Group and individual coverage will be prohibited from rescinding a plan or coverage to an enrollee once the enrollee is covered under a plan, unless the individual covered has engaged in fraud or misrepresented a material fact as prohibited by the terms of the plan.

The sponsor of a group health plan cannot establish rules relating to health insurance eligibility of any full-time employee, under the terms of that plan, that have the effect of discrimination in favor of higher-wage employees.


Preventive Care

The PPACA expands coverage of preventive health services for group and individual policies, stating that minimum coverage will be provided (without cost-sharing requirements) for preventive services rated A or B by the U.S. Preventive Services Task Force; certain immunizations; evidence-informed preventive care for infants, children, and adolescents; and preventive screenings for women including breast cancer screening and mammography.

In other health reform news, President Obama focused his weekly address on implementation of reform. He stated that although little over a month has passed since the legislation was signed into law, reform is already delivering real, tangible benefits to Americans. In addition, the president said, under reform the worst practices of insurance companies are coming to an end.

The President announced the creation of the OCIIO, which will provide grants to states with the best oversight programs. He also announced the creation within the next month of a Patients' Bill of Rights, which will have clear information for consumers on their choices and rights, will set up an appeals process to protect consumers' rights, and will prevent insurance companies from limiting access to choice of primary care physicians, obstetrical and gynecological care, or emergency room care.

Illinois Update

Illinois Governor Pat Quinn has initiated legislation to expand insurance coverage for uninsured citizens with pre-existing conditions, and also introduced a measure to create a Health Consumer's Bill of Rights. Governor Quinn said in a press release, "The state is committed to meeting President Obama's vision of expanding health coverage, making it more affordable and ensuring health insurance companies are more accountable."

The first bill would allow expansion of a high-risk pool with approximately $200 million in federal funds available in the summer to help uninsured persons with pre-existing conditions to obtain coverage. The second bill ensures coverage for children with pre-existing conditions; state review of health insurance rescissions; women's access to obstetrical and gynecological care; that dependents under the age of 26 are eligible to remain covered under a parent's plan; it also requires insurance companies to cover wellness and prevention benefits at no cost; and requires health insurers to publicly disclose information concerning premiums, health care costs, enrollment and claims information.

More Focus on Reform

More Industry Headlines