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Health Care Reform 
Impact on Employees

 Included provisions to be implemented over next decade  New requirements known as Market Reforms  Individual mandate requiring insurance
20, Congressional Committees instructed to propose changes to the law Insurance Market Reforms effective 10/1/10
Dependent Coverage to age 26:

Employee Impact: Until now, health plans could remove enrolled children usually at age 19,
sometimes older for full-time students. Now, most health plans that cover children must make
coverage available to children up to age 26. By allowing children to stay on their parents’ plan,
the Affordable Care Act makes it easier and more affordable for young adults to get health
insurance coverage. Your adult children can join or remain on your plan whether or not they are:
Health Care Reform 
Impact on Employees
 Eligible to enroll in their employer’s plan, with one temporary exception: Until 2014, “grandfathered” group plans do not have to offer dependent coverage up to age 26 if a young adult is eligible for group coverage outside their parents’ plan.
Some Important Details:
 Your plan is required to provide a 30-day period—no later than the first day of your plan’s next “plan year” or “policy year” that begins on or after September 23, 2010—to allow you to enroll your adult child. Your plan must notify you of this enrollment opportunity in writing.  If you enroll your adult child during this 30-day enrollment period, your plan must cover your adult child from the first day of that plan year or policy year.
Elimination of Lifetime Maximum:

$5,000,000 maximum on Comprehensive plan. Employee Impact: Unless Employees can guarantee themselves good health throughout their
lifetime, the maximum benefit amount might easily be enough for health coverage, but one serious health incident can quickly eat through a $1,000,000.00 maximum benefits policy; and then employees are pretty much on their own. The possibility of these policies holders finding themselves in a real health care dilemma has prompted the government to ban such health insurance policies and protecting many Americans, that would otherwise be at the mercy of no health care. The true nature of this health insurance care option elimination by the Federal Government has given health insurance companies the green flag to drastically increase policy premiums in exchange for this policy cap elimination. In other words, it will, without any doubt, significantly raise Employee cost to have a health insurance policy, while not having to worry about your policy expiring because your health care has reached its coverage amount and the policy is automatically voided.

Annual Dollar Limits:

Health Care Reform 
Impact on Employees
Employee Impact: Before the Affordable Care Act, many health plans set an annual limit—a
dollar limit on their yearly spending for Employee’s covered benefits. Many plans also set a lifetime limit—a dollar limit on what they would spend for Employee’s covered benefits during the entire time Employees were enrolled in that plan. Employees were required to pay the cost of all care exceeding those limits.  Under the new law, lifetime limits on most benefits are prohibited in any health plan or insurance policy issued or renewed on or after September 23, 2010.  The new law restricts and phases out the annual dollar limits that all job-related plans, and those individual health insurance plans issued after March 23, 2010, can put on most covered health benefits. Specifically, the law says that none of these plans can set an annual dollar limit lower than: $750,000—for a plan year or policy year starting on or after September 23, 2010 but before September 23, 2011. $1.25 million—for a plan year or policy year starting on or after September 23, 2011 but before September 23, 2012. o $2 million—for a plan year or policy year starting on or after September  No annual dollar limits are allowed on most covered benefits beginning on
Pre-Existing Condition Clause:

Employee Impact: Health insurance companies have traditionally tried to control costs by
using a "pre-existing condition" clause — refusing to cover a condition that existed before an Employee purchased a health insurance plan. The concept of pre-existing conditions is simple: If you were to purchase car insurance and your windshield was cracked before you bought your coverage, you can't expect your new car insurer to replace it. Title 1 limits any group health plan from imposing eligibility rules or assessing premiums for individuals based on health status, medical history, genetic information or disability. Before HIPAA was enacted, if an Employee switched to a new group health plan, the new insurer could consider the Employee’s diabetes a pre-existing condition and refuse to cover treatment. Employee would then have to pay for all of their diabetes treatment. HIPAA imposes limits on the extent to which some group health plans can exclude health insurance for pre-existing conditions. For instance, if an Employee had "creditable" health insurance for 12 months, with no lapse in coverage of 63 days or more a new group health plan cannot invoke a pre-existing condition exclusion. It must cover an Employee’s medical problems as soon as they enroll in the plan. Health Care Reform 
Impact on Employees
On the other hand, if an Employee is not switching from a “creditable” coverage plan when they enroll in a new group plan — or had coverage from an overseas health insurer — the new insurer can refuse to pay for treatment of the pre-existing conditions for 12 months (except pregnancy, if the plan has maternity coverage). Late enrollees in group health plans might have to wait up to 18 months for coverage of pre-existing conditions. Preventive Services:

Employee Impact:
If an Employee has a new health insurance plan or insurance policy
beginning on or after September 23, 2010, the following preventive services must be covered without having to pay a copayment or co-insurance or meet the deductible. This applies only when these services are delivered by a network provider. Previously – these services would require co-payment, co-insurance and/or deductable. Covered Preventive Services for Adults
 Abdominal Aortic Aneurysm one-time screening for men of specified ages who  Alcohol Misuse screening and counseling  Aspirin use for men and women of certain ages  Blood Pressure screening for all adults  Cholesterol screening for adults of certain ages or at higher risk  Colorectal Cancer screening for adults over 50  Type 2 Diabetes screening for adults with high blood pressure  Diet counseling for adults at higher risk for chronic disease  HIV screening for all adults at higher risk  Immunization vaccines for adults--doses, recommended ages, and  Obesity screening and counseling for all adults  Sexually Transmitted Infection (STI) prevention counseling for adults at higher Health Care Reform 
Impact on Employees
 Tobacco Use screening for all adults and cessation interventions for tobacco  Syphilis screening for all adults at higher risk Covered Preventive Services for Women, Including Pregnant Women
 Anemia screening on a routine basis for pregnant women  Bacteria urinary tract or other infection screening for pregnant women  BRCA counseling about genetic testing for women at higher risk  Breast Cancer Mammography screenings every 1 to 2 years for women over 40  Breast Cancer Chemoprevention counseling for women at higher risk  Breast Feeding interventions to support and promote breast feeding  Cervical Cancer screening for sexually active women  Chlamydia Infection screening for younger women and other women at higher  Folic Acid supplements for women who may become pregnant  Gonorrhea screening for all women at higher risk  Hepatitis B screening for pregnant women at their first prenatal visit  Osteoporosis screening for women over age 60 depending on risk factors  Rh Incompatibility screening for all pregnant women and follow-up testing for  Tobacco Use screening and interventions for all women, and expanded  Syphilis screening for all pregnant women or other women at increased risk
Covered Preventive Services for Children:
 Alcohol and Drug Use assessments for adolescents
 Autism screening for children at 18 and 24 months  Behavioral assessments for children of all ages  Blood Pressure screening for children  Cervical Dysplasia screening for sexually active females  Congenital Hypothyroidism screening for newborns  Depression screening for adolescents at higher risk  Developmental screening for children under age 3, and surveillance throughout  Dyslipidemia screening for children at higher risk of lipid disorders  Fluoride Chemoprevention supplements for children without fluoride in their water  Gonorrhea preventive medication for the eyes of all newborns  Height, Weight and Body Mass Index measurements for children  Hematocrit or Hemoglobin screening for children  Hemoglobinopathies or sickle cell screening for newborns  HIV screening for adolescents at higher risk Health Care Reform 
Impact on Employees
 Immunization vaccines for children from birth to age 18 —doses, recommended  Iron supplements for children ages 6 to 12 months at risk for anemia  Lead screening for children at risk of exposure  Medical History for all children throughout development  Oral Health risk assessment for young children  Phenylketonuria (PKU) screening for this genetic disorder in newborns  Sexually Transmitted Infection (STI) prevention counseling and screening for  Tuberculin testing for children at higher risk of tuberculosis  Vision screening for all children INSURANCE MARKET REFORMS EFFECTIVE 1/1/1

FSA and HSA:

Employee Impact: OTC requires Prescription: If you use your FSA to pay for over the
counter medication (any cold medicine, allergies, motion sickness) then you are in for a rough ride with the new changes beginning January 1, 2011. Your over the counter (OTC) drug now requires a prescription to be reimbursed from your FSA. Talk about an oxymoron. There are a few exceptions to this (like insulin, contact lens solution) which I will describe below. Health Care Reform 
Impact on Employees
List of eligible medications that do not require a prescription: This change impacts only
medication. This means crutches, band aid, condoms and other medical supplies that are
covered by your plan will not require any extra documentation. Here is a sample of stuff that
doesn’t require any prescription.
Adult incontinence products (e.g. Depends) Health monitors (e.g. blood pressure, cholesterol, HIV, thermometers) Birth control products (e.g. prophylactics) Supports/braces (e.g. ankle, knee, wrist, therapeutic glove) List of eligible medications that require prescription: Unfortunately a lot of medications, over
the counter medications, now require a prescription. Some examples include:
Allergy and sinus medications (e.g. Benadryl, Pain relievers (e.g. aspirin, Excedrin, Tylenol, Advil, Anti-fungal medications (e.g. Lotramin AF) Anti-itch medications (e.g. Caladryl, Cortizone) Nasal sprays for congestion (e.g. Afrin) Decongestants Suppositories Diaper rash ointments List of eligible medications that will require a prescription and a letter of necessity: There
is no change in this category. Some medications always required an extra letter of necessity from
the doctor, like the following:
Health Care Reform 
Impact on Employees


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