Information contained in this publication is intended for informational purposes only and does not constitute legal advice or opinion, nor is it a substitute for the professional judgment of an attorney.
Three months after the Patient Protection and Affordable Care Act (“Affordable Care Act” or PPACA) was signed into law, President Obama released a Patient’s Bill of Rights outlining consumer protections provided by the health care law, and implemented by newly-issued interim regulations. Specifically, these regulations put into practice the rules for group health plans and health insurance coverage in the group and individual markets under provisions of PPACA regarding preexisting condition exclusions, lifetime and annual dollar limits on benefits, rescissions, and patient protections. In essence, these regulations, among other things, bar health plans and insurers from denying coverage to children under 19 with preexisting medical conditions; imposing lifetime caps on essential health benefits; and withdrawing coverage unless there is evidence of fraud or intentional misrepresentation. The rules will phase out annual coverage limits on essential benefits (cannot be less than $750,000 for plan years beginning on or after Sept. 23, 2010, but before Sept. 2011; less than $1.25 million for plan years beginning on or after Sept. 23, 2011, but before Sept. 23, 2012; and less than $2 million for plan years beginning on or after Sept. 23, 2012 through the end of 2013). The rule will provide protections for doctor selection and disallow plans and insurers from demanding prior approval for emergency care outside the provider network, except for grandfathered plans. Click here for a more detailed analysis of these regulations.
The Patient’s Bill of Rights is in the form of a fact sheet describing how and when the various provisions take effect. According to a summary of the regulations provided by U.S. Dept. Health and Human Services Secretary Kathleen Sebelius, “these new protections create an important foundation of patients’ rights in the private health insurance market that puts Americans in charge of their own health.”
This entry was written by Ilyse Schuman.
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