How health benefits will change in the near future
Aug. 3, 2010
The Patient Protection and Affordable Care Act (PPACA) requires that several benefit changes be made starting with plan years that begin Sept. 23, 2010, and after, including the provision to extend dependent coverage up to age 26.
Blue Cross Blue Shield of Michigan and Blue Care Network will implement near-term benefit changes required under PPACA for most groups and individuals on Jan. 1, 2011, with a few exceptions.
This first round of benefit changes required by PPACA will impact all employers who offer health care coverage, their employees, and those who purchase insurance in the individual market.
Since PPACA became law on March 23, 2010, the federal Department of Health and Human Services (HHS) has released interim regulations for various provisions.
BCBSM and BCN will implement the following near-term benefit changes required by PPACA for most groups and individuals on Jan. 1, 2011:
- Extending dependent coverage up to age 26
- Removal of lifetime dollar limits
- Removal of pre-existing condition exclusions for children up to age 19
- Prohibiting rescissions with limited exceptions
- Clarifying emergency services
Many of these patient protection provisions are consistent with longstanding business practices and values of the Michigan Blues, and will cause little disruption to our groups and members. In fact, BCBSM and BCN were already substantially compliant with the following near-term requirements prior to the passage of PPACA:
Extending dependent coverage up to age 26
Of all of the near-term reforms, there has been the most interest, from customers and individual members, regarding how and when they can enroll or re-enroll dependents up to age 26.
The Blues define child dependents as those related to the employee by birth, marriage, legal adoption or legal guardianship. Dependent eligibility will no longer be limited by financial dependency, marital status or enrollment in school. Also, rates charged for dependents can no longer vary by age.
BCBSM and BCN will adjust their policies to allow coverage of dependents through the end of the calendar year of their 26th birthday.
We will begin allowing the addition of dependents between the age of 19 and 26 during a special open enrollment period from Nov. 1, 2010, through Nov. 30, 2010. Some groups may accomplish this with their regular fourth-quarter open enrollment periods. In most cases, coverage will be effective for added dependents on Jan. 1, 2011.
Some near-term implementation strategies to be determined
HHS recently released interim regulations for immunization and preventive coverage with no cost-sharing. BCBSM and BCN are analyzing the impacts of these regulations, and will provide implementation details once we’ve thoroughly reviewed the regulations.
HHS has yet to issue clarifying regulations for “essential benefits” related to annual dollar limits. When these regulations become available, BCBSM and BCN will move forward with benefit changes related to those provisions.
The information on this website is based on BCBSM's review of the national health care reform legislation and is not intended to impart legal advice. Interpretations of the reform legislation vary, and efforts will be made to present and update accurate information. This overview is intended as an educational tool only and does not replace a more rigorous review of the law's applicability to individual circumstances and attendant legal counsel and should not be relied upon as legal or compliance advice. Analysis is ongoing and additional guidance is also anticipated from the Department of Health and Human Services. Additionally, some reform regulations may differ for particular members enrolled in certain programs such as the Federal Employee Program, and those members are encouraged to consult with their benefit administrators for specific details.