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Guide to the Latest Highlights of the Health Care Reform Law

We’ve been privy to lots of uproar and false impressions concerning the heath care reform act. It’s not unpredictable; we felt more than a little of that confusion too. There may be a great amount of news articles, except that it seems to be targeted on separate issues, and market responses, rather than exploring the varied changes made by the Affordable Care Act.

But it’s not so bad; the essentials are very simple to fully grasp. It is not our job to give you any more spin…but we will get on our soapbox just far enough to say it’s not so much a “medical care reform” as it is “health insurance sector refom”. It causes no hands-on alterations to medical methods, aside from how they will be paid for (or not). The question of “whether finance should really be the defining aspect of healthcare” is something that we aren’t able to do credit to in this simple write-up.

The Affordable Care Act was devised to afford added rights, benefits, and protections, and to curtail some of the more gross practices of the insurance industry. Supporters of the Act usually refer to this as shifting the balance of control towards consumers versus health insurance companies.

One vital portion of the reform is intended to prevent insurance companies from decreasing or denying plans for anyone under 19 as a result of pre-existing conditions. A further beneficial portion is a moratorium on “lifetime limits”, meaning clearly that insurance companies may no longer put a max on the overall amount of benefits.

Health insurors are also now subject to a restriction on their capability to eliminate a current plan. The intent is to block insurance companies from ending someone’s plan except when theycompany will have the ability to demonstrate actual fraud taking place. In a similar fashion, there is a constraint on the insurors’ power to deny claims without the option for appeal (which would be assessed by the health insurance company themself and/or a third-party).

The crucial improvement to consumers is a guarantee that encouraged regular services, such as screenings, vaccines and counseling, will be provided at no cost. Additionally, parent’s plans now includes children until they are 26 years old. The children need to be named on the parent’s plan, of course, and they cannot be eligible for group coverage at their employer (though this will change in 2014).

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A popular change is the capability to pick your own health professional, including primary care and pediatricians. OB-GYNs are additionally at the consumer’s discretion, without any need for a referral. All doctors will need to be listed on your insurance plan’s provider network, but you wouldn’t be punished (e.g., with bigger co-pays) in the event that you have no choice but to go to a critical care facility (i.e., an emergency room) which happens to be out of your network, and you do not have to seek prior consent from the health care insurance company.

A word of caution: the majority of the new regulations pertain specifically to new policies created or written after March 23, 2010. Existing policies will not be held to the changes in laws (i.e., “grandfathered plans”). Furthermore, even in the event specific plan was created or issued somewhere between March 23rd and September 23rd, the new regulations may not be in force until the beginning of the next ‘policy year’ for the insurance plan.

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