ST. CLAIRSVILLE - As the federal government implements the Patient Protection and Affordable Care Act this year, officials with The Health Plan of the Upper Ohio Valley are helping patients understand how the new health care system will impact their lives.
The act, more commonly known as Obamacare, came about under the leadership of the then Democrat-controlled U.S. House of Representatives, the Democrat U.S. Senate and Democrat President Barack Obama, for whom it is named.
The nation finds itself on a road of uncertainty this year and moving forward, as numerous changes and delays to the law have taken place, and assurances that costs would stabilize have proven false.
One of Obamacare's key provisions is the health insurance exchange, now known as the marketplace. Ohio and West Virginia both opted to enter into a partnership with the federal government to develop these marketplaces, found on healthcare.gov. The website was fraught with technical difficulties, so much so that the enrollment deadline was moved from Dec. 31 to March 31.
Insurers opting to participate in the marketplace were required to add 3.5 percent into their premiums to fund the plan's operating expenses.
Health Plan officials said they have been watching the implementation to date, and continue to work to understand the law.
"The Health Plan has chosen not to participate in the insurance marketplace in 2014, and is keeping a close eye on any new developments while plotting our strategies to compete in the all new health care environment over the next decade," said E. David Mathieu Jr., vice president of marketing for The Health Plan.
Although The Health Plan will not participate in the exchanges, Mathieu said patients need to know their rights under Obamacare. He identified some of the changes the plan brings to the health care system as follows.
Adults with Pre-Existing Conditions - Obamacare permits eligible adults with pre-existing conditions to join temporary high-risk insurance pools, Mathieu said. These plans will be superseded by the health care exchanges later this year.
To be eligible, one must be a U.S. citizen, national, or "lawfully present" in the U.S. You must have been uninsured for at least six months and denied insurance due to a pre-existing condition. These temporary pools are set to dissolve on March 31.
Elimination of Annual and Lifetime Limits Mathieu said Obamacare prohibits both individual and group health plans from imposing lifetime financial limits on benefits. Plans may only impose annual limits on coverage as determined by the U.S. Secretary of Health and Human Services. Insurers cannot terminate coverage except in cases of fraud.
Dependent Coverage Mathieu said Obamacare provides dependent coverage for eligible children up to age 26 for all individual and group policies. Eligible dependents can include married children. The child does not need to be financially dependent, reside in the parent's home, or be a full-time student.
Children with Pre-Existing Conditions The new law prohibits health insurance companies from imposing pre-existing condition exclusions in children's coverage.
Preventive Care Mathieu said Obamacare requires qualified health plans to cover certain preventive services and recommended immunizations.
Individual Mandate - This generally compels everyone to maintain some type of health coverage, or become subject to a federal tax penalty starting this year.
There is no legal requirement under Obamacare that an employer provide health coverage to any of its employees. However, starting in 2015, there will be tax and financial implications if any employer with 50 or more workers chooses not to do so.