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LEGAL DISCLAIMER:
Information contained in this publication is not legal advice, and
should not be construed as legal advice. If you need legal advice upon which you can rely,
you should seek a legal opinion from your attorney.
Extension of dependent coverage to age 26 (unless the
dependent
has
coverage available through their own employer); HOWEVER, Non-
grandfathered plans must offer age 26 coverage even if the dependent has
other employer-sponsored coverage available;
No pre-existing conditions exclusions for children under 19; and
Development and utilization of uniform explanation of coverage documents
and standardized definitions. (These standards are to be developed by March
23, 2011 and group health plans will be required to use such documents and
information for participants and others by March 23, 2012.
Plans should begin the process of amending their plan document to comply
with these changes and comply with any new notice requirements, such as
informing those eligible for coverage due to the age 26 change or
elimination of lifetime limits.
The section below lists reforms applicable only to Non-grandfathered plans. These
reforms are applicable to such plans’
first Plan
Year beginning on or after
September 23, 2010. For calendar year plans, that is January 1, 2011. These
reforms are in addition to the requirements applicable to both grandfathered
and
Non-grandfathered plans discussed above.
NON-GRANDFATHERED PLANS
Coverage of recommended preventative services with no cost sharing;
Patient protections such as guaranteed access to OB-GYNs and pediatricians;
Appeals process for appeals of coverage determinations and claims (includes
internal appeals and external review); and
Coverage of emergency services without prior authorization and at the same
cost sharing as in-network.
Non-grandfathered plans should begin the process of amending their plan
document to comply with these changes that are specifically applicable to
them and to comply with any new notice requirements.
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