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HHS Issues Regulations on ACA Health Insurance Market Reforms

Posted on 11/21/2012 by NTOCC ® in Public Policy Updates

Yesterday, The Department of Health and Human Services (HHS) issued highly anticipated Affordable Care Act (ACA) regulations related to health insurance market reforms, including the ban on insurance companies considering pre-existing conditions and the essential health benefits standards for coverage.

As you know, starting in 2014, the ACA will make it illegal for insurance companies to deny coverage for an individual with a pre-existing condition.  In the proposed rule, health insurance issuers would generally be barred from denying coverage for such conditions, and individuals would have the opportunity to purchase insurance on the individual market when they have certain losses of other coverage. Under the regulation, insurance companies will be permitted to vary premiums within limits based on age, tobacco use, family size and geography. For more information regarding this rule, please click here.

The regulation also further outlines policies and standards for coverage of essential health benefits, a core set of benefits that states must ensure covers items and services in at least ten categories of care, including preventive care, emergency services, maternity care, hospital and physician services, and prescription drugs. For more information regarding this rule, please click here.
In addition, HHS released proposed rules regarding employment-based wellness programs, which aim to promote health and help control health care spending, while also ensuring that individuals are protected from unfair underwriting practices that could otherwise reduce benefits based on health status.  For more information regarding this rule, please click here.