HHS Releases proposed rule on pre-existing conditions

HHS Releases proposed rule on pre-existing conditions

Ryan Ball

11/20/2012

Expect a lot of rulemaking and guidance to come from HHS/CMS now that the election is over and more regulations are set to kick in over the next 18 months. HHS issued one of several highly anticipated regulations to implement provisions of the 2010 healthcare reform law related to health insurance market reforms. Starting in 2014, the Patient Protection and Affordable Care Act will make it illegal for health insurance companies to discriminate against people who have pre-existing conditions, which HHS estimates affect some 129 million nonelderly Americans. In the proposed rule, health insurance issuers would generally be barred from denying coverage for such conditions, and individuals would have new special enrollment opportunities in the individual market when they have certain losses of other coverage. Under the regulation, insurance companies will be permitted to vary premiums within limits based on age, tobacco use, family size and geography. Health insurance companies will no longer be able to use factors such as pre-existing conditions, health status, claims history, gender and occupation as reasons to increase premiums. Read the full proposed rule here:
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The proposed rule also discusses the actuarial value of individual insurance plans that can be offered on the state insurance exchanges, determining different levels of essential benefits.


Ryan Ball
OPGA Government Relations
319-236-6868 ~ 319-610-2634
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