Health Care Reform
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Top Seven Things to Know About Health Reform In 2011
1. Dependent child age rises to 26.
As of Jan. 1, all Viva Health members have had an opportunity to add dependent children up to age 26, regardless of whether the child is a tax dependent, married, living with the parent or full-time student. Some employers limit coverage to children who are not offered insurance at their own jobs. Coverage ends for dependent children at the end of the month the child turns 26, unless the child is disabled.
2. No lifetime maximum.
The lifetime cap on the total amount paid for a member's health care no longer applies to plans that cover active employees. Many members had a $1 million lifetime maximum allowance, but the limit no longer exists.
3. No annual prescription drug maximum.
Many plans had a maximum amount of prescription costs that would be paid per year, but the cap goes away at the first plan renewal after Sept. 23, 2010. For most people, the limit was lifted Jan. 1.
4. No pre-existing condition exclusion for children under 19.
Children under age 19 no longer have to wait 12 months for coverage of health conditions that were diagnosed before their insurance began. While many large employers do not have such waiting periods, smaller employers often do. Now those waiting periods are only for adults 19 and older.
5. Guaranteed value for every premium dollar.
Viva Health will spend at least 80 cents of every premium dollar on payment of members' health care costs and other activities that directly benefit the members' health. For health plans of large employers, Viva Health will spend at least 85 cents of every dollar of premium collected on those expenses. If the targets are not met, members would get rebates the following year.
6. More preventive coverage for some plans.
For non-grandfathered health plans – Viva Health calls them the "Wellness Plans" – many preventive services are now covered at 100 % without the member paying anything out of pocket. Preventive services covered at no cost to the member include an annual physical, many cancer screenings and tobacco cessation products if prescribed by the primary care physician. Please see "Bonus Benefits for Wellness Plans ," for more details.
7. Not all health plans have the same changes.
Grandfathered health plans were in existence when the health reform law (Affordable Care Act) was enacted in March 2010 and made few benefit changes for 2011. Non-grandfathered plans are either new health plans or ones that changed substantially from 2010. Grandfathered plans still must comply with many aspects of the new law but they do not have to provide preventive services for free.