Much of the federal healthcare reform that passed in March 2010 will not take effect until 2014. However, key parts of the legislation began this fall, offering expanded insurance benefits and protections to members of the bleeding disorders community now and during the next year.

End of Lifetime Limits

Beginning September 23, 2010, as individual and group health plan policies are issued or renewed during the next year, they will no longer have lifetime limits. By September 22, 2011, no health plan will have a lifetime limit.

Annual Limit Minimums

Until January 1, 2014, when annual limits for all insurance plans will be abolished, the law sets a minimum annual limit dollar amount for all group policies and new individual policies. (However, the law does not apply to existing individual policies.) For a plan or policy year beginning between September 23, 2010, and September 22, 2011, the minimum annual limit can be no less than $750,000. That amount will increase in subsequent years. 

Addressing Pre-Existing Condition Exclusions

Individual and group health plan policies issued or renewed on or after September 23, 2010, will no longer be permitted to exclude or restrict coverage for an individual younger than age 19 with a pre-existing condition. By September 22, 2011, no policy will be able to exclude this group.

End of Insurance Plan Cancellations

As of September 23, 2010, individual and group health plans cannot cancel an insurance policy because an individual had high-cost medical claims.

Medicare Drug Benefit Savings

This year, Medicare will provide a one-time $250 rebate to help pay for prescriptions in the “donut hole,” a gap in Medicare Part D coverage that occurs when drug costs exceed the initial coverage limit, but do not reach the catastrophic coverage threshold. In 2011, there will be a 50% discount on covered brand-name prescription drugs for those in the donut hole.

Coverage for Children

All children younger than 19, regardless of medical condition, must be accepted by individual plans for an individual policy (for the child) or as a dependent under an approved family policy.  

New Dependent Coverage Limit

The law requires all insurance plans that offer dependent coverage under a parent’s policy to provide it until an adult child turns 26, whether single or married. The only exception is if the parent has an employer-based plan and the child is eligible for his or her own employer-based coverage. By September 22, 2011, all eligible adult children should be enrolled. 

New Pre-Existing Condition Insurance Plans

If you have a pre-existing condition and have been without insurance for six months or more and have no insurance options, the law has created a pre-existing condition insurance plan in each state. Often referred to as temporary high-risk pools, these plans will serve as a bridge until 2014, when all individuals, including those with pre-existing conditions, will be able to purchase qualified individual plan coverage through state-based American Health Benefit Exchanges.

The material provided in Headline News is for your general information only. GLHF does not give medical advice or engage in the practice of medicine. GLHF under no circumstances recommends particular treatment for specific individuals, and in all cases recommends that you consult your physician or treatment center before pursuing any course of treatment.

Great Lakes Hemophilia Foundation

Phone: (414) 257-0200
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