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Health reform expands access to affordable health insurance and protects consumers who have private insurance.

Improving Health Coverage and Increasing Access

Many health reforms under the Affordable Care Act (ACA) are changes to health insurance, designed to expand access to health coverage and protect consumers who have private insurance.

Find out more about changes in health insurance by topic:

Coverage for Young Adults :  Information about the expanded opportunity for young adults to remain covered under their parent's health plan until age 26, about Minnesota public health programs for young adults, and student health insurance plans for Minnesota college students.

Alternatives if Turned Down for Coverage :  Information about options under state and federal high risk pools and Minnesota public health programs if a person is turned down for coverage in the private market.

Coverage of Preexisting Conditions :  Information about requirements for insurance companies to cover preexisting condition, which have already started for children under age 19 and will begin for adults in January 2014.

Restrictions on Lifetime and Annual Limits :  Information about changes to lifetime and annual dollar limits on health plan benefits.

Medicaid Expansion :  Details on the expansion of Medical Assistance (Minnesota's Medicaid program)

Right to Appeal Health Plan Decisions :  Information on appealing health plan decisions.

Requirement to have Health Coverage :  Information about the health coverage requirement, penalties and exceptions under federal health reform. This section looks at requirements for both consumers and employers.

Essential Health Benefits :  Details on other changes to insurance coverage under the Affordable Care Act (ACA) through Essential Health Benefits.

When does the federal health care reform law take effect?

Federal health reform is being phased in over a seven year period into 2017.  Most provisions will not take effect until Jan. 1, 2014.  However, some new protections have already been added to health plans, grant funds are being made available to states, and additional changes are happening on a state and national level.  Information about the reforms being made on a state level can be found on this site (Healthreform.mn.gov) and information from federal agencies related to health reform can be found on the federal site (HealthCare.gov).

How will my existing coverage change under federal health reform?

Plans may change in several ways. Plans must:

• eliminate lifetime limits on essential health benefits; and
• extend coverage for young adult children to age 26.

Plans may also need to:

• eliminate preexisting condition exclusions
• add coverage for preventive services (like mammograms) with 100 percent reimbursement and no copayment,
• change the appeals process,
• allow greater choice of primary care providers and ob/gyn specialists, and
• eliminate pre-authorization requirements for emergency services

The changes that apply to each plan depend on the type of policy and whether the plan is considered a grandfathered plan under federal health reform.  Insurance companies and employers will be required to let the insured person know if the plan is a grandfathered plan.

The dates these changes take effect can also vary.  More detailed information can be found by clicking the links in the paragraphs above to learn more on each specific change.

What is a grandfathered plan?

Under the federal health reform, a grandfathered plan is any group or individual health plan that was in force on or before March 23, 2010.  New employees and dependents may be added to a grandfathered plan.

When does the federal health care reform law take effect?

Federal health reform is being phased in over a seven year period into 2017.  Most provisions will not take effect until Jan. 1, 2014.  However, some new protections have already been added to health plans, grant funds are being made available to states, and additional changes are happening on a state and national level.  Information about the reforms being made on a state level can be found on this site (Healthreform.mn.gov) and information from federal agencies related to health reform can be found on the federal site (HealthCare.gov).

How will my existing coverage change under federal health reform?

Plans may change in several ways. Plans must:

• eliminate lifetime limits on essential health benefits; and
• extend coverage for young adult children to age 26.

Plans may also need to:
• eliminate preexisting condition exclusions
• add coverage for preventive services (like mammograms) with 100 percent reimbursement and no copayment,
• change the appeals process,
• allow greater choice of primary care providers and ob/gyn specialists, and
• eliminate pre-authorization requirements for emergency services.

The changes that apply to each plan depend on the type of policy and whether the plan is considered a grandfathered plan under federal health reform.  Insurance companies and employers will be required to let the insured person know if the plan is a grandfathered plan.

The dates these changes take effect can also vary.  More detailed information can be found by clicking the links in the paragraphs above to learn more on each specific change.

What is a grandfathered plan?

Under the federal health reform, a grandfathered plan is any group or individual health plan that was in force on or before March 23, 2010.  New employees and dependents may be added to a grandfathered plan.

How do I know if my plan is a grandfathered plan?

Insurance companies and employers are required to send a notice to let those covered by their policies know if their policy is grandfathered.

What requirements apply to grandfathered plans?

The requirements for grandfathered health plans are different depending on whether coverage is under an individual policy, that a person purchased on their own, or a group policy offered through an employer or union.

Requirements that apply to all Grandfathered Plans:  All grandfathered plans must eliminate lifetime benefit limits and allow young adult children to remain eligible for their parents’ plan until age 26.  Health insurers are also prohibited from canceling policies due to an unintentional mistake in the application or using waiting periods longer than 90 days.

Requirements that apply only to Group Grandfathered Plans:  If a plan is a group plan, and if it is grandfathered, it will still need to eliminate annual limits on essential health benefits and eliminate preexisting condition exclusions for plan participants under age 19.

Requirements that do not apply to any Grandfathered Plan:  Grandfathered health plans do not need to comply with other requirements, including the requirement to cover 100 percent of preventive care costs and new options for appealing health plan decisions.

If my plan is a grandfathered plan, will it always stay a grandfathered plan?

Not necessarily. If a plan makes certain changes, it can lose grandfathered status. In order to remain grandfathered, the plan:

• Cannot significantly cut or reduce benefits;
• Cannot raise co-insurance charges;
• Cannot significantly raise copayment charges;
• Cannot significantly raise deductibles;
• Cannot lower employer contributions by more than 5 percent;
• Cannot add or lower an annual limit; or
• Cannot change insurance companies.

Will I be required to give up my current coverage?

No. Minnesotans will not be required to give up their current coverage.  Health plans in effect when the federal law was signed on March 23, 2010, can be continued.  When the requirement to have health insurance begins in January 2014, health plans that were in effect prior to March 23, 2010 can satisfy the requirement.

My employer offers a self-funded health plan to employees. I know that since my employer is self-funded, they do not have to follow any of the Minnesota insurance laws. Do federal health reform provisions apply to self-funded plans?

Yes.  Many provisions of federal health reform that apply to insurance companies also apply to self-funded plans.

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