Now that you know the IMMEDIATE Reforms, on to Protections and Standards for Qualified Health Benefit Plans, TITLE II of Division A starting on Page 89.
This will be brief as possible since some of the plans were already discussed under Immediate Reforms and similar here.
We already know that no one can be denied insurance regardless of preexisting conditions for NEW plans (available some time 3-5 years from now?). Remember, existing insurance plans must conform to lower limits of periods for which they do not have to cover preexisting conditions; there was no provision though between now and when new plans become available at exchanges that address new applicants. I believe it is still the case that you can be turned away and forced to apply for the high-risk pool insurance that the federal government or maybe the states will administer (undecided yet and probably not priced by CBO).
Guaranteed renewal is goodness as is prohibiting rescissions, but these might increase premiums.
Insurance premiums, like policies today, can vary by Age, Geographical Area, Family Size. The nice part is that the Age equation cannot be greater than 2:1 (High:Low). This will benefit the 50-65 bunch. Don't quite understand how this older health care pool is going to be funded with just a maximum of 2x the lower age group premiums. Unless -- ahah -- the premium picked is the same as that of the 50-65 group now and the younger groups get blistered a higher premium no less than 1/2 of that. The devil in the details. 2:1 could be good for the old folks if their premiums are based on a low younger group premium equal to those today, However, somebody will pay more while the other the same. Hence, higher premiums on the average!
Ensuring adequacy of networks would be nice. This means the government will examine the networks providers and ensure they are adequate to the population for specific areas. Does that mean they are going to build hospitals in the rural areas or improve hospitals in your area? Does that mean they will ship in physicians? Not necessarily -- could mean that you may still have to travel 30-60 miles to get to an "adequate" facility or physician. I don't have a clue how they are going to ensure adequacy and sure they don't either. These are just political propaganda words.
Already covered dependency changes to include children (hah, children) up to 27 years old (at a higher premium) in previous posts.
Consistency of costs and coverage is simply the insurance companies must notify you 90 days in advance of a change. Big deal.
The NEW plans will be "Essential Benefits", "Enhanced", and "Premium" with coinsurance of 70%, 85%, and 95% respectively; that is what the insurer will pay after deductible and out-of-pocket expenses. The "Essential Benefits" plan (also included in other plans) excluded annual and lifetime limits, limits cost sharing (coinsurance, co-pays -- out-of-pocket dollars) to under $10K for family or $5K for individual, included preventive care for whatever grade A/B is at no cost (no limits on quantity defined yet),and does NOT cover abortions -- "Enhanced" and "Premium" apparently do cover abortions.
Oral Health Care? Not defined in the packages, but availability is open later. I am sure this is another way to defer additional cost estimates.
This takes us to Page 119. Having read the previous House Bill, we can expect pain at the end of the bill that deceptively tells us a little about how we are going to be taxed. Done for tonight. Peace.
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