On June 28, 2010, the Department of Labor (Employee Benefits Security Administration) (EBSA) along with the Departments of the Treasury (Internal Revenue Service) and Health and Human Services published regulations implementing the new “Patient’s Bill of Rights” under the Patient Protection and Affordable Care Act. For plan years starting on or after September 23, 2010, health plans will not be able to:
- Deny coverage to children based on a pre-existing condition, whether in the form of a benefit limitation or a denial of coverage for the child. So-called “grandfathered” plans will not be subject to this rule until 2014;
- Rescind coverage for individuals or groups, except in cases involving fraud or intentional misrepresentation of material facts. Insurers and plans seeking to rescind coverage must provide at least 30 days advance notice to provide time to appeal the rescission;
- Impose lifetime limits on coverage;
- Impose annual dollar limits on coverage. Existing limits will be phased out over the next three years. Plans issued or renewed beginning September 23, 2010 may set annual limits no lower than $750,000, with the permissible limit increasing to $1.25 million beginning September 23, 2011 and to $2 million beginning September 23, 2012. Beginning with plans issued or renewed beginning January 1, 2014, all annual dollar limits on coverage of essential health benefits will be prohibited.
- Prohibit a health plan member from designating any available participating primary care provider as their provider. Parents may choose any available participating pediatrician to be their child’s primary care provider.
- Require a referral for obstetrical or gynecological care.
- Impose higher cost-sharing requirements (copayments or coinsurance) for emergency services obtained outside of a plan’s network of participating providers.
These regulations may be found at http://edocket.access.gpo.gov/2010/pdf/2010-15278.pdf and the Fact Sheet is available at http://www.healthreform.gov/newsroom/new_patients_bill_of_rights.html
I work for a hospital in Minneapolis. We have a question about the Patient Bill of Rights included in our welcome packet. Does this need to be reviewed with the family/patient or is handing them the sheet of paper sufficient?
The regulations simply say that the notice must be provided whenever a summary plan description or other similar description of benefits is provided. There is no need to meet with an employee or the family.