Newsroom

October Health Care Reform Changes

August 2010

Health care reform requires specific benefit changes that impact all employer group plans. The following changes will go into effect for all groups beginning on the first renewal after September 23, 2010. HealthPartners will be making the following changes to all fully insured plans upon renewal:

• Annual dollar limits changes - Annual dollar limits will not be applied to in-network coverage of the benefits that are considered essential, pending guidance from the federal government.
• Removal of lifetime limits - Lifetime dollar limits no longer apply to in-network coverage. Fully insured plans will continue to have a lifetime dollar limit for out-of-network coverage. Members will receive a required notice of this change in their member welcome packet at renewal.
• No cost-sharing on preventive services - Preventive care must be covered at 100 percent when received from an in-network provider (exception for grandfathered plans). HealthPartners was already covering preventive care at 100 percent for most plans. All non-grandfathered plans will now cover preventive care at 100 percent.
• Out-of-network emergency services benefit must match in-network benefit – The copay or coinsurance levels for emergency services must be the same for both in-network and out-of-network facilities. Grandfathered plans are not required to make this change.
• Dependents to age 26 – All HealthPartners group plans will now cover dependents up to age 26, per a group’s eligibility file. Members will receive a required notice of this change in their member welcome packet at renewal. Grandfathered plans may exclude dependents that have access to other employer-sponsored coverage (not through their parents).

For more information on these changes, including the notices you are required to provide to your employees, an overview of the “Mega-Reg,” an overview of non-discrimination testing requirements, grandfathered plan status and more, please visit the health care reform section of healthpartners.com/broker.