‘SEC. 2714. EXTENSION OF DEPENDENT COVERAGE.
‘(a) In General- A group health plan and a health insurance issuer offering group or individual health insurance coverage that provides dependent coverage of children shall continue to make such coverage available for an adult child (who is not married) until the child turns 26 years of age. Nothing in this section shall require a health plan or a health insurance issuer described in the preceding sentence to make coverage available for a child of a child receiving dependent coverage.This states that parents can extend their coverage for dependent children. It also states the children that were covered and become 'independent' of their parents' coverage is not automatically eligible for the health care insurance they enjoyed for 18 to 26 years of their life, not including pre-natal care.
I thought C.O.B.R.A. allowed that, but, I could be mistaken. I am fairly certain this is one of the provisions that was changed in the Reconciliation Act of 2010.
Qualifying Events for Covered (click here)
Dependent Children
�� The parent-employee dies;
�� The parent-employee’s hours of employment are reduced;
�� The parent-employee’s employment ends for any reason other than his or her gross misconduct;
�� The parent-employee becomes entitled to Medicare benefits (Part A, Part B, or both);
�� The parents become divorced or legally separated; or
�� The child stops being eligible for coverage under the plan as a “dependent child.”
‘(b) Regulations- The Secretary shall promulgate regulations to define the dependents to which coverage shall be made available under subsection (a).
The Secretary of Health and Human Services has the right to define 'dependents.' That can change with every administration though. I don't like that.
(c) Rule of Construction- Nothing in this section shall be construed to modify the definition of ‘dependent’ as used in the Internal Revenue Code of 1986 with respect to the tax treatment of the cost of coverage.
The definition that the Secretary of Health and Human Services is law. There is no other definition such as the one in the Tax Code that applies. The Senate bill was completely 'designed' to alienate the electorate from the achievements of this administration. It is very hostile. Very. There should never be a bill that removes the rights of citizens, so much as increases them. This provision was specifically written to victimize the citizens of the USA. There was one purpose in mind and that was to 'kill the bill.'
‘SEC. 2715. DEVELOPMENT AND UTILIZATION OF UNIFORM EXPLANATION OF COVERAGE DOCUMENTS AND STANDARDIZED DEFINITIONS.
‘(a) In General- Not later than 12 months after the date of enactment of the Patient Protection and Affordable Care Act, the Secretary shall develop standards for use by a group health plan and a health insurance issuer offering group or individual health insurance coverage, in compiling and providing to enrollees a summary of benefits and coverage explanation that accurately describes the benefits and coverage under the applicable plan or coverage. In developing such standards, the Secretary shall consult with the National Association of Insurance Commissioners (click here) (referred to in this section as the ‘NAIC’), a working group composed of representatives of health insurance-related consumer advocacy organizations, health insurance issuers, health care professionals, patient advocates including those representing individuals with limited English proficiency, and other qualified individuals.The only way States can complain about States' Rights is if their regulations are tighter than the ones passed by the federal government. The States have to live up to the higher of the two standards and improve the quality of life of their citizens. The States do not have the 'right' to impoverish their people in regard to their quality of life if federal regulations demand it.
Health Care Reform Bill Draws Measured State Regulators' Response (click here)
By PHIL GUSMANPublished 3/22/2010
NU Online News Service, March 22, 3:32 p.m. EDT
State insurance commissioners said they will work to implement aspects of federal health care reform where they are required to do so, but acknowledged that state legislatures could still challenge the reforms.
Oklahoma Commissioner Kim Holland, who is secretary treasurer of the National Association of Insurance Commissioners (NAIC) said during a teleconference she expects her state’s legislature may push back against the upcoming federal law.
Oklahoma is a conservative state, and the health care reform bill represents “extraordinary preemption.” she said.
In that case, she said, it is the role of insurance commissioners to provide impartial information as it is requested so that the legislators can make decisions.
Kansas Insurance Commissioner Sandy Praeger, who is chair of the NAIC Health Insurance and Managed Care Committee agreed, stating that regulators are responsible for making sure that when legislatures do make decisions, those decisions are based on accurate information and experiences from insurance departments.
Speaking to the threats of lawsuits that have cropped up from some states since the passage of the bill in the House of Representatives, Commissioner Praeger said such actions will not delay insurance commissioners from beginning work on implementing reforms where they are required to do so....
The Constitutional challenge to the Health Care Reform Bill will also be defeated here:...“State regulators (click here) are best positioned to perform rate review and many of us do so with great success,” said Jane L. Cline, NAIC President and West Virginia Insurance Commissioner. “Some, however, have not been given the authority by their state legislatures to review and deny unjustified increases. We believe that a federal backstop could help encourage these legislatures to provide that authority.”
“It is absolutely critical that the state role in assuring the solvency of health plans and promoting competitive markets be preserved,” said Sandy Praeger, Chair of the NAIC Health Insurance and Managed Care Committee and Kansas Insurance Commissioner. “Protecting consumers from high premiums remains a priority, but it is even more important to protect them from insolvency.”
Vice-Chair of the NAIC Health Insurance and Managed Care Committee and Pennsylvania Insurance Commissioner Joel Ario pressed insurers to support reforms that would reduce the fragmentation of health insurance pools. “One problem with premium increases is that rates go up a lot more for some people than for others,” he said, noting that premiums in a reformed marketplace would be more stable for all Americans....
The Obama Administration was thorough in calling in all the authorities to the dynamics of the bill. They didn't leave a stone unturned and that defeat any challenge to the bill....Members of the NAIC met with President Barack Obama (click here) and Health and Human Services Secretary Kathleen Sebelius to discuss rate increases in the health insurance industry. The meeting, which also included top health insurance executives, was called to address recent significant rate increases as part of a larger discussion on how to improve health insurance markets for all consumers....
NAIC’ is an age old non-profit organization that has a lot of clout. It was established in 1871 and has advised State Regulators for that entire time. They are the quinessential authority on the health care insurance industry and how States interface with those companies. If this organization says the States need guidance and interference by the federal government than the States are out of bounds when it comes to screaming about Constitutionality. The people of the USA rely on their 'infrastructure' to discern what is best in policy and legislation, that is exactly the course President Obama took. There is no challenge to the bill here.
Everybody has been CONSULTED.
‘(b) Requirements- The standards for the summary of benefits and coverage developed under subsection (a) shall provide for the following:
(1) APPEARANCE- The standards shall ensure that the summary of benefits and coverage is presented in a uniform format that does not exceed 4 pages in length and does not include print smaller than 12-point font.
No fine print.
‘(2) LANGUAGE- The standards shall ensure that the summary is presented in a culturally and linguistically appropriate manner and utilizes terminology understandable by the average plan enrollee.
Grammar and spelling count. If health insurance companies are selling their products to the citizens of the USA then they have to speak their language in ways they understand.
‘(3) CONTENTS- The standards shall ensure that the summary of benefits and coverage includes--
‘(A) uniform definitions of standard insurance terms and medical terms (consistent with subsection (g)) so that consumers may compare health insurance coverage and understand the terms of coverage (or exception to such coverage);
Nothing unclear here.
‘(B) a description of the coverage, including cost sharing for--
All the costs have to be relieved along with the coverage the policy provides.
‘(i) each of the categories of the essential health benefits described in subparagraphs (A) through (J) of section 1302(b)(1) of the Patient Protection and Affordable Care Act; and
‘(ii) other benefits, as identified by the Secretary;
The Secretary has considerable power here to fine tune the benefits as they are to be addressed by the insurance companies, however, there is nothing in the verbiage that indicates the Secretary can 'diminish' any benefits. It clears states, "other benefits." That is a clear understanding there are MORE and not LESS benefits for the insured.
‘(C) the exceptions, reductions, and limitations on coverage;
The policies have to include in readable format the above. This is consumer protection and seeks to limit the ability to commit fraud. ie: ERISA and the fraud in Medicare Advantage. It will all be controlled by demands for explicit language. It is really unfortunate the American people have been 'worked over the coals' so to speak by this industry. It is plainly clear the legislative bodies of the USA don't trust them at all. Very unfortunate.
‘(D) the cost-sharing provisions, including deductible, coinsurance, and co-payment obligations;
‘(E) the renewability and continuation of coverage provisions;
The critics of this legislation simply do not recognize the damage the health care insurance industry has done to the people of this nation. They don't take this issue seriously.
‘(F) a coverage facts label that includes examples to illustrate common benefits scenarios, including pregnancy and serious or chronic medical conditions and related cost sharing, such scenarios to be based on recognized clinical practice guidelines;
And the legislators in the House and Senate that opposed this bill for political fodder are divisive as well as unethical. To actually allow it to continue for over 20 years and do NOTHING. Wow. And to realize the opportunity came in the way of a minority President dedicated to the 'people' and maintain a posture of 'obstructionism?' Double wow.
‘(G) a statement of whether the plan or coverage--
‘(i) provides minimum essential coverage (as defined under section 5000A(f) of the Internal Revenue Code 1986); and
‘(ii) ensures that the plan or coverage share of the total allowed costs of benefits provided under the plan or coverage is not less than 60 percent of such costs;
The bill provides for ''minimal essential'coverage as stated in a military bill which contains health and dental coverage for the military. It states the 'benefits' of any policy will be no less than 60% of the cost to the consumer. That is a low percentage, but, the consumer will at least know it. This is exactly why there needs to be a Public Option. That low percentage qualifies for 'mandatory coverage' but allows a lot of cost to fall on the shoulders of the consumer.
Using 'standard issue' government language also prevents any unconstitutionality as well.
- Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. TREATMENT OF DEPARTMENT OF DEFENSE HEALTH COVERAGE AS MINIMAL ESSENTIAL COVERAGE.
- (a) In General- Section 5000A(f)(1) of the Internal Revenue Code of 1986, as added by section 1501(b) of the Patient Protection and Affordable Care Act, is amended--
- (1) by striking clause (iv) and inserting the following new clause:
- `(iv) medical coverage under chapter 55 of title 10, United States Code, including coverage under the TRICARE program;';
-CITE-
10 USC CHAPTER 55 - MEDICAL AND DENTAL CARE 01/05/2009 (click here
- (2) by striking `or' at the end of clause (v);
- (3) by striking the period at the end of clause (vi) and inserting `; or'; and
- (4) by inserting after clause (vi) the following new clause:
- `(vii) the Nonappropriated Fund Health Benefits Program of the Department of Defense, established under section 349 of the National Defense Authorization Act for Fiscal Year 1995 (Public Law 103-337; 10 U.S.C. 1587 note).'.
- (b) Effective Date- The amendments made by this section shall take effect as if included in section 1501(b) of the Patient Protection and Affordable Care Act and shall be executed immediately after the amendments made by such section 1501(b).
I need to pause here for awhile.
continued...
