This is a part of a continuing series of posts which address significant features found in the 2,074 pages of the pending U.S. Senate Health Care Bill.
The pending Senate Health Care Bill would also affect Eligibility for Health Insurance Coverage, Renewability of that Coverage, and Limits on its Benefits over the course of a lifetime.
Section 1201 of the Health Care Bill contains amendments to another Federal Law, the Public Health Services Act. One of those amendments would enact Section 2702 of the Public Health Services Act, adding a provision entitled, "Guaranteed Availability of Coverage". Subject to certain exceptions, "each health insurance issuer that offers health insurance coverage in the individual or group market in a State must accept every employer and individual in the State that applies for such coverage." Download Senate-Patient-Protection-Affordable-Care-Act, at 82. [Emphasis added.]
Another amendment in Section 1201 of the Health Care Bill would enact Section 2703 of the Public Health Services Act, which would be entitled, "Guaranteed Renewability of Coverage". Section 2703 would provide that once having issued the Health Insurance Coverage described above, the health insurance issuer "must renew or continue in force such coverage at the option of the plan sponsor or the individual, as applicable." Download Senate-Patient-Protection-Affordable-Care-Act, at 83. [Emphasis added.]
Another Section 1201 amendment would enact Section 2705 of the Public Health Services Act. Section 2705 would provide that "rules for eligibility (including continued eligibility)" may not be based on certain listed "health status-related factors". Among these are "health status," apparently meaning that no matter how sick an applicant for the Health Insurance Coverage may be, she or he cannot be turned down, and "claims experience," indicating that perhaps persons with many Health Insurance Coverage claims cannot be denied eligibility for the regulated Health Insurance Coverage. Download Senate-Patient-Protection-Affordable-Care-Act, at 83-84. It is striking that "claims experience" is treated as an impermissible "health status-related factor" when a Health Insurance issuer regulated by the Bill would determine eligibility, including continued eligibility.
It is also significant in connection with Eligibility and Renewal, that the pending Bill would also amend the Public Health Services Act by prohibiting "lifetime limits on the dollar value of benefits for any participant or beneficiary," at least for a regulated Group Health Plan or Health Insurance Coverage "that is not required to provide essential health benefits under section 1302(b) of the Patient Protection and Affordable Care Act". Even if a Plan or Coverage is not required to provide such "essential health benefits," it is not prohibited "from placing annual or lifetime per beneficiary limits on specific covered benefits" only to the extent that such limits are otherwise permitted by Federal or State Law. Download Senate-Patient-Protection-Affordable-Care-Act, at 16.
To be Continued .....
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