September 23, 2010 will be a significant date for all of us who provide Group Health Insurance plans for ourselves and/or our employees, as the following important provisions take effect:

  • The use of multiple carriers will no longer be an option, as newly enacted legislation requires that the selected carrier will require 75% of all eligible’s to be insured with that particular carrier. Multiple plans will be permitted but we anticipate limits (number of plans) based upon the size of the group.
  • No Lifetime Limits on Individual and/or Group Plans for “essential” benefits.

Note: NJ the carriers currently provide for Unlimited Benefits for “In Network” services but only Horizon provides for Unlimited Benefits for “Out–of–Network services, as the other carriers vary between $2 million and $5 million.

PA the typical Out–of–Network coverage ranges from $500,000 to $1 million

  • No Annual Limits on Individual and/or Group Plans for “essential” benefits are currently permitted but are intended to be restricted and ultimately prohibited in 2014.
  • Dependent Children coverage up to age 26 (through age 25), unless their employer offers a health plan. NJ and NY allow up to age 30.
  • No pre–existing condition exclusions for children under 19.
  • *Families USA found, One in Five Americans under 65 have conditions that could result in denial of coverage.
  • For groups of 200+ fulltime employees, automatic enrollment into the employer Health plan AND presumably, the employer will be able to automatically charge the employees paycheck,
  • unless the employee elects out.
  • *USPSTF List of Preventive Services will no longer have cost sharing.

HSA’s – Health Saving Accounts reaches 10,000,000 covered Americans.
*AHIP showed a 25% (33% large groups, 50+ and 22% small groups) increase from last year, according to a new census recently released, bringing the total to nearly 10 million Americans.

Defensive Medicine adding to the cost of services.
*Jackson Healthcare reports that in addition to driving up the costs of healthcare, physicians reported that defensive medicine limits access to certain patients, drives over–and under–treatment, delays adoption of medical innovations and negatively impacts the supply and satisfaction of physicians.

*Links to these articles or reports can be viewed on the Resources page of our website.