Summary of Health Plan

[frizzyrazzy]

woah..that's a whole 'nother hot topic forum.

[Becky Stevens mom]

Originally Posted by Flutterby

Ok, Wilf, thats two times you've mentioned cross-dressing, I'm beginning to wonder.. are you trying to tell us something?

I want to see some pictures! I'll play some ABBA

[Illinifan]

Originally Posted by Illinifan

I am hoping to get a version of this from the company I work for so we can compare them and see how similiar they are.

3 weeks later and our HR director finally sent this to all employees today:

President Obama signed the Patient Protection and Affordable Care Act into law, which is designed to expand insurance coverage to nearly 95 percent of Americans by the end of its implementation in 2018. The historic healthcare overhaul will extend health coverage to 32 million Americans, expand the government Medicaid programs for individuals who cannot afford coverage, impose new taxes, and prohibit insurance companies from limiting or denying coverage to people with pre-existing medical conditions.

The Health care reform bill will have an impact in many facets. Following is a summary of the key employer health plan impacts as we understand today that will take affect for XXXXXX?s January, 1, 2011 plan year.

? Dependent children can now be covered up to age 26 if a covered employee?s child lacks access to other employer coverage
? Health plans will be required to eliminate lifetime benefit maximums and restrict annual limits. The XXXXXX health plans, with the exception of the High Deductible Health Plan, do not contain in network lifetime benefit maximums.
? Health plans would be prohibited from imposing pre-existing condition exclusions for covered children under age 19. The XXXXXX health plans do not contain pre-existing condition exclusions.
? Reimbursements from a healthcare flexible spending account (FSA)or health savings account (HSA) for over the counter medications will be prohibited unless prescribed by a doctor
? There will be increased penalties for non qualified healthcare savings account distributions. The current penalty is 10% and will be increased to 20%.
? Cost sharing for certain preventive services will be prohibited such as services being subject to deductibles and copayments

Other provisions in the bill are expected to be implemented each year and all provisions should be implemented by 2018. The Company intends to be fully compliant with these new health care provisions, will continue to monitor the updates we receive, and communicate any additional information as it becomes available. Should you have any questions about how these provisions will impact the XXXXXX health plans, please feel free to contact me with any questions.

[susanH]

i called Highmark yesterday about my college graduating son. his commencement is may 15th. i was told the 'extension to age 26' won't take effect till 2014 and they are terminating him. period. the HR department at work knows absolutely nothing more than that either.

i understand, from a previous post in this thread, that the change will go into effect within 6 months, not 4 years. however, that still leaves him in a gap. i know administration of this redtape nightmare takes time, but you'd think a force as big and strong and involved as Highmark Blue Cross/Blue Shield would have a portion of their crap together on it by now.

i am hopeful we can put cobra in place within the next month.

so the plan's timing is almost, but not quite beneficial for us/him.

[Darryl]

Originally Posted by susanH

i called Highmark yesterday about my college graduating son. his commencement is may 15th. i was told the 'extension to age 26' won't take effect till 2014 and they are terminating him. period. the HR department at work knows absolutely nothing more than that either.

i understand, from a previous post in this thread, that the change will go into effect within 6 months, not 4 years. however, that still leaves him in a gap. i know administration of this redtape nightmare takes time, but you'd think a force as big and strong and involved as Highmark Blue Cross/Blue Shield would have a portion of their crap together on it by now.

i am hopeful we can put cobra in place within the next month.

so the plan's timing is almost, but not quite beneficial for us/him.

The coverage through age 26 does begin 6 months after the bill's enactment:
http://www.healthreform.gov/reports/keyprovisions.html
HR should be able to describe the theory under which this provision does not apply to you.

With regard to the "gap" that on the surface may affect this year's graduating college students, perhaps if due to incompletion of a Spring course requirement, the course was marked "Incomplete" and graduation was deferred until the Fall, an employer might be forced to cover the child through age 26. Who is to say, but I wouldn't be surprised if a LOT of this year's Spring term graduations get delayed for one reason or another until the Fall

[Austinian]

Wow,
I was hoping to come to this forum and thread to find out more information re. my diabetic son. Unfortunately, it seems everyone here is in the dark as well.

Brensdad seems to hit the nail on the head - thanks for sharing your insights and information. It's been almost two months since the signing, and I can find no further "official" information regarding the bill - just the flurry of news reports that came out in March.

Others need to have their lips, which seem to be surgically attached to our president?s %ss, removed so they can actually start thinking and reasoning based upon the facts at hand.

I apologize for the directness, but blind partisanship on both sides of the coin seems to be what's driving our nation and our government into complete ineffectiveness. And, as of this week, I and my family are now part of the "uninsured". Here's my story - any help or guidance would be welcome...

My son was diagnosed Type 1 5 years ago. He is now 15, and a healthy, athletic, intelligent young man.

18 months ago, I accepted a great new position with a smaller firm. The firm did NOT have a group plan, but was "in process" of acquiring one as it is growing. I quickly realized how hard it was going to be to get my son covered (boy, is it easy to take things for granted!), and so was able to get continuation of coverage through Cobra. 18 months to find a new solution!

Unfortunately, this began a string of applications, and subsequent denials, for health care for him. The three other family members were always accepted, but in order to begin the new insurance, I would have to cancel Cobra, thus leaving my son out in the cold

The deadline for finding coverage was fast approaching. Facing reality, we resigned ourselves to prepare to accept one of the offers that covered the rest of us. Then, The Health Care Reform bill passed! Yay!! To be honest - I cried like a baby when I read about the exclusion of pre-existing condition denials. My son was going to be covered! (at least By September).

So, we called up the agency that handles many of the other guys at my work, the agency that we are looking into for providing a group plan, and stated that we wanted to go ahead and accept their earlier offer. Back when we applied with them, they had actually sent us cards and billed us for the first month's coverage. We had to petition to get at least part of that back after we decided initially not to go with them.

They said that since we were just over the 60 day acceptance limit, we would have to re-apply. No problem - I had zeroxed the 25 page application the first time around and kept a copy. I pulled out the copy, updated the dates, and sent it in, expecting no problems. Sadly, this was not the case.

We received a letter within two weeks stating that ALL of us had been denied -
* Me, for having used a Flonase/generic ONCE in the past 12 months (Allergy nose spray).
* My Wife for having listed her last Menstrual cycle as having been SIX weeks prior to the application rather than the customary FOUR (actually a typo - she had another one during the course of re-applying, I just didn't bother to change the date).
* My Older son for Playing soccer, and having visited the emergency room twice during the previous year (too high a risk).
* And of course my younger son for having type 1.

I was floored. This was the same ACTUAL application they had just approved in December!
I of course appealed, sent in letters from my doctor, corrected my wife?s info, and included my older son's athletics physical results (in INCREDIBLE shape!), after which two weeks passed and we received ANOTHER letter of denial for all but my wife, which didn't help because they don't insure just dependants.

After many, many angry phone calls, I had one rep for the company, in a moment of candidness, say "To be honest Mr.____________, our underwriting policies have had to be revamped in lieu of the recently signed Health Care Bill and its impending implications. I'm very sorry".

Basically - now that companies may have to accept my son eventually, they are going to avoid the issue by just denying coverage altogether, for whatever reason they can drum up. I have received the same letter (for the most part) from two other companies in the preceding 3 weeks. Thank you very much, big government

Basically - we are screwed.

I tried applying for the Texas High Risk Pool. No go - we are ineligible, because my company pays as a benefit a portion of its employee?s health insurance costs. This constitutes a form of "employee-provided health care" and thus makes us ineligible. My small company would have to stop making this available to ALL of its employees in order for it to be in compliance. Everyone there has an individual plan, paid for up to 80% by the company. To convert to a group plan, it would cost both the company and the employees almost 50% MORE per year, something no can afford.

And now, I'm wondering how ANY of these wonderful provisions in the reform bill are going to be implemented?!? If I WERE to somehow get insurance for the three of us now, and when I try to add my D son in September, what's to stop them from just saying, "Uhh, no". What regulations have been enacted, or will be, by that time? How will they be enforced? What sort of litigation or legal representation will I have to engage in order to make the insurance company comply???????

So -
No individual Health care
No Group Health care
No High Risk Pool
Too high of an income for Medicaid, etc.
And not a lot of hope for September 23rd.

My son has signed up to go on a 10 day mission trip with World Changers to go and renovate impoverished neighborhoods in southwest Texas. He'll be replacing roofs, rebuilding rotted house supports, painting, cleaning up condemned lots/homes, etc. He has done this the last two summers, and I'm very proud of him for his desire to help those in need.

But dare I risk letting him go? What if he required a visit to an emergency room? Or, had complications due to D and the hard work schedule??

I am seriously depressed, disillusioned, and to be honest, angry (as if you couldn't tell)

[Lisa P.]

Originally Posted by Austinian

Wow,
I was hoping to come to this forum and thread to find out more information re. my diabetic son. Unfortunately, it seems everyone here is in the dark as well.

Brensdad seems to hit the nail on the head - thanks for sharing your insights and information. It's been almost two months since the signing, and I can find no further "official" information regarding the bill - just the flurry of news reports that came out in March.

Others need to have their lips, which seem to be surgically attached to our president?s %ss, removed so they can actually start thinking and reasoning based upon the facts at hand.

I apologize for the directness, but blind partisanship on both sides of the coin seems to be what's driving our nation and our government into complete ineffectiveness. And, as of this week, I and my family are now part of the "uninsured". Here's my story - any help or guidance would be welcome...

My son was diagnosed Type 1 5 years ago. He is now 15, and a healthy, athletic, intelligent young man.

18 months ago, I accepted a great new position with a smaller firm. The firm did NOT have a group plan, but was "in process" of acquiring one as it is growing. I quickly realized how hard it was going to be to get my son covered (boy, is it easy to take things for granted!), and so was able to get continuation of coverage through Cobra. 18 months to find a new solution!

Unfortunately, this began a string of applications, and subsequent denials, for health care for him. The three other family members were always accepted, but in order to begin the new insurance, I would have to cancel Cobra, thus leaving my son out in the cold

The deadline for finding coverage was fast approaching. Facing reality, we resigned ourselves to prepare to accept one of the offers that covered the rest of us. Then, The Health Care Reform bill passed! Yay!! To be honest - I cried like a baby when I read about the exclusion of pre-existing condition denials. My son was going to be covered! (at least By September).

So, we called up the agency that handles many of the other guys at my work, the agency that we are looking into for providing a group plan, and stated that we wanted to go ahead and accept their earlier offer. Back when we applied with them, they had actually sent us cards and billed us for the first month's coverage. We had to petition to get at least part of that back after we decided initially not to go with them.

They said that since we were just over the 60 day acceptance limit, we would have to re-apply. No problem - I had zeroxed the 25 page application the first time around and kept a copy. I pulled out the copy, updated the dates, and sent it in, expecting no problems. Sadly, this was not the case.

We received a letter within two weeks stating that ALL of us had been denied -
* Me, for having used a Flonase/generic ONCE in the past 12 months (Allergy nose spray).
* My Wife for having listed her last Menstrual cycle as having been SIX weeks prior to the application rather than the customary FOUR (actually a typo - she had another one during the course of re-applying, I just didn't bother to change the date).
* My Older son for Playing soccer, and having visited the emergency room twice during the previous year (too high a risk).
* And of course my younger son for having type 1.

I was floored. This was the same ACTUAL application they had just approved in December!
I of course appealed, sent in letters from my doctor, corrected my wife?s info, and included my older son's athletics physical results (in INCREDIBLE shape!), after which two weeks passed and we received ANOTHER letter of denial for all but my wife, which didn't help because they don't insure just dependants.

After many, many angry phone calls, I had one rep for the company, in a moment of candidness, say "To be honest Mr.____________, our underwriting policies have had to be revamped in lieu of the recently signed Health Care Bill and its impending implications. I'm very sorry".

Basically - now that companies may have to accept my son eventually, they are going to avoid the issue by just denying coverage altogether, for whatever reason they can drum up. I have received the same letter (for the most part) from two other companies in the preceding 3 weeks. Thank you very much, big government

Basically - we are screwed.

I tried applying for the Texas High Risk Pool. No go - we are ineligible, because my company pays as a benefit a portion of its employee?s health insurance costs. This constitutes a form of "employee-provided health care" and thus makes us ineligible. My small company would have to stop making this available to ALL of its employees in order for it to be in compliance. Everyone there has an individual plan, paid for up to 80% by the company. To convert to a group plan, it would cost both the company and the employees almost 50% MORE per year, something no can afford.

And now, I'm wondering how ANY of these wonderful provisions in the reform bill are going to be implemented?!? If I WERE to somehow get insurance for the three of us now, and when I try to add my D son in September, what's to stop them from just saying, "Uhh, no". What regulations have been enacted, or will be, by that time? How will they be enforced? What sort of litigation or legal representation will I have to engage in order to make the insurance company comply???????

So -
No individual Health care
No Group Health care
No High Risk Pool
Too high of an income for Medicaid, etc.
And not a lot of hope for September 23rd.

My son has signed up to go on a 10 day mission trip with World Changers to go and renovate impoverished neighborhoods in southwest Texas. He'll be replacing roofs, rebuilding rotted house supports, painting, cleaning up condemned lots/homes, etc. He has done this the last two summers, and I'm very proud of him for his desire to help those in need.

But dare I risk letting him go? What if he required a visit to an emergency room? Or, had complications due to D and the hard work schedule??

I am seriously depressed, disillusioned, and to be honest, angry (as if you couldn't tell)

Do you have an insurance agent?
Sure sounds like you can't catch a break with a whale-sized net, but maybe an agent can navigate for you.
The high-risk decline sounds wiggy, maybe the person you talked to didn't understand? But our state's high-risk pool seems to work differently.
Hey, any comfort in knowing that you've just made the rest of us feel very, very luck? Didn't think so. . . .

[OSUMom]

Originally Posted by Darryl

The coverage through age 26 does begin 6 months after the bill's enactment:
http://www.healthreform.gov/reports/keyprovisions.html
HR should be able to describe the theory under which this provision does not apply to you.

With regard to the "gap" that on the surface may affect this year's graduating college students, perhaps if due to incompletion of a Spring course requirement, the course was marked "Incomplete" and graduation was deferred until the Fall, an employer might be forced to cover the child through age 26. Who is to say, but I wouldn't be surprised if a LOT of this year's Spring term graduations get delayed for one reason or another until the Fall

The coverage doesn't start until the "new plan year" after the 6 months after the bill's enactment. My dh's company enacts it January 1, 2011. My son will be off our plan the end of the month which is the company's policy since he graduated June 13, 2010. This is BCBS who did come out and say they were going to "bridge the gap" - apparently not all the BCBS groups are participating even though it's on BCBS's Web site. My dh's company is self-insured so the company can do what they want regarding bridging the gap.

It's very misleading, complicated and difficult to get accurate information.