Final rule implements 5 key provisions of the ACA

The U.S. Department of Health and Human Services (HHS) today issued a final rule that implements five key consumer protections from the Affordable Care Act (ACA).

Under the reforms, all individuals and employers have the right to purchase health insurance coverage regardless of health status. In addition, insurers are prevented from charging discriminatory rates to individuals and small employers based on factors such as health status or gender, and young adults have additional affordable coverage options under catastrophic plans.

Today’s final rule implements five key provisions of the ACA that are applicable to non-grandfathered health plans:

Guaranteed Availability

Nearly all health insurance companies offering coverage to individuals and employers will be required to sell health insurance policies to all consumers. No one can be denied health insurance because they have or had an illness.

Fair Health Insurance Premiums

Health insurance companies offering coverage to individuals and small employers will only be allowed to vary premiums based on age, tobacco use, family size and geography. Basing premiums on other factors will be illegal. The factors that are no longer permitted in 2014 include health status, past insurance claims, gender, occupation, how long an individual has held a policy or size of the small employer. 

Guaranteed Renewability

Health insurance companies will no longer refuse to renew coverage because an individual or an employee has become sick. You may renew your coverage at your option.

Single Risk Pool

Health insurance companies will no longer be able to charge higher premiums to higher cost enrollees by moving them into separate risk pools. Insurers are required to maintain a single state-wide risk pool for the individual market and single statewide risk pool for the small group market.

Catastrophic Plans

Young adults and people for whom coverage would otherwise be unaffordable will have access to a catastrophic plan in the individual market. Catastrophic plans generally will have lower premiums, protect against high out-of-pocket costs and cover recommended preventive services without cost sharing.

“Because of the Affordable Care Act, being denied affordable health coverage due to medical conditions will be a thing of the past for every American,” said HHS Secretary Kathleen Sebelius, in a statement. “Being sick will no longer keep you, your family, or your employees from being able to get affordable health coverage.”

In addition, today the U.S. Department of Labor announced an interim final rule in the Federal Register that provides protection to employees against retaliation by an employer for reporting alleged violations of Title I of the Act or for receiving a tax credit or cost-sharing reduction as a result of participating in a Health Insurance Exchange or Marketplace.

Patricia Sheehan

Patricia Sheehan was Editor in Chief of I Advance Senior Care / Long Term Living from 2010-2013. She is now manager, communications at Nestlé USA.