It’s been a long time coming and there are likely many more changes and tweaks on the way, but the mandatory health care insurance reforms under the Affordable Care Act went into effect Jan. 1, 2011. These sweeping and historic changes impact many of the medical care policies we’ve been living under for years, and impact the policies guiding who has access to health care coverage and what the coverage includes. The more you know about these changes the better your ability to protect yourself and your family going forward.

If you have children you’ll be happy to know that all health insurance providers are now prohibited from denying children 18 years of age and younger with coverage for pre-existing conditions and, beginning in 2014, the laws extend to cover all persons. In addition, new laws allow parents to keep children living at home on their health plans until their children reach the age of 26.

Women gain substantially Under the Affordable Care Act. To begin with, all women signing on to new insurance policies will have the freedom to choose from any primary care provider, OB-GYN, or pediatrician in their health plan’s network, or emergency care outside of the plan’s network, without a referral. In addition, women joining a new health care plan are now eligible for recommended preventive services, such as mammograms, new baby care and well-child visits, without paying any out-of-pocket costs.

Keep in mind, health care costs were already rising as much as 14 percent for many Americans before the new law took effect. Employers have already begun to exclude coverage for children in their workers’ policies in order to avoid the new requirements. Keep close eye on your plans provisions.

Women will also see more equality with payments. Prior to the law, women were often charged more for individual insurance policies simply because of their gender.

The Affordable Care Act also places restrictions on health insurance companies who put caps on lifetime benefits. In fact, these are being lifted altogether for plans that renew this year. No longer will Americans have to worry about a cap unexpectedly preventing them from receiving care for a catastrophic accident or illness because they have “maxed out” their policies.

While grandfathered plans are exempt, new laws prohibit insurers from charging co-payments or deductibles for checkups, breast cancer screenings, annual blood work and other routinely recommended annual screenings. This makes it possible for more Americans to take an active and proactive role in their health care without the fear of copayments and higher premiums.
Also key is the new provision that forces additional or higher co-payments on plan members for emergency room visits out of their coverage area network. However, grandfathered plans are also exempt in this category.

The law also demands new requirements on standards of care. Insurers who provide policies to individuals or small groups to spend at least 80% of premiums on direct medical care and efforts to improve the quality of care. Insurers selling to large groups (usually 50 or more employees) must spend 85% of premiums on care and quality improvement. However, this rule does not apply to those employers offering what “self-insured plan.” Be sure you know the details of your employers plan If you’re not sure whether your plan matches this description, ask your employer or check your plan materials.

In addition, health insurance companies must report annual to the Secretary of Health and Human Services on the share of premium dollars spent on health care services and quality improvement and any rebates required. The first report, covering calendar year 2011, will be filed June 1, 2012.

Lastly, in March of 2010, President Obama signed the Affordable Care Act-the new health insurance law. The law creates a new program-The Pre-Existing Condition Insurance Plan (PCIP). It makes Health insurance coverage available to you by your state or the US Department of Health & Human Services if you have been denied heath coverage because of a pre-existing health condition. This $5 billion program may be able to help you until 2014 when the bulk of the health care reform law goes into effect-including a provision that will ban all health insurance companies from discriminating against individuals with pre-existing conditions.

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