverage is dropped each year because they get sick or make a technical mistake on their application, will be protected under the new law.
Ban on Insurance Companies Limiting Coverage:
Before reform, cancer patients and individuals suffering from other serious and chronic diseases were often forced to limit or go without treatment because of an insurer’s lifetime limit on their coverage. Starting September 23rd, insurance companies can no longer put a
lifetime limit on the amount of coverage they provide, so families can live with the security of knowing that their coverage will be there when they need it most. Up to 20,400 people who typically hit their lifetime limits on the dollar amount that can be spent on coverage,
along with the nearly 102 million enrollees who have policies with lifetime limits, will no longer have to worry about hitting their benefits caps. The use of annual dollar limits will be restricted, and in 2014will be banned completely. By 2013, up to 3,500 people will gain coverage as a result of the ban on annual limits that insurers impose on nearly 18 million people today.
Ban on Insurance Companies Limiting Choice of Doctors:
Before reform, insurance companies could decide which doctor you could go to. Starting September 23rd, if you purchase or join a new plan you have the right to choose your own doctor in your insurer network. Up to 88 million people will benefit from the provision that protects primary care provider choice by 2013.
Ban on Insurance Companies Restricting Emergency Room Care:
Before reform, insurance companies could limit which emergency room you could go to or charge you more if you went out of network. Starting September 23rd, if you purchase or join a new plan, those plans are banned from charging more for emergency services obtained out of network. Up to 88 million people will benefit from this provision.
Guarantee You a Right to Appeal:
Before reform, when insurers denied you coverage or restricted your treatment, you were left with few options to appeal. Starting September 23rd, if you purchase or join a new policy, you will be guaranteed the right to appeal insurance company decisions to an independent third party. Up to 88 million people will benefit from the new appeals process provisions by 2013.
Covering Young Adults on Parent’s Plan:
Starting September 23rd, young adults will be allowed to remain on their parent’s plan until their 26th birthday, unless they are offered coverage at work. Up to 2.4 million young adults, up to 1.8 million who are uninsured and nearly 600,000 who purchase coverage in the
individual market, could gain coverage through their parents.
Covering Preventive Care With No Cost:
Starting September 23rd, if you join or purchase a new plan, you will receive recommended preventive care with no out-of-pocket cost. Services like mammograms, colonoscopies, immunizations, pre-natal and new baby care will be covered and insurance companies will be
prohibited from charging deductibles, co-payments or co-insurance. Up to 88 million people will have access to preventive care with no out of pocket costs.
Six Months of Progress
In addition to implementing the Patient’s Bill of Rights, the Obama Administration has worked to deliver other benefits of reform to the American people. In the last six months, the Administration has:
Fought Waste, Fraud and Abuse: The Affordable Care Act includes robust new tools that will help fight fraud and protect taxpayer dollars. Using these new tools, HHS Secretary Kathleen Sebelius has pledged to cut Medicare’s error rate (the percentage of claims paid inappropriately) in half by 2012. A proposed regulation that implements the first round of Affordable Care Act policies to combat Medicare and Medicaid fraud was issued on September 17.
Helped Fight Premium Increases: The Affordable Care Act also includes critical new resources and authorities to crack down on unjustified rate hikes. Today, 46 states are using resources under the new reform law to pass or strengthen premium rate review laws which will have a significant impact on keeping year-to-year increases in premiums low. In a number of states (California, Massachusetts, Maine) regulators have already reviewed and rejected these proposed increases. We expect this pattern to continue. The Administration has also been working on rules that require insurance companies to spend at least 80 percent of premium dollars on health care instead of overhead, salaries or administrative expenses, in 2011. If they fail to do so, they will be required to provide rebates to consumers.
Offered Support for Small Businesses: Under the Affordable Care Act, up to 4 million small businesses nationwide could qualify for a small business tax credit this year, which will provide a total of $40 billion in relief for small firms over the next 10 years. Small businesses have been notified of these tax credits and can make plans knowing the credits will help bring down their health care costs.
Helped Make Prescription Drugs More Affordable: More than 1 million seniors who have fallen into the prescription drug coverage gap known as the donut hole have received $250 rebate checks. The checks are the first step toward closing the donut hole in 2020.
Launched a New Website to Make it Easier to Find Coverage: On July 1, the Administration launched www.HealthCare.gov. www.Healthcare.gov is a new, easy to use website that helps consumers take control of their health care and make the choices that are right for them by putting the power of information at their fingertips. The website is the first of its kind to bring information and links to health insurance plans and other coverage options to one place, making it easier for consumers to learn about their insurance options. The site includes extensive, easy to understand information about patients’ rights, how to navigate the current insurance market, and how the Affordable Care Act will help them. A Spanish language version – www.CuidadodeSalud.gov – was launched on September 8th, 2010, and additional pricing information will be added on October 1th, 2010.
Started Covering Individuals With Pre-Existing Conditions: On July 1, the Administration announced the establishment of the Pre-Existing Condition Insurance Program to provide coverage for eligible Americans who have been uninsured for six months because of a pre-existing condition. Coverage started in 47 states by August, and will be provided in all states by the end of September.
Provided Employers Support to Cover Early Retirees: On August 31, the Administration announced that over 2,000 employers and unions across all fifty states had been approved to receive help to pay for their early retirees’ health care through the Early Retiree Reinsurance Program. This program will help many older Americans, who are not yet eligible for Medicare, continue to have quality affordable coverage through their employer.
On September 23rd 2010, critical new consumer protections in the new law – a Patient’s Bill of Rights -- begin to take effect. The Patient’s Bill of Rights puts an end to some of the worst insurance company abuses, and puts consumers, not insurance companies, in control of their health care. These new protections include:
Ban on Discriminating Against Kids with Pre-Existing Conditions:
Before reform, tens of the thousands of families had been denied insurance each year for their children because of an illness or condition. Starting September 23rd, plans cannot discriminate against kids with pre-existing conditions. In 2014, no one seeking coverage can be discriminated against because of a preexisting condition. Up to 72,000 uninsured children are expected to gain coverage by banning insurers from refusing them coverage due to a pre-existing condition. Coverage for up to 90,000 children will no longer exclude benefits because of a pre-existing condition.
Ban on Insurance Companies Dropping Coverage:
Before reform, insurance companies could cancel your coverage when you got sick and needed it most because of a simple mistake on your application. Starting September 23rd, insurance companies are banned from cutting off your coverage due to an unintentional mistake on your application. Approximately 10,700 people’s coverage, whose coverage is dropped each year because they get sick or make a technical mistake on their application, will be protected under the new law.
Ban on Insurance Companies Limiting Coverage:
Before reform, cancer patients and individuals suffering from other serious and chronic diseases were often forced to limit or go without treatment because of an insurer’s lifetime limit on their coverage. Starting September 23rd, insurance companies can no longer put a
lifetime limit on the amount of coverage they provide, so families can live with the security of knowing that their coverage will be there when they need it most. Up to 20,400 people who typically hit their lifetime limits on the dollar amount that can be spent on coverage,
along with the nearly 102 million enrollees who have policies with lifetime limits, will no longer have to worry about hitting their benefits caps. The use of annual dollar limits will be restricted, and in 2014will be banned completely. By 2013, up to 3,500 people will gain coverage as a result of the ban on annual limits that insurers impose on nearly 18 million people today.
Ban on Insurance Companies Limiting Choice of Doctors:
Before reform, insurance companies could decide which doctor you could go to. Starting September 23rd, if you purchase or join a new plan you have the right to choose your own doctor in your insurer network. Up to 88 million people will benefit from the provision that protects primary care provider choice by 2013.
Ban on Insurance Companies Restricting Emergency Room Care:
Before reform, insurance companies could limit which emergency room you could go to or charge you more if you went out of network. Starting September 23rd, if you purchase or join a new plan, those plans are banned from charging more for emergency services obtained out of network. Up to 88 million people will benefit from this provision.
Guarantee You a Right to Appeal:
Before reform, when insurers denied you coverage or restricted your treatment, you were left with few options to appeal. Starting September 23rd, if you purchase or join a new policy, you will be guaranteed the right to appeal insurance company decisions to an independent third party. Up to 88 million people will benefit from the new appeals process provisions by 2013.
Covering Young Adults on Parent’s Plan:
Starting September 23rd, young adults will be allowed to remain on their parent’s plan until their 26th birthday, unless they are offered coverage at work. Up to 2.4 million young adults, up to 1.8 million who are uninsured and nearly 600,000 who purchase coverage in the
individual market, could gain coverage through their parents.
Covering Preventive Care With No Cost:
Starting September 23rd, if you join or purchase a new plan, you will receive recommended preventive care with no out-of-pocket cost. Services like mammograms, colonoscopies, immunizations, pre-natal and new baby care will be covered and insurance companies will be
prohibited from charging deductibles, co-payments or co-insurance. Up to 88 million people will have access to preventive care with no out of pocket costs.
Six Months of Progress
In addition to implementing the Patient’s Bill of Rights, the Obama Administration has worked to deliver other benefits of reform to the American people. In the last six months, the Administration has:
Fought Waste, Fraud and Abuse: The Affordable Care Act includes robust new tools that will help fight fraud and protect taxpayer dollars. Using these new tools, HHS Secretary Kathleen Sebelius has pledged to cut Medicare’s error rate (the percentage of claims paid inappropriately) in half by 2012. A proposed regulation that implements the first round of Affordable Care Act policies to combat Medicare and Medicaid fraud was issued on September 17.
Helped Fight Premium Increases: The Affordable Care Act also includes critical new resources and authorities to crack down on unjustified rate hikes. Today, 46 states are using resources under the new reform law to pass or strengthen premium rate review laws which will have a significant impact on keeping year-to-year increases in premiums low. In a number of states (California, Massachusetts, Maine) regulators have already reviewed and rejected these proposed increases. We expect this pattern to continue. The Administration has also been working on rules that require insurance companies to spend at least 80 percent of premium dollars on health care instead of overhead, salaries or administrative expenses, in 2011. If they fail to do so, they will be required to provide rebates to consumers.
Offered Support for Small Businesses: Under the Affordable Care Act, up to 4 million small businesses nationwide could qualify for a small business tax credit this year, which will provide a total of $40 billion in relief for small firms over the next 10 years. Small businesses have been notified of these tax credits and can make plans knowing the credits will help bring down their health care costs.
Helped Make Prescription Drugs More Affordable: More than 1 million seniors who have fallen into the prescription drug coverage gap known as the donut hole have received $250 rebate checks. The checks are the first step toward closing the donut hole in 2020.
Launched a New Website to Make it Easier to Find Coverage: On July 1, the Administration launched www.HealthCare.gov. www.Healthcare.gov is a new, easy to use website that helps consumers take control of their health care and make the choices that are right for them by putting the power of information at their fingertips. The website is the first of its kind to bring information and links to health insurance plans and other coverage options to one place, making it easier for consumers to learn about their insurance options. The site includes extensive, easy to understand information about patients’ rights, how to navigate the current insurance market, and how the Affordable Care Act will help them. A Spanish language version – www.CuidadodeSalud.gov – was launched on September 8th, 2010, and additional pricing information will be added on October 1th, 2010.
Started Covering Individuals With Pre-Existing Conditions: On July 1, the Administration announced the establishment of the Pre-Existing Condition Insurance Program to provide coverage for eligible Americans who have been uninsured for six months because of a pre-existing condition. Coverage started in 47 states by August, and will be provided in all states by the end of September.
Provided Employers Support to Cover Early Retirees: On August 31, the Administration announced that over 2,000 employers and unions across all fifty states had been approved to receive help to pay for their early retirees’ health care through the Early Retiree Reinsurance Program. This program will help many older Americans, who are not yet eligible for Medicare, continue to have quality affordable coverage through their employer.
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