Health Care Reform
General Communication to Employees on Health Care Reform
We would like to take this opportunity to describe and explain the improvements made to several of our group health plans as required under Health Care Reform. It is important that you review and share this communication with your family to ensure that all are aware of the expanded coverage, additional rights and effective dates. The rules under Health Care Reform continue to evolve. As we receive additional information and guidance we will share that with you.
There have been some misunderstandings and mis-communications in the press which need clarification. Under Health Care Reform, plans must be revised as described in this communication and the law requires that these changes become effective on January 1, 2011.
We would like to take this opportunity to describe and explain the improvements made to several of our group health plans as required under Health Care Reform. It is important that you review and share this communication with your family to ensure that all are aware of the expanded coverage, additional rights and effective dates. The rules under Health Care Reform continue to evolve. As we receive additional information and guidance we will share that with you.
There have been some misunderstandings and mis-communications in the press which need clarification. Under Health Care Reform, plans must be revised as described in this communication and the law requires that these changes become effective on January 1, 2011.
Expanded Coverage for Children
Effective January 1, 2011, children will be eligible for coverage until they attain age 26. There will be no conditions to eligibility such as student status, parent financial support, requirement to live with a parent or that the children are unmarried. As long as the children are under the age of 26 and not eligible to participate in their own employer’s plan, they will be eligible to participate. A “child” is a son, daughter, stepchild, foster child and adopted child. Grandchildren and spouses of children are not eligible for coverage.
Elimination of Overall Lifetime Dollar Limits
Effective January 1, 2011, there will be no overall lifetime dollar limit on many of the benefits of the plans. If you or a family member were denied benefits because of attainment of a plan’s overall lifetime limit, you will have an opportunity to re-enroll in a plan and receive benefits under the plan for services provided on or after the January 1, 2011. Limits on the number of visits with respect to some conditions and financial restrictions will remain largely unchanged.
Change in Annual Limits
Although overall lifetime limits have been eliminated from our plans, there may be an overall annual dollar limit added. Please be sure to check your summary of benefits. Limits on the number of visits with respect to some conditions and financial restrictions will remain largely unchanged.
Pre-existing Condition Exclusions for Children
The plan cannot deny coverage or eligibility for benefits for a condition that a child had prior to enrolling in a plan. In this case, the child must be under the age of 19 and the benefits must have been otherwise available under the plan.
Termination of Coverage for Fraud and Misrepresentation
Health Care Reform permits us to terminate your coverage, retroactively, in cases of fraud or intentional misrepresentation. Please make sure that the individuals you are enrolling in our plans are eligible for coverage and be prepared to show proof of that eligibility.
Over-the-Counter Drugs
Effective January 1, 2011, over-the-counter drugs will not be reimbursable expenses unless purchased under a doctor’s prescription or is insulin. Purchases of over-the-counter drugs made on or before December 31, 2010 will be reimbursable even if the expense is submitted after that date but no later than April 1, 2011. Any over-the-counter drug purchased on or after January 1, 2011 without a physician’s prescription will be rejected.