Illinois Department of Insurance Highlights Pending Health Reform Changes

The Illinois Department of Insurance is reminding Illinois families and employers that significant new health insurance benefits and protections become effective Sept. 23, 2010. The changes — a result of the Patient Protection and Affordable Care Act (the “Act”) signed by President Obama on March 23, 2010 — will improve the accessibility, transparency and value of health insurance products in Illinois, the department said.

The changes that take effect September 23 include:

• Ban on pre-existing condition denials for children under 19. For children under age 19, health insurers and employer plans will be prohibited from denying coverage based on a pre-existing condition, and from denying claims for the treatment of pre-existing conditions.
• Protection from unfair cancellations. Health insurers and employer plans will be prohibited from rescinding policies except in cases of fraud or intentional misrepresentation.
• Elimination of lifetime caps and phasing out of annual caps. Health insurers and employer plans will be prohibited from setting lifetime dollar limits (except for specific benefits, such as dental coverage for adults, that are not considered “essential benefits” under the Act), and must phase out the use of annual dollar limits before 2014.
• Free preventive care. Health insurers and employer plans will be required to provide first-dollar coverage for a defined list of preventive health services. In other words, plans will be required to include wellness and prevention benefits such as immunizations and screenings, without cost to the policyholder, when the services are provided by in-network providers.
• Independent review of claim denials. Effective July 1, 2010, State law provides Illinoisans with health insurance the right to an external, independent review of claims denied by health insurers. The law does not apply to “self-insured” plans typically provided by large employers or through unions. Beginning Sept. 23, all health insurers and employer plans, including self-insured plans, must provide internal appeals procedures and allow for the external, independent review of denied claims. In Illinois, self-insured employer plans may utilize the external independent review process established by State law. The list of Independent Review Organizations approved by the Department of Insurance is available on the Department’s Web site at insurance.illinois.gov/EIRO/eirolist.asp.
• Improved access to care for women. Health insurers and employer plans providing obstetrical or gynecological coverage must allow women to visit any in-network OB-GYN without the need for authorization or referral.

The reforms above take effect for “plan years” beginning on or after Sept. 23, 2010. A new plan issued on Sept.23, for example, would have to immediately comply with the Act’s requirements. For a person covered by an employer-based plan that renews every year on January 1, for example, the reforms will take effect Jan. 1, 2011. For an individual purchasing a policy on her own in the individual market, the plan year may begin on the anniversary date of when she bought the plan, the date that the plan begins calculating annual expenses to meet a deductible, or the beginning of the calendar year.

Source: Illinois Department of Insurance

Topics Carriers Illinois