Expect Changes in Employer-provided Health Insurance

When the Affordable Care Act (“Obamacare”) became law, there was a lot of news and public debate regarding people who bought health insurance “on the exchange,” meaning they are purchasing individual policies.  But group policies offered by employers also experienced some new requirements.  Here are five of those changes imposed by the Affordable Care Act on employer-provided health care plans.  The future of these rules is now in doubt.  If you are in an employer-provided health care plans.  The future of these rules is now in doubt.  If you are in an employer-provided health care plan, you may see some changes in these areas.  

1.  Young adult coverage was added.  Before the Affordable Care Act (ACA), many group policies provided health insurance for the employees’ children only until they turned 19 or graduated from college.  After that, the children were on their own.  The Affordable Care Act requires that adult children can remain on their parents’ plans until they turn 26.  If the AFA is repleased or replaced, your 20-something children ay have to scramble for an individual health care policy.

2.  Lifetime coverage limits were abolished.  Before the Affordable Care Act, nearly 6 in 10 employees were in plans that cut off medical benefits if the cost of the patient’s care exceeded a certain cap.  Most people never had to worry about this happening, but the limits posed a real problem for those with medical catastrophes, such as premature infants with long stays in intensive care, people who needed costly cancer treatments, or patients who had organ transplants.  Under the ACA no health insurance can have annual or lifetime limits.  New laws may permit those limits to return.

3.  Preventive services were made free.  Even with high-deductible plans, the ACA requires that health insurance must cover certain preventative services free of charge.  For working families, the most significant are contraception, prenatal care, immunizations, and well-child visits.  That could change in the near future.

4.  Long waits for coverage were eliminated.  Before ACA, employers could restrict health insurance benefits to employees who had been on the job for six months or a year.  The ACA says employees must be covered within 90 days after starting work.

5.  The right to appeal decisions was added.  About 6 in 10 covered workers are in “self-funded” plans, meaning that employers pay the cost of their care directly, using insurance companies only to administer the plan.  Before the ACA, employees in this type of plan had no rights to appeal health coverage decisions to an impartial outside entity.  Under the ACA, there must be an impartial appeal process.