Health care provisions kick in Friday

Wednesday, September 22, 2010 | 6:38 p.m. CDT

COLUMBIA — Beginning Friday, several provisions of the controversial Patient Protection and Affordable Care Act passed in March will take effect.

According to the U.S. Department of Health and Human Services, the following portions of the legislation will be applied to new and renewed insurance plans that begin Friday and after:

  • Insurance providers that offer coverage to children on their parents’ policy must allow children to remain on their parents’ policy until they turn 26, unless the adult child is offered coverage from an employer.
  • Insurance companies can no longer place lifetime limits on the coverage they provide.
  • People who become ill cannot be dropped by their insurance provider.
  • Insurers cannot exclude children from coverage because of a pre-existing condition.
  • Insurers will not be able to set annual limits on new policies lower than $750,000 per year. That minimum limit will rise to $1.25 million next year, on Sept. 23, 2011, and $2 million the following year. Starting Jan. 1, 2014, annual limits will be prohibited for most health plans.
  • New plan members can choose any participating primary care provider within their insurance network, including pediatricians and ob-gyn’s, without a referral.
  • Insurers cannot deny coverage or demand that patients pay co-insurance for the use of out-of-network emergency services.
  • Insurance plans must cover preventive services such as vaccinations and mammograms.
  • Insurance companies cannot cancel coverage if an individual or an employer made a mistake on an insurance application.
  • Insurers cannot deny claims without a giving patients a chance to appeal, which includes an external appeal to an independent reviewer.

Plans that existed before the law was passed in March—"grandfathered" plans—do not have to meet all of the new requirements.

In order for young adults to qualify for their parents’ plan, the policy must be a family plan that includes dependents. Insurers are required to provide a 30-day enrollment period for young adults to join their parents’ plans.

In 2004, a Missouri Department of Health and Senior Services survey found persons ages 19-24 to were the most uninsured group in Boone County.

According to the U.S. Department of Health & Human Services, the extension of coverage for young adults “will bring relief to roughly 20,000 individuals in Missouri who could now have quality affordable coverage through their parents.”

A report from the U.S. House Energy and Commerce Committee said the legislation could extend health coverage to 30,000 residents in Missouri's 9th District, which includes Columbia. Additionally, the committee said 9,600 residents with pre-existing conditions will be guaranteed coverage.

2008 Missouri Census data reported that 15,900 people in Boone County were without health insurance. A total of 750,636 residents statewide were uninsured.

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