Source: http://kssinsurance.com/obamacare-101/
Timestamp: 2017-10-17 12:54:38
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ObamaCare 101 | KSS Insurance
Government Discount Eligibility Process
Follow the arrows below…
Useful ObamaCare Links
If you would like more information about ObamaCare and all the agencies involved, please visit the websites below:
Dept of Health and Human Services: www.HHS.gov
Federal HealthCare website: www.HealthCare.gov
The Center for Consumer Information & Insurance Oversight: www.cms.gov/cciio/index.html
Federal Medicare website: www.Medicare.gov
Mental Health resources and services: www.MentalHealth.gov
Henry J. Kaiser Family Foundation: www.kff.org
Where to read the Affordable Care Act
You can read the Affordable Care Act by visiting the links below. The health care law, sometimes known as “ObamaCare,” was signed March 23, 2010.
The Full Law
The law has 2 parts: the Patient Protection and Affordable Care Act (Public Law 111-48), signed March 23, 2010, and the Health Care and Education Reconciliation Act (Public Law 111-152) signed March 30, 2010). We provide links to them in PDF and HTML formats below. We also provide a link to an unofficial, consolidated version that is more readable.
The documents are searchable using the “Control Official certified full-text of the laws in PDF form:
Affordable Care Act (.pdf – 2.41 MB)
Reconciliation Act (.pdf – 257 KB)
Certified full-text version in HTML (Web page) format:
Everything you wanted to know about ObamaCare (Healthcare Reform) but haven’t asked
Part 1 - The Basics Behind the Affordable Care Act
Part 2 - The Health Insurance Marketplace
Plans in the new Health Insurance Marketplace will be offered by private companies, and every health insurance plan will cover a core set of benefits called essential health benefits. You’ll be able to compare your options based on price, benefits, quality, and other important features. More people than ever will qualify to save money on private insurance coverage.
Get ready and enroll!
Sign up for email or text updates about the Marketplace. We’ll let you know when there’s important new information about the Marketplace, and we’ll send timely reminders about important dates. You can also visit our Facebook page at facebook.com/KSSinsurance or follow @KSSinsurance on Twitter.
Learn about different types of health coverage: Through the Marketplace, you’ll be able to choose a health plan that gives you the right balance of costs and coverage. You can be better prepared if you understand the types of coverage you’ll choose from. Different types of health insurance include: Health Maintenance Organizations, Preferred Provider Organizations, Point-of-Service Plans, High Deductible Health Plans, Catastrophic Health Insurance Plans.
Make a list of questions you have before it’s time to choose your health plan.
Make sure you understand how coverage works, including things like premiums, deductibles, out-of-pocket maximums, copayments, and coinsurance. You will want to consider these details while you’re looking for health insurance.
Gather basic information about your household income: Most people using the Marketplace will qualify for lower costs on monthly premiums or out-of-pocket costs. To find out how much savings you’re eligible for, you’ll need income information, like the kind you get on your W-2, current pay stubs, or your tax return.
Set your budget: There will be different types of health plans to meet a variety of needs and budgets. You’ll need to figure out how much you want to spend on premiums each month.
Ask your employer if it plans to offer health insurance in 2014: If not, you may need to get insurance through the Marketplace or from other sources in 2014. If you don’t have coverage, you may have to pay a fee or “penalty”.
Part 3 - Coverage for Pre-Existing Conditions
For plan years beginning in 2014, health plans can’t turn you down or charge you more because you’re sick or have a health condition. They also can’t charge women more than men. The only exception is for grandfathered individual health insurance plans.
Starting in 2014, being sick won’t keep you from getting health coverage. An insurance company can’t turn you down or charge you more because of your condition.
Once you have insurance, it can’t refuse to cover treatment for pre-existing conditions. Coverage for your pre-existing conditions begins immediately.
A. Grandfathered plans
B. How to find out if your plan is grandfathered
Check with your employer or your health plan’s benefits administrator.
C. What grandfathered plans do and don’t have to cover
Here’s a quick look at the consumer protections that do and don’t apply to grandfathered plans:
In addition to the above, grandfathered individual health insurance plans (the kind you buy yourself, not the kind you get from an employer) don’t have to:
Part 4 - Summary of Benefits and Coverage
All individual and group health plans must use the same standard form to help you compare plans. The SBC also includes details, called coverage examples, which allow you to see what the plan would cover in 2 common medical situations: diabetes care and childbirth.
You’ll find a link to each plan’s SBC in the Marketplace when you’re comparing plans.
When can I get a Summary of Benefits and Coverage?
You have the right to get this summary when shopping for or enrolling in coverage.
The SBC is available for every plan in the Marketplace. You’ll find a link to it on each plan page when you enroll through the website.
Yes. You can get a Summary of Benefits and Coverage for most health plans, including grandfathered plans, whether you get coverage through your employer or buy it yourself.
Part 5 - Cracking Down on Frivolous Cancellations
The health care law stops insurance companies from canceling your coverage just because you made a mistake on your insurance application.
In the past, if your insurance company found that you’d made a mistake on your insurance application, they could:
Take away your coverage
Declare your policy invalid from the day it started
Ask you to pay back any money they’ve already spent for your medical care
It’s now illegal for insurance companies to cancel your coverage simply because you made an honest mistake or left out information that has little bearing on your health.
Yes. These protections apply to all health plans, including grandfathered plans, whether you get coverage through your employer or buy it yourself.
Does this mean that my plan can’t be canceled for any reason?
No. Your insurance company can still cancel your coverage if you put false or incomplete information on your insurance application on purpose. They can also cancel your coverage if you don’t pay your premiums on time.
Will I be notified before my plan is cancelled?
Yes. Your insurance company must give you at least 30 days’ notice before they can cancel your coverage for the reasons stated above. This gives you time to appeal the decision or find new coverage.
Part 6 - Doctor Choice & Emergency Room Access
You have the right to choose the doctor you want from your health plan’s provider network. You also can use an out-of-network emergency room without penalty.
You pick your doctor: You can choose any available primary care provider in your insurance plan’s network. You can choose any available network pediatrician as your child’s primary care doctor.
No referrals needed for OB-GYN services: You don’t need to get a referral from a primary care provider before you can get obstetrical or gynecological (OB-GYN) care from a specialist.
Access to out-of-network emergency room services: Insurance plans can’t require higher copayments or coinsurance if you get emergency care from an out-of-network hospital. They also can’t require you to get prior approval before getting emergency room services from a provider or hospital outside your plan’s network.
Does this apply to my plan? It depends. These rights don’t apply to health plans created or bought before March 23, 2010, which are known as grandfathered plans. Check your plan’s materials or ask your employer or benefits administrator to find out if your health plan is grandfathered.
Part 7 - Young Adult Coverage
If you’re under 26 years old, you may be able to get insured under a parent’s plan.
You can join, remain, or return to a parent’s plan even if you’re:
eligible to enroll in your employer’s plan (with one exception, below)
Learn more about covering young adults under 26.
Does this apply to my plan? Yes. These rights apply to all health plans that offer dependent coverage, including grandfathered plans, whether you get coverage through your employer or buy it yourself.
But there’s one temporary exception: Until 2014, grandfathered group plans that offer dependent coverage don’t have to offer it up to age 26 if a young adult is eligible for job-based coverage through their own employer.
If you’re under 30, you may buy an insurance policy that covers only very high medical costs. Learn more about these “catastrophic” plans.
Part 8 - Free Preventive Care
Many health plans are required to cover certain preventive care services at no cost to you.
You may be eligible for free preventive screenings, like blood pressure and cholesterol tests, mammograms, colonoscopies, and more. This includes coverage for vaccines and new preventive services for women.
Part 9 - Ending Lifetime & Yearly Limits
Some health insurance plans may have received a temporary waiver from the rules on yearly dollar limits. Yearly limit waivers end with plan or policy years beginning in 2014.
Part 10 - Rate Review & the 80/20 Rule
Part 11 - Your Right to Appeal Coverage Decisions
You have the right to appeal private health plan decisions.
Private Insurance plans have to tell you why a claim has been denied and they have to let you know how you can dispute their decision.
You can request an appeal when a health plan denies payment for a treatment or service. When your plan gets your request it is required to review its own decision. When your plan denies a claim, it’s required to notify you of:
The reason your claim was denied
Your right to request an external review if your internal appeal was unsuccessful
The availability of a Consumer Assistance Program (if your state has one)