Health reform implementation

Obama administration expected to unveil new healthcare regulations this week

Some of the questions the rules are expected to clarify include:

— Lifetime and annual limits. The law bans lifetime limits for the essential benefits package that plans must offer to be part of health insurance exchanges, but that package has not yet been defined; industry sources expect some kind of interim benefits package could be announced. The law also allows “restricted” annual limits before 2014 but that qualifier has not yet been defined.

— Pre-existing conditions. The law was unclear as to whether health plans had to accept all children before 2014 or only had to cover all of a child’s illnesses if that child already had coverage. Sebelius wrote to Karen Ignagni of America’s Health Insurance Plans on March 29 to share her intention to “issue regulations in the weeks ahead ensuring that the term ‘pre-existing condition exclusion’ applies to both a child’s access to a plan and to his or her benefits once he or she is in the plan.” Health plans have already said they won’t fight that interpretation. In her letter, Sebelius also wrote that the coming regulations will confirm that “children with pre-existing conditions may not be denied access to their parents’ health insurance plan” and “insurance companies will no longer be allowed to insure a child, but exclude treatments for that child’s pre-existing condition.”

— Policy rescissions. Under the new law, policies can only be terminated for reasons of “fraud” or “intentional misrepresentation.” Health plans have broad agreement on how those terms are defined, and it’s not clear how much new detail will be unveiled. Rescissions won’t be an issue starting in 2014 because health plans will have to accept all applicants.

The expected regulations are what’s called an interim final rule, which means they will have force of law but can be retroactively modified depending on industry and consumer feedback after they’re adopted.


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