August 2010
Patient Protection and Affordable Care Act (PPACA)
Asuris has long been an advocate for transforming our health care system to one that rewards efficiency, improves access and outcomes, and reduces health care costs.
With the recent passage of the federal Patient Protection and Affordable Care Act (PPACA), some of the issues plaguing our health care system have been addressed. However, our goal of creating a sustainable health care system is far from over. Part one of reform focused on expanding access. Part two—controlling costs—will continue to be Asuris' priority, in the near and long-term, as we work with members, employers, providers, lawmakers and the general public to better understand the implications and implement the requirements of PPACA.
To assist you in keeping current with steps we are taking in response to PPACA, we've outlined the changes we've made to date to our standard benefits:Benefit | Changes |
|---|---|
Dependent Age |
On plans that currently provide dependent coverage for children, coverage will now be available for adult children up to age 26, regardless of marital or student status or financial dependence. |
Emergency Services |
PPACA requires all health plans to cover services in a hospital emergency department without prior authorization and regardless of provider contracting status. This is Asuris' current practice; therefore, we are already in compliance with this provision. |
Annual Dollar Limits |
Beginning in 2014, PPACA prohibits annual dollar limits for benefits that are deemed "essential." Prior to 2014, there are "restricted" annual dollar limits for essential benefits. While "essential benefits" have not been officially defined by the U.S. Department of Health and Human Services (HHS), the agency responsible for implementing much of PPACA, the essential benefits will likely include:
Asuris believes our plans are in compliance with this provision; however, future plan changes may be needed once a final definition of "essential benefits" is reached by the HHS. |
Lifetime Dollar Limits |
Overall lifetime dollar limits and lifetime dollar limits on essential benefits are prohibited under PPACA. However, we are waiting on a final definition of "essential benefits" to make the appropriate benefit plan updates. There are no dollar limit requirements for non-essential covered benefits. The overall lifetime dollar limit of the policy will be removed. |
Pre-existing Exclusions for Enrollees Under Age 19 |
PPACA prohibits health plans from imposing pre-existing condition exclusions on coverage for enrollees up to age 19. Any Asuris plan enrollee up to age 19 will not have a pre-existing condition waiting period requirement for coverage, unless enrolled in an Individual "grandfathered" plan. (Under PPACA, some individuals will be able to keep their current health insurance plans and be exempt, or "grandfathered," from some reform mandates.) |
Preventive Services* |
PPACA requires coverage of specified preventive services and prohibits cost-sharing for those services. Preventive services included in this mandate are based on current recommendations of the United States Preventive Services Task Force (USPSTF), Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA). These recommended preventive services will be covered at 100%, no deductible and no copayment. Please note that in addition to preventive procedures, some medications are included in the preventive services list. These medications do require a prescription. *Does not apply to "grandfathered" plans. |
Read additional information on rising health care costs.
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