How Health Care Reform Affects You and Your Family
Guaranteed coverage and benefits
Starting January 1, 2014, you will no longer be declined coverage or charged extra for health insurance because of a health issue you have now or in the past.
One of the biggest ways that Health Care Reform will affect you is through the benefits that will be available to you through the health insurance policies that you purchase starting on January 1, 2014.
No annual or lifetime dollar limits on Essential Health Benefits
The Health Care Reform Law sets as a standard for all plans in the individual and small group market a minimum level of benefits that must be provided. These benefits are referred to as Essential Health Benefits.
Essential Health Benefits are a set of health care services that must be covered with no “annual or lifetime dollar limits.” These benefits may still have other limitations, such as a visit limit. These benefits include:
- Ambulatory patient services;
- Emergency services;
- Maternity and newborn care;
- Mental health and substance use disorder services, including behavioral health treatment;
- Prescription drugs;
- Rehabilitative and habilitative services and devices;
- Laboratory services;
- Preventive and wellness services and chronic disease management; and
- Pediatric services, including dental and vision care.
Preventive Care Services
Preventive care services must be provided without any cost-sharing to you long as the service is provided by a network provider. This means that a network provider cannot charge copays, deductibles or coinsurance to you or your family. These services include, but are not limited to:
- Blood pressure, diabetes and cholesterol tests;
- Many cancer screenings, including mammograms and colonoscopies;
- Counseling on such topics as smoking cessation, weight loss, eating healthy, treating depression, and reducing alcohol use;
- Regular well-baby and well-child visits from birth to age 21;
- Routine vaccinations against diseases such as measles, polio and meningitis;
- Counseling, screening and vaccines to ensure healthy pregnancies; and
- Flu and Pneumonia shots.
Read more about Preventive Care Services.