a. Lifetime Maximums - Effective for plans years on or after the date that is six months after enactment of the PPACA, health insurance policies in the individual and group markets may not include lifetime maximums.
b. Annual Limits - Beginning January 1, 2014, group health plans may not impose annual limits on the dollar value of coverage.2
c. Rescission and Cancellation – Effective for plan years beginning on or after the date that is six months after enactment of the PPACA, a group health plan and a health insurance issuer that offers group or individual health insurance coverage may not rescind coverage for an enrollee (once covered), except in cases of fraud. In addition, a group health plan and health insurance issuer may not cancel health insurance coverage without prior notice to the enrollee and then only for those reasons specifically permitted by the Public Health Service Act (e.g., for nonpayment of premiums, termination of the plan, movement outside the area, etc.).
d. Guaranteed Access and Renewability – Effective for plan years on or after January 1, 2014, all health insurance issuers that offer health insurance coverage in the individual or group markets are subject to the “guarantee access and renewability” rules (originally established under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”)) and must accept every employer and individual in the State that applies for coverage.
e. Pre-Existing Condition Limitation – Beginning six months after enactment, all health insurance policies in the individual and group markets and group health plans are prohibited from imposing pre-existing condition limitations for children. The prohibition is expanded to adults beginning in 2014.
f. High-Risk Pool – Beginning ninety days after enactment of the PPACA, the Secretary of HHS will establish a temporary national high-risk pool to provide health coverage to individuals with pre-existing medical conditions. U.S. citizens and legal immigrants who have a pre-existing medical condition and who have been uninsured for at least six months will be eligible to enroll in the high-risk pool and receive subsidized premiums. If an employer or health insurance issuer offers an incentive to an individual to disenroll from his or her current coverage and the individual disenrolls and enrolls in the temporary high-risk pool, the employer or health insurance issuer will be required to reimburse any expense incurred under the high-risk pool.
g. Waiting Periods – Effective for plan years beginning on and after January 1, 2014, group health plans and health insurance issuers in individual or group markets may not impose waiting periods in excess of ninety days.
h. Automatic Enrollment – An employer that is subject to the Fair Labors Standard Act, that has more than 200 FTEs, and that offers its employees one or more health benefit plans is required to automatically enroll all new FTEs in one of the plans offered and continue the enrollment of current employees in an employer offered health benefit plan. The employer must provide adequate notice to employees of the automatic enrollment and give employees the opportunity to opt-out of any coverage in which the employee was automatically enrolled.
2 Group health plans and health insurance policies may impose an annual or lifetime per beneficiary limitation on specific covered benefits if such limits are permitted by federal and state law.
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