The Department of Health and Human Services recently revealed details about new laws for health insurers. In a previous blog, pointed out how those laws help you and your family. In this blog, I go over more new rules, and how those are going to help your family with health insurance.
The new rules make it clear that health insurance plans must cover items and services in a minimum of 10 categories that were defined by the Affordable Care Act in 2010. Each category is defined as “essential health benefits”.
Those categories include: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services (including behavioral health treatment), prescription drugs, rehabilitative and rehabilitative services and devices, laboratory services, preventative and wellness services and chronic disease management, and pediatric services, (including oral and vision care).
Those are the types of things that a typical employer health plan would cover. Soon, all health insurance plans must include that type of coverage. This means your family can buy health insurance that is not connected to your place of employment, and still get those essential benefits covered.
Another change stops insurers from increasing a person’s premium by a lot of money when a person reaches a certain age. The new rules say that premium rates cannot vary by age for individuals who are under the age of 21.
Right now, when a person hits a certain age, (the age that moves them from one “age band” to another), insurance companies raise the cost of the person’s premium. That can make it too expensive for a person to keep their insurance.
To prevent this, insurers will have to spread out that cost. Insurers can charge slightly more each time a person has a birthday, (but not nearly as much as they would have otherwise charged). That stops when a person hits age 63. Everyone over 63 will pay the same rate (no matter how many more birthdays the person has). This will make things more affordable.
The proposed rules say that insurance companies can charge people who use tobacco 50% more than the customers who do not use tobacco. This is not good news for people who smoke. However, there is an option that can help with the extra cost. Insurers can offer an exemption of that higher cost to people who try to quit smoking.
The new laws also give employers permission to provide discounts on health insurance to workers who achieve certain medical or fitness goals. Those goals can include losing weight (or maintaining a specific weight), lowering their cholesterol level, or lowering their blood pressure.
This is good for people who get their insurance through their job. Some healthy choices can make your premiums be less expensive. You have some control over that.
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