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Patient’s Bill of Rights

(source: newsletter from SmarTax and Accounting, 720-744-9958)

Patient's Bill of Rights

New regulations issued June 22nd

On June 22nd the Departments of Labor, Treasury and Health and Human Services issued regulations to implement a new Patient's Bill of Rights as part of the Health Care Reform Act. The goal of the Patient's Bill of Rights is to "Put American consumers back in charge of their health coverage and care." The new Patient's Bill of Rights applies to health coverage issued on or after September 23, 2010.

The major initial provisions include: 

Pre-Existing Condition Exclusions for Children under age 19.
Insurance plans can no longer deny coverage to children based upon a pre-existing condition. This limit applies to both specific coverage denials (because of a pre-existing condition) AND banning benefit limits (refusing you a policy).

Note: This pre-existing condition right will apply to all Americans beginning in 2014.

Elimination of Arbitrary Rescission of Coverage.
Insurance companies may no longer retroactively cancel your policy when you become sick or because of an "unintentional" mistake on your paperwork. The only exception is if the case involves fraud or intentional misrepresentation of the facts.

Note: It is not yet clear who holds the burden of proof on this provision.

3 No Lifetime Limits.
Effective for all policies issued after September 23, 2010 and those renewing after this date, there can no longer be lifetime limits placed on health care plans.
Annual Dollar Limits.
There is a phase out of annual dollar expenditure limits on health plans over the next three years:
annual limit
Beginning September 23, 2010: $750,000
  2011: $1,250,000
  2012: $2,000,000
After January 1, 2014: none
5 Protect Your Choice of Doctors. Health plan members are able to designate any available participating primary care provider. This includes pediatricians for your children and OB-GYN providers. An important provision in this area is the prohibition of requiring a referral prior to seeing an OB-GYN for care.
6 Removing Insurance Barriers to Emergency Services. Insurance providers may no longer place barriers or differentiate payment for using emergency services that are outside a plan's network versus other out of network providers.

The "grandfather" loophole?
Many of the provisions in the new Patient's Bill of Rights have a "grandfather" clause included. The clause means different things in different parts of the Bill, but generally allows for current health plans and insurers to be partially excluded from the Patient's Bill of Rights. What should you do? Ask your employer or health insurance provider if they plan to be fully compliant with your new rights.

The "cost" question.
All these new provisions will logically cost health insurance providers more money. The statisticians are estimating up to 1% in added cost will be incurred with these changes. There is also hope that by providing more appropriate coverage for more Americans that overall health costs can go down. Unfortunately, no one is really sure what the true financial impact will be.

If interested in more information please review the "Fact Sheet" at This website will also provide ongoing updates as the Health Care Reform Act is implemented.