The Departments of Labor and Health and Human Services on Nov. 20 issued three proposed rules implementing major provisions of the Affordable Care Act that regulate insurers and bring new rights to consumers.
The first rule proposes health insurance market reforms, including prohibiting denial of coverage because of a pre-existing condition or other factors. Insurance issuers could vary premiums--within specific limits--based only on age, tobacco use, family size and geography. Banned are other factors besides pre-existing conditions such as health status, claims history, duration of coverage, gender, occupation and small employer size and industry. States can enact stronger protections than the minimum standards under the federal rating rules. The rule is available here with a fact sheet here.
The second proposed rule sets policies and standards for coverage of essential health benefits. These are a core set of benefits that ease consumer comparison between health care plans in the small group and individual markets. HHS also issued guidance to Medicaid programs on how existing private plans in Medicaid must meet the standards of the essential health benefits regulations. The rule is available here with a fact sheet here.
The third proposed rule, by HHS and Labor, outlines standards for implementing and expanding employment-based wellness programs “to promote health and help control health care spending, while ensuring that individuals are protected from unfair underwriting practices that would otherwise reduce benefits based on health status,” according to the departments. The rule is available here with a fact sheet here.
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