The Patient Protection and Affordable Care Act
Aka Obama Care
This document can be utilized in addressing your federal representatives regarding the Affordable Care Act (ACA). You can also use the document to forward to your Congressman or Sen. to ask whether all the provisions will exist in the replacement plan. Not every section of the act is included below as some are strictly for administrative or ministerial purposes. You should understand that every American that has health care coverage is impacted by all the provisions affecting healthcare services in the ACA. As a result, eliminating any of the health care provisions, such as preventative health services would affect more than 300 million Americans.
We should note that most of the time in the media you hear comments about the 20+ million people who currently have insurance because of the ACA possibly losing coverage. You may also recall hearing comments by Republicans indicating they will keep provisions such as leaving children on their parents plan until age 26 and maintaining coverage for pre-existing conditions. But there are some provisions rarely discussed by the media and at Town hall meetings that affect every American with health insurance coverage. These include provisions for preventative health services and no differentiation between men and women for premium cost. Prior to implementation of the ACA women were charged more than men for premiums.
Sec. 2711. No lifetime or annual limits. Prohibits all plans from rescinding coverage except in instances of fraud or misrepresentation.
Sec. 2713. Coverage of preventative health services. Requires all plans to cover preventative services and immunizations recommended by the U.S. Preventive Services Task Force and the CDC, and certain child preventive services recommended by the Human Resources and Services Administration, without any cost – sharing.
These preventative services were built in to the ACC and are covered by plan premiums. Prior to the establishment of the ACA, these services were not included in a typical plan.
Sec. 2714. Extension of dependent coverage. Requires all plans offering dependent coverage to allow unmarried individuals until age 26 to remain on their parents health insurance.
Sec. 2716. Prohibition of discrimination based on salary. Employers that provide health coverage will be prohibited from limiting eligibility for coverage based on the wages or salaries of full-time employees.
Prior to the ACA, some employers required a minimum salary level in order to participate in healthcare coverage.
Sec. 2718. Breaking down the cost of health care coverage. Health insurance companies will be required to report publicly the percent of total premium revenue that is expected on clinical services, and quality rather than administrative costs. Health insurance companies will be required to refund each enrollee by the amount by which premium revenue extended by healthcare insurer for non-claims costs exceeds 20% in a group market and 25% in the individual market. The requirement to provide a refund expires on December 31, but the requirement to report percentages continues.
Sec. 2702. Guaranteed availability of coverage. Each health insurance issuer must accept every employer and individual in the state that applies for coverage, permitting and he will and special open enrollment periods for those with qualifying lifetime events.
Sec. 2703. Guaranteed renewability of coverage. Requires guaranteed renewability of coverage regardless of health status, utilization of health services or any other related factor.
Sec. 2704. Prohibition of pre-existing condition exclusions or other discrimination based on health status. No group health plan or insurer offering group or individual coverage may impose any pre-existing condition exclusion or discriminate against those who have been sick in the past.
Sec. 2708. Prohibition on excessive waiting periods. Prohibits any waiting periods for group or individual coverage which exceed 90 days.
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R.J. Intindola