As PPACA Deadlines Near, States Dawdle

John Commins, for HealthLeaders Media , February 1, 2013

"There has been some uncertainty about the law given the Supreme Court decision as well as the election. Now that those uncertainties are gone you would expect to see in this legislative session more action by a large number of states," she says.

"So far not many states have passed the needed legislation or issued regulations that the need to but you probably can expect some considerable activity in the coming year. States really need to press forward and implement these provisions and bake them into their laws."

According to The Commonwealth Fund, the seven reforms that begin Jan. 1,2014 apply to health plans inside and outside the exchange include:

  • Guaranteed Issue: Requires insurers to accept every individual and employer that applies for coverage.
  • Ban on Waiting Periods: Employers cannot impose waiting periods longer than 90 days before an employee can be eligible for coverage.
  • Rating Requirements: Insurers are restricted from using health status, gender, and other such factors in setting premiums.
  • Ban on Preexisting Condition Exclusions: Insurers cannot exclude or limit coverage for people with preexisting health problems.
  • Essential Health Benefits: Requires insurers to cover a comprehensive set of health benefits.
  • Out-of-Pocket Cost Limits: Holds out-of-pocket costs to the level established for high-deductible health plans that qualify for health savings accounts.
  • Actuarial Value: Requires insurers to cover at least 60% of total costs under each plan and sell plans that meet new benefit tiers based on average costs covered.
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