Health Care Reform for Individuals & Families

The new law includes many provisions that are designed to improve women's health. The new law will eliminate cost sharing for certain preventive screenings and ensure direct access to obstetricians and gynecologists. Many additional benefits will be made available to women beginning in 2014, including:

• Covering maternity services on all coverage
• Eliminating pre-existing coverage exclusions for women who are pregnant, have had a previous cesarean, or are the victims of domestic violence
• Eliminating gender rating in most policies that may cause women to pay more than men for insurance at certain ages

Beginning in 2014, state health insurance exchanges will enable consumers to compare benefits, prices, and networks of health care providers, and to purchase coverage. In 2014, subsidies also will be made available (as noted in the following question on affordability).

"Policy year" means the 12-month period that is designated as the policy year in the individual health insurance coverage policy documents. For specific information related to the policy year, please check the coverage policy document.

If there is no designated policy year in the policy document (or no such policy document is available), then the policy year is the deductible or limit year used under the coverage. If deductibles or other limits are not imposed on a yearly basis, the policy year is the calendar year.

Please note that policy year is defined differently for group policies.

For policies that are not grandfathered, beginning with the first renewal on or after September 23, 2010 (including new policies with an effective date on or after September 23, 2010), members will be able to receive certain preventive services without having to pay deductibles, copayments, or co-insurance. The types of services include several evidence-based cancer and disease screenings, as well as specific immunizations. Contact your account executive to find out what services are covered.

For plans that are not grandfathered, the new law generally states that coverage for emergency department services must be provided without prior authorization of services. In addition, out-of-network emergency services must be covered and reimbursed the same as in-network emergency services, including cost-sharing requirements (i.e., copayments, co-insurance, etc.) for both in-network and out-of-network services.