OHA: Healthcare Reform

Your Rights

Healthcare Reform

Q: I understand that there are tax benefits related to the extension of dependent coverage. Can you explain these benefits?

A: Yes.

Under a change in tax law included in the Affordable Care Act, the value of any employer-provided health coverage for an employee's child is excluded from the employee's income through the end of the taxable year in which the child turns 26. This tax benefit applies regardless of whether the plan or the insurer is required by law to extend health care coverage to the adult child or the plan or insurer voluntarily extends the coverage. To read IRS Guidance, go here.

Q: Will my premiums / costs go up because of health reform?

A: Generally, no.

According to the independent and non-partisan Congressional Budget Office, people who get coverage through their employer today will likely see lower premiums.

Reform will lower premiums by reducing administrative costs, increasing competition between insurance companies and creating a larger pool of insured Americans.

And remember, the cost of doing nothing is high. In ten years, health care spending for each employee at an average big company will be $28,530.

Q: Will my coverage at work change?

A: Generally, no.

What the Affordable Care Act does is strengthen the coverage you get at work by making it easier to understand and adding some clear rules to rein in the worst insurance company abuses.

Language explaining what's in your plan will have to be simple and clear so that you know what your benefits are and what's covered.

Insurance companies will no longer be allowed to place a lifetime limit on the amount of care they pay for. And in some cases insurance companies with excessive overhead costs will be required to give you a rebate. And, if your adult children are living at home, up to age 26 they can be covered under your family policy.

Q: What consumer protections will I get?

A: Beginning in September 2010, insurers will be prohibited from placing lifetime limits on what they will pay for your medical care, and they can only apply restricted annual benefit limits. Insurers will no longer be able to arbitrarily cancel your insurance policy when you get sick, except in cases of fraud.

Insurance companies will be prohibited from denying coverage to children with pre-existing conditions. This applies to all new and existing employer plans.

Beginning in September 2010, all new (also called "non-grandfathered"  group health plans must provide coverage for preventive services. Recommended prevention and vaccination services will be covered without any deductibles or copayments. Plans must also have a straightforward and independent appeals process so you can appeal decisions by your health insurance plan.  (Check with your employer or your plan to find out if your plan is grandfathered or not.)

Beginning on January 1, 2011, insurance companies will be requred to spend most of your premium dollars on your care, not on profits and overhead--85 percent in the group market and 80 percent in the individual market--and rebate any excessive overhead to enrollees.

Similarly, starting in plan year 2011, insurance companies that jack up rates will have to disclose requested premium increases publicly. If that rate increase is found to be unreasonable, the insurer may be prohibited from competing for your business in the new state-based exchange that will begin operating in 2014.

Q: What consumer protections will I get this year if I get insurance at work?

A: Several.

Insurers are prohibited from placing lifetime limits on what they will pay for your medical care and they can only apply restricted annual benefit limits. Insurers will no longer be able to arbitrarily cancel your insurance policy when you get sick, except in cases of fraud.

Insurance companies are prohibited from denying coverage to children with pre-existing conditions. This applies to all new and existing employer plans.

All new group health plans must provide coverage for preventive services. Recommended prevention and vaccination services will be covered without any deductibles or copayments. Plans must also have a straightforward and independent appeals process so you can appeal decisions by your health insurance plan.

Insurance companies are requred to spend most of your premium dollars on your care, not on profits and overhead--85 percent in the group market and 80 percent in the individual market--and rebate any excessive overhead to enrollees.

Similarly, starting in plan year 2011, insurance companies that increase rates excessively will have to disclose requested premium increases publicly. If that rate increase is found to be unreasonable, the insurer may be prohibited from competing for your business in our health insurance marketplace, Access Health CT.