My personal quest is to become better informed about the Affordable Care Act since it is the primary reason I am sitting at home on furlough from my job. Also listening to the news and reading commentaries, that are more inflammatory than explanatory, is drudgery. I make no claim to being a subject matter expert. If you have any questions or reservations about the material presented below there are more educated individuals and I invite you to contact them.
That said, let's begin.
Sec 1301-1304 Qualified plan definition. Plans offered will meet minimum requirements for coverage for emergency, hospitalization, preventative care, etc. Emergency services will cost the same whether in network or out of network. Periodic reviews of plans will be made by Sec of Labor to identify gaps in care or healthcare accessibility. These sections regulate the insurance provided and ensure minimum coverages are intact. There is no requirement to provide abortion service coverage. It also provides a non-discrimination clause.
"(3) PROVIDER CONSCIENCE PROTECTIONS.—No individual
health care provider or health care facility may be discriminated
against because of a willingness or an unwillingness, if doing
so is contrary to the religious or moral beliefs of the provider
or facility, to provide, pay for, provide coverage of, or refer
for abortions."
Health care providers are required to continue providing emergency services.
Health care providers are required to continue providing emergency services.
Sec 1311The federal government will provide money to the states to establish the insurance purchasing exchanges and will ensure the health plan providers meet the minimum requirements of the ACA. States may require an additional benefits be added to the plans. The state exchanges will not be funded by the government after 2015 and the states may charge the health plans a fee to manage the exchanges. A consumer notification of health plan costs will be provided on the health care exchange site. Prior to an increase in fees, health plan providers must publicly provide justification for the new fee. States may work together and share exchanges. The state can contract these services with a minimum requirement in type and qualifications of the providers of services.
Individuals may purchase insurance outside of the exchange. An insurer cannot charge a cancellation fee if someone goes elsewhere for their insurance. Non citizens cannot participate in the exchange.
Sec 1313 Protections against fraud and abuse are defined in this section. Government Accountabilities Office has oversight authority and will audit the exchanges within the first five years.
Sec 1321 Provides states flexibility in operation, establishment and enforcement of the health care exchanges.
Sec 1322 FEDERAL PROGRAM TO ASSIST ESTABLISHMENT AND OPER- ATION OF NONPROFIT, MEMBER-RUN HEALTH INSURANCE ISSUERS. Provides the ability for consumer owned cooperative exchanges to be established. It is defined as a Consumer Operated and Oriented Plan. CO-OP. The federal government will provide loans and grants for start ups. Loans became available in July 2013.
A personal interjection here:
I am very surprised at Sec 1322 CO-OP and the fact that it is not a well known fact. This ability to form cooperatives may in fact create competition in the market thus health plan prices in theory could go down. Additionally, if I read this correctly groups of individuals that want to create health plans specific to their religious beliefs can do so as long as the plans meet the minimum requirements of the law. I hope this has been as educational for you as it has been for me.
Happy Monday. Diane
No comments:
Post a Comment