Health Insurance Market Reforms
The Affordable Care Act includes a number of provisions that reform the health insurance market. These reforms work to put American consumers back in charge of their health coverage and care, ensuring they receive value for their premium dollars. The law creates a more level playing field by cracking down on unreasonable health insurance premiums and holding insurance companies accountable for unjustified premium increases.
Starting in 2014, the law bans annual dollar limits. This means plans can not limit annual coverage of essential benefits, such as hospital, physician and pharmacy benefits.
Under the law, if a plan includes children, a parent can cover children on their health insurance plan until the child turns 26 years old.
Grandfathered Health Plans protect the ability of individuals and businesses to keep their current plan, while providing important consumer protections that give Americans control over their own health care.
Medical loss ratio (MLR) is the proportion of premium revenues spent on clinical services and quality improvements. The law requires health insurance issuers to submit data on MLR and issue rebates to enrollees if this percentage does not meet minimum standards.
The Patient’s Bills of Rights helps children (and eventually all Americans) with pre-existing conditions gain and keep their coverage, protects all Americans’ choice of doctors, ends lifetime limits on the care consumers may receive and includes other provisions.
Prevention regulations require new private health plans to cover certain evidence-based preventive services and eliminate cost sharing requirements for these services.
Rate review is part of a series of reforms to improve insurer accountability and consumer transparency. Grants will be used to help states crack down on unreasonable health insurance premium hikes.
Student Health Plans are health insurance plans that are offered to students. These plans are often purchased when family coverage is not available. Some of these plans are comprehensive but other offer limited benefits.
Prior to enactment of the Affordable Care Act, sponsors of self-funded, nonfederal governmental plans were permitted to elect to exempt those plans, or “opt out of,” from certain provisions of the Public Health Service (PHS) Act. This election was authorized under section 2721(b)(2) of the PHS Act.
The Affordable Care Act made a number of changes, with the result that sponsors of self-funded, nonfederal governmental plans can no longer opt out of as many requirements of Title XXVII.