Health Insurance Reform Highlights – NAIC

The Patient Protection and Affordable Care Act or health insurance reform law remains a hot button for some. For others, the law represents access to affordable healthcare. For most, the law remains shrouded in confusion and secrecy. As a result, the National Associate of Insurance Commissioners released a video highlighting new rules regarding health insurance reform.

According to the NAIC, most of the law’s provisions will be phased in over the next few years. Most provisions will not take effect until January 21, 2014. However, as of 2010, some new protections like the new federal high pool provisions were implemented. Currently, the PCIP – Pre-existing Codition Insurance Plan has coverage available for hard to insure cases. For more details, visit http://www.pcip.ca.gov/Home/default.aspx.

The primary goal of the Health Insurance Law was to ensure that everyone has access to affordable coverage, and to ensure that no one is denied credible coverage for pre-existing condition. Another provision of the health insurance law is the setup of state and federal health insurance exchanges. The purpose of the exchanges is the provide a resource for consumers to find and compare insurance options available in their states. These exchanges will also facilitate CHiPs, Medicaid, and health insurance subsidy programs.

According to the NAIC, consumers are not required to purchase insurance through state or federal exchanges. However, government subsidy programs can only be obtained through exchanges.

Health insurance rates are expected to continue increasing over time. NAIC and government officials hope that by mandating the purchase of minimum amount of health insurance, the rates will begin to level because of the increased number of health and unhealthy insureds purchasing coverage. Compliant plans are designed to match high deductible HSA plans.

Self Employed individuals and their families will now be counted in the group markets. Self employed individuals will also be able to purchase health insurance through the exchange. Small businesses with fewer than 50 employees are exempted from being required to purchase health insurance for their employees. Employees of small businesses may also purchase insurance through the exchange.

No such luck for businesses with greater than 50 employees. These businesses will be required to purchase insurance for their entire state of pay fines for each employee. For details regarding the fines visit www.naic.org or the department of health and human services. Businesses with coverage purchased prior to 1/23/2010 and individuals with policies purchased prior to 9/23/2010 are grandfathered into the new law.

Senior Insurance plans remain relatively the same. In fact, the new law has provisions that will reduce the medicare donut hole. The NAIC states that seniors in the donut hole have started receiving rebates. Provisions will phase in a reduction of the donut hole provision until it is completely gone in 2020. As for some seniors with medigap (medicare supplement) policies, there has been a cost sharing option added to plans C and F.

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