2010 Requirements

 

Requirements that apply for health plans with plan years beginning on or after September 23, 2010.

Click any of the following items to learn more.

Pre-Existing Conditions

Plans may not impose any pre-existing condition limits for enrollees under age 19.

Lifetime Limits

Plans may not impose any lifetime limits on the dollar value of essential health benefits. Regulations impose notice and special-enrollment rules.

 

Annual Limits

Plans may only impose annual dollar limits on essential health benefits to the extent allowed by regulations.

Rescissions

Plans may not retroactively terminate coverage except in the case of fraud or intentional misrepresentation of material fact as prohibited by the terms of the plan.

 

Adult Children

Plans must provide coverage to adult children up to age 26. A special rule is available for grandfathered plans. Regulations impose notice and special-enrollment rules.

Nondiscrimination

Fully-insured, non-grandfathered plans may not discriminate in favor of highly compensated individuals.*

 

Preventive Care

Non-grandfathered plans cannot require cost-sharing (such as copayments or deductibles) for preventive care services that are specified by the federal government.*

Provider Access

Non-grandfathered plans must provide certain access to PCPs/pediatricians, OB/GYNs, and emergency services. Regulations impose notice requirements.*

 

Internal and External Review

Non-grandfathered plans must comply with new internal claims procedures and external review standards.*

* Indicates grandfathered plans do not have to comply.

ESB-957(0311)

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