Changes coming to health insurance plans

Julie Appleby, Kaiser Health News – Kaiser Health News


Consumers and employers who provide health insurance are scrambling to understand what will change in their premiums and benefits once the recently passed law goes into effect.

The new legislation applies broadly to nearly all private plans. That includes policies offered by large self-insured employers, through whom about half of the nation’s covered workers get their insurance.

Some new rules — such as barring insurers from rejecting children with medical conditions or from canceling policies retroactively — are aimed at problems that mainly affect the 17 million people who buy their own insurance in the so-called non-group market.

But even the approximately 175 million Americans who get group coverage through their jobs will see changes.

Employers are flooding benefit firms with questions. “We’re getting a lot of calls (asking) … to translate what this law means,” says Kelly Traw, a principal with benefits consultancy Mercer. “That’s a daunting task right now.”

Some specific changes to policies and benefits aren’t spelled out in the law. While some changes mandated by the new law appear fairly straightforward — no lifetime caps on coverage, for example — other provisions are missing crucial details, which must be clarified by the Department of Health and Human Services in regulations. 

It will be up to the HHS secretary, for example: 

  • To define the breadth of coverage in an “essential benefits package.”  
  • To determine how insurers will calculate how much they spend on direct medical care, a key point because insurers who don’t meet specific spending benchmarks must issue rebates to consumers.

 An HHS spokesman wouldn’t provide details on when regulations will be issued. But, with some provisions set to go into effect by the end of September, pressure is on to move quickly. 

Among the unknowns is the effect on premiums in the next couple of years. New taxes on drug companies, device makers and insurers don’t begin until at least 2012. But when they do, economists expect that the increases will be passed along to employers and consumers. Barring insurers from setting lifetime coverage limits may also put upward pressure on premiums. Read more:


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