Medical Insurance Blog

Health Net's Medical Insurance Plans Adhering to Healthcare Reform

Health Net has recently announced that their medical insurance plans have implemented some important changes in 2010 because of healthcare reform.

Some of the changes to their plans this year are:

• Medical insurance plans can't put lifetime limits on what's considered essential medical benefits, such as hospital stays, for plan years starting on September 23, 2010 or later.  However, they may put a restricted yearly limit only on the value of what's considered essential medical benefits.  There's still some ambiguity regarding what exactly is included in an "essential benefits package".  Therefore, we're waiting for further clarification from legislators.
  
  
• Both individual and group medical insurance plans will raise the age for adult children up to 26.  However, for existing group medical plans, this does not apply if the young adult has insurance offered to them through their employer.
  
  
• Children that have pre-existing conditions cannot be denied medical insurance.
  
  
• The expansion of medical coverage for early retirees: To keep employer medical insurance for early retirees until the medical insurance exchanges are open in 2014, the new legislation has created a temporary reinsurance plan to reimburse companies for the cost of particular medical benefits to retirees.  The reimbursements apply just to a certain percentage of medical claims that cost $15,000-$90,000 for individuals that are age 55 to 64 who are signed up with an early retiree medical benefit program, and aren't actively working for that employer, and who are not eligible for Medicare, along with their dependents and spouses who are covered.  This program will end on January 1, 2014 or when the federal funding for this program has been used up, whichever occurs first.
  
  
• Seniors who have reached the gap in their Medicare prescription drug coverage (aka "the donut hole") will each receive a $250 rebate this year.
  
  
• The Health & Human Services department will be establishing a process to review unreasonable premium rate increases that occur within the individual and group medical insurance market.
  
  
• Grandfathered plans - any individual plan or group plan that a member was enrolled on as of 3/23/10 is considered a grandfathered plan.  Grandfathered plans are exempt from some of the healthcare reforms.  However, grandfathered plans will become un-grandfathered if they decide to make changes that either diminish benefits or raise consumer costs.

Emergency services coverage - For plans that cover emergency services, they must meet now not require prior authorization, and they must cover services performed by non-participating providers and not allow out-of-network cost sharing to be more than in-network rates.  In addition, plans have to provide coverage for a variety of preventative care services.