What immediate insurance reforms must be made to health plans that are effective on or after March 24, 2010 (Non-grandfathered)?
• No lifetime limits on overall plan benefits, and no lifetime limit on the dollar value of specific “essential benefits.” • Annual limits on essential benefits, only until 1/1/14. • Rescission only for fraud or intentional misrepresentation of material facts. • Coverage of preventive health services and immunizations without cost sharing. • Dependent coverage extended to adult children to age 26. • Prohibition of pre-existing exclusions for individuals under 19. • Compliance with specific internal claims appeals processes and external review requirements. (Note that components of Washington’s internal appeals process and external review requirements differ from that directed in the PPACA. We are still in the process of analyzing these differences to determine the impact on existing contract language and administration.
