Wednesday, Dec. 5, 2012
This Week's News
AMA reviewing proposed ACA rules outlining insurance provisions
A set of proposed rules recently released by the U.S. Department of Health and Human Services would implement a number of health insurance market reforms required in the Affordable Care Act.
The first proposed rule would prohibit health insurance companies from denying health insurance coverage based on pre-existing conditions beginning in 2014. Insurers also would be barred from charging higher premiums to certain enrollees because of their present or past health problems, gender, occupation, or the size or industry of their small employer.
The rule also makes provisions for access to a catastrophic coverage plan in the individual market for young adults and others for whom coverage would be otherwise unaffordable.
Another proposed rule outlines policies and standards for coverage of essential health benefits, a required core package of health care items and services. This consistent baseline also would help patients who are comparing health plans in individual and small-group markets.
A third rule would implement and expand employment-based wellness programs in an effort to promote health and help control health care spending. At the same time, the rule guards against underwriting practices to reduce benefits based on the enrollee's health status.
The AMA is analyzing the proposals and will submit comments, should they require additional revisions to protect physicians and patients from unfair practices in the health insurance market.
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