Healthcare Reform Implements Today for Texans

Today, September 23rd brings with it major new new federal healthcare mandates for Texans:

• Guaranteed issue of all health insurance plans covering children until age 18, regardless of their health.  (However, Texas insurance carriers have stopped issuing child-only policies, so a parent must be covered on the policy.)
• Adult Dependent Children on Parents’ Plan until 26th birthday. (So dependent children with serious chronic health conditions or pregnant children can stay on their parents' group health plans until their 26th birthday.)
• No Lifetime Maximum Benefits to insurance policies. (Prior to today, a typical lifetime maximum benefit for a major medical insurance plan is $1 to $5 million.)
• No Recission of Coverage. (this means that insurance companies can't cancel polices of insureds with high health claims.)

The above list of mandates will occur for new plans purchased beginning today, and for existing plans upon their next renewal date.

And for all new health plans purchased begininning today, or for group plans in which the benefits have been materially changed, the following list of benefits are added:

• 100% coverage for evidence-based preventive services in network.  (These preventative "wellness" benefits are paid 100% by the insurance plan with no out of pocket cost by the policyholder.)
• No prior authorization for emergency services or higher cost-sharing for out-of-network emergency services.

Plans that have not been materially altered have been tagged as "grandfathered," and do not have to include these last two new benefits.  Even a slight reduction in benefits, for example a change in drug copays, would mean the plan would lose its "grandfather" status and must then include the last two benefits.

For more advice and clarification on Healthcare Reform impact on Texas employers and employees, contact Group Benefits Advisors at 214-764-6315 office, or 888-398-6346.