Rules in Place for the Health Insurance Market Under Affordable Care Act

by Vanessa Jones on Feb 27 2013 3:06 PM

 Rules in Place for the Health Insurance Market Under Affordable Care Act
A final mandate was issued by The U.S. Department of Health and Human Services (HHS) with five rules applicable for consumer protection under the Affordable Care Act, to make the health insurance market work better for individuals, groups, small families and small businesses.
”Because of the Affordable Care Act, being denied affordable health coverage due to medical conditions will be a thing of the past for every American,” said HHS secretary Kathleen Sebelius. “Being sick will no longer keep you, your family, or your employees from being able to get affordable health coverage.”

With these reforms all individuals and employers can buy health cover irrespective of health status. Insurers will be bound to charge rates without discrimination towards gender or health. Young adults will have affordable cover under catastrophic plans.

All insurers will now offer individuals or employers health cover without being able to refuse anyone due to previous or ongoing illness.

The premiums offered to individuals and small employers will only vary due to age, use of tobacco, family size or geography, no other factors like gender, past insurance claims, size of the employer or health issues will count.

An individual or employer can renew their cover even after illness, as insurance companies can no longer refuse to renew health cover.

Insurance companies can no longer charge high premiums to high cost consumers or move them into a separate risk pool. They are required to maintain a single state wide risk pool for individuals and a state-wide risk pool for the small group market.

Young adults and people for whom insurance cover would otherwise be unaffordable will now have access to a catastrophic plan in the individual market. Catastrophic plans normallyhave lower premiums and protect against high out-of-pocket costs.

The HHS has increased transparency in the new program by directing all insurance companies to report any rate increase requests.


Hannah Punitha (IRDA Licence Number: 2710062)

Redwood Times, Feb 2013