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New Consumer Protections Begin

Starting on September 23, many of the new consumer protections in the Affordable Care Act take effect when you purchase a health insurance policy or your new plan year begins.  As with other Federal standards for health insurance issuers, States have the lead in enforcing them.  The Department of Health and Human Services (HHS) has contacted States and the National Association of Insurance Commissioners has surveyed them about their enforcement options.  Based on those contacts and surveys, as well as discussions with States and review of State laws, HHS believes that all States are taking steps to enable their residents to receive these new consumer protections under the Affordable Care Act.  Such steps include, but are not limited to, reviewing the policy forms of insurers, requiring certifications of compliance from insurers, and responding to consumer complaints as they arise.   

People enrolled in individual-market policies or fully-insured group health plans who have a concern or complaint about not receiving the new protections afforded to them by the Affordable Care Act should call their State insurance department – just as they do today with concerns or complaints about not receiving other federal protections.  If their State insurance department is unable to address the concern or complaint, they should call HHS: 888-393-2789. 

Working with our State partners, the Administration is committed to making the promise of the Affordable Care Act a reality.  When you purchase a new policy or when a new plan year begins, depending on the type of plan you have, the following protections will begin:

  • Prohibition on the denial of coverage to children because of a pre-existing condition;
  • Prohibition on rescissions of coverage based on a mistake on an application;
  • Ban on lifetime dollar limits on benefits;
  • Restriction on the annual dollar limits on coverage;
  • Coverage of recommended preventive services with no deductible, copayment, or coinsurance;
  • Access to dependent coverage for adult children under the age of 26 if they don’t already have access to their own job-based coverage;
  • Choice of any available primary care doctor or pediatrician in a plan’s network;
  • Access to an OB/GYN without a referral;
  • Access to out-of-network emergency care without prior authorization or higher cost sharing than would otherwise be charged; and
  • Improved appeals processes.