HSAs and HMOs?

[crons79]

I thought moderators were suppose to be seen and not heard. (or something like that) lol

 

[CHUMPS FROM OXFORD]

Nah! I'm moderating but have no power to make any changes. Probably because I gave myself the title.

This thread has been approved and all posters receive an additional 15 points.

 

[STIBROKER]

{This thread approved by STIBROKER}

 

[crons79]

This thread is brought to you by the Letters H, M, O and the number 3.

 

[harbinger]

If the carrier approves them they will have coverage for px conditions but at least for now the carriers are not required to issue coverage to every child.

See page 4 (I don't have enough posts here to be able to post URLs, so you'll have to add the h t t p and remove the spaces, sorry!):

edocket . access . gpo . gov / 2010 / pdf / 2010-15278.pdf

Do you know of any carriers that plan on trying to fight that?

II. Overview of the Regulations
A. PHS Act Section 2704, Prohibition of
Preexisting Condition Exclusions (26
CFR 54.9815–2704T, 29 CFR 2590.715–
2704, 45 CFR 147.108)
Section 1201 of the Affordable Care
Act adds a new PHS Act section 2704,
which amends the HIPAA 4 rules
relating to preexisting condition
exclusions to provide that a group
health plan and a health insurance
issuer offering group or individual
health insurance coverage may not
impose any preexisting condition
exclusion. The HIPAA rules (in effect
prior to the effective date of these
amendments) apply only to group
health plans and group health insurance
coverage, and permit limited exclusions
of coverage based on a preexisting
condition under certain circumstances.
The Affordable Care Act provision
prohibits any preexisting condition
exclusion from being imposed by group
health plans or group health insurance
coverage and extends this protection to
individual health insurance coverage.
This prohibition generally is effective
with respect to plan years (in the
individual market, policy years)
beginning on or after January 1, 2014,
but for enrollees who are under 19 years
of age, this prohibition becomes
effective for plan years (in the
individual market, policy years)
beginning on or after September 23,
2010. Until the new Affordable Care Act
rules take effect, the HIPAA rules
regarding preexisting condition
exclusions continue to apply.
HIPAA generally defines a preexisting
condition exclusion 5 as a limitation or

condition based on the fact that the
condition was present before the date of
enrollment for the coverage, whether or
not any medical advice, diagnosis, care,
or treatment was recommended or
received before that date. Based on this
definition, PHS Act section 2704, as
added by the Affordable Care Act,
prohibits not just an exclusion of
coverage of specific benefits associated
with a preexisting condition in the case
of an enrollee, but a complete exclusion
from such plan or coverage, if that
exclusion is based on a preexisting
condition.
The protections in the new PHS Act
section 2704 generally apply for plan
years (in the individual market, policy
years) beginning on or after January 1,
2014. The Affordable Care Act provides,
however, that these protections apply
with respect to enrollees under age 19
for plan years (in the individual market,
policy years) beginning on or after
September 23, 2010. An enrollee under
age 19 thus could not be denied benefits
based on a preexisting condition. In
order for an individual seeking
enrollment to receive the same
protection that applies in the case of
such an enrollee, the individual
similarly could not be denied
enrollment or specific benefits based on
a preexisting condition. Thus, for plan
years (in the individual market, policy
years) beginning on or after September
23, 2010, PHS Act section 2704 protects
individuals under age 19 with a
preexisting condition from being denied
coverage under a plan or health
insurance coverage (through denial of
enrollment or denial of specific benefits)
based on the preexisting condition.

 

[somarco]

Your reference is new and part of the regs the carriers have been waiting on. The Patient Protection and Unaffordable Health Care Act did not explicitly mandate a GI provision for children under age 18.

Of course this kind of thing is to be expected since they are making all this up on the fly.

If GI is now part of the clarification, which it appears to be, then the carriers will have no choice but to comply.

Of course that means even higher children's rates than have been discussed before.

And all this just in time for the November elections. Thank you Obama for this gift.

 

[Dave020]

This thread is brought to you by the Letters H, M, O and the number 3.

 

[somarco]

Your reference is new and part of the regs the carriers have been waiting on. The Patient Protection and Unaffordable Health Care Act did not explicitly mandate a GI provision for children under age 18.

Of course this kind of thing is to be expected since they are making all this up on the fly.

If GI is now part of the clarification, which it appears to be, then the carriers will have no choice but to comply.

Of course that means even higher children's rates than have been discussed before.

And all this just in time for the November elections. Thank you Obama for this gift.

 

[harbinger]

And all this just in time for the November elections. Thank you Obama for this gift.

Yeah, it's crazy. They have no idea what they're doing.

I was happy to hear that they're at least talking about having an open enrollment period for the full guaranteed issue for all in 2014, but apparently that thought never occurred to them when writing this reg.

All the healthy kids dropping coverage will screw the rates up just as much as all the new sick ones coming in.

 

[somarco]

News flash. Only the sick kids will be added to insurance . . . as long as the parents can afford it . . . which is questionable at this point.

Some carriers already surcharge child premiums for age 0 - 1 or 0 - 2. Those rates might well triple if GI is the mandate.