In­sur­ers gear up for changes re­quired for re­form

Modern Healthcare - - Special Report -

In­sur­ers spend most of the year comb­ing through the new health re­form law af­ter its pas­sage in March, and adapt­ing to sub­se­quent reg­u­la­tions that HHS has is­sued on its pro­vi­sions. The first changes come on Sept. 23, as health plans be­gin ac­cept­ing adult de­pen­dents up to age 26 and elim­i­nat­ing life­time cov­er­age lim­its. Also in the sum­mer, HHS kicks off two new cov­er­age pro­grams: a tem­po­rary $5 bil­lion high-risk pool for unin­sured adults with pre-ex­ist­ing con­di­tions that will run un­til 2014, and a rein­sur­ance pro­gram for em­ploy­ers to sub­si­dize their cov­er­age to early re­tirees from 55 and 65. Many in­sur­ers also must now pro­vide pre­ven­tive ser­vices such as mam­mo­grams and im­mu­niza­tions at no cost to mem­bers.

In­sur­ers and em­ploy­ers have to make the de­ci­sion start­ing this year on whether to by­pass some of these new rules by seek­ing “grand­fa­thered” sta­tus for their plans. If a health plan was in ef­fect be­fore March 23, when the re­form bill be­came law, it could

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