We’re Here for You with the Latest on Health Care Reform
Health Care Reform will affect everyone differently - benefit changes, plan choices and tax changes are just a few ways it may impact you. We encourage you to take part in a conversation with your agent, discuss it with your benefit manager at work, call us directly or visit a Florida Blue Center. You can count on us to help you understand the new world of health care.
Medicare Beneficiaries: To learn about Medicare reform please visit www.BlueMedicareFL.com
Choose a category to learn more: Be sure to check back often for updates.
All U.S. citizens and legal residents will be required to have “minimal essential health coverage,” which will be fully defined prior to 2014. In 2014, the government will provide subsidies to those with moderate and low incomes. The tax (as determined by the Supreme Court) for not having qualified insurance coverage will be either a flat dollar amount per person or a percentage of a household’s taxable income, whichever is greater.
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Whether you have questions about your existing coverage or are looking for new, you can count on us to help you find a plan that meets your needs.
In 2014, when health insurance coverage becomes mandatory, there will be premium credits and cost-sharing subsidies available to low-income individuals. To qualify, you must be enrolled in a health plan offered through the Exchange and have a household no greater than four times the Federal Poverty Level for your family size. Undocumented residents will not receive subsidies.
A grandfathered is any health insurance plan that was in effect prior to March 23, 2010. The biggest difference between grandfathered and non-grandfathered plans is that grandfathered plans are not required to make certain benefit changes. However, to maintain grandfathered status, a plan must follow specific guidelines.
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We've already added new plans that include health care reform benefits and enhancements. When you're ready, we'll help you understand your plan options, choose a plan that fits your needs, maximize your coverage and save you money on your medical costs.
Individuals and small businesses will have the option of shopping and comparing health insurance through this Exchange beginning no later than January 1, 2014. Plans offered through the Exchange will meet certain cost and benefit requirements.
Preventive services like mammograms and colonoscopies, help prevent and detect diseases early. This benefit ensures that you receive preventive services, such as screening tests and immunizations, without a cost-share when you go to an in-network provider. All plans that are not grandfathered are required to provide this benefit.
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Preventive care is the key to long-term good health. That's why we removed many of the preventive care limits on most of our plans before health care reform. We’re now offering health care plans with no cost-share on routine preventive services and immunizations received in-network.
Beginning August 1, 2012, some health insurance plans (but not all) will be required to provide the expanded Women's Preventive services at $0 member cost share for in-network providers.
These services include, but are not limited to the following:
1) Annual Well Woman Visits
2) Screening for Gestational Diabetes
3) HPV Testing
4) Counseling for Sexually Transmitted Infections
5) Counseling & Screening for HIV
6) Contraceptive Methods & Counseling
7) Breastfeeding support, supplies and counseling
8) Screening & Counseling for Interpersonal & Domestic Violence
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To determine if your plan is eligible for this coverage, please call us at 1-800-876-2227 to speak with one of our representatives.
This change removes annual dollar limits for essential benefits. This means that insurance plans will not limit the annual dollar amount paid for these benefits.
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It reassuring to know that you can choose a plan that pays for all your essential benefits, without an annual dollar limit.
This change removes lifetime dollar limits for essential benefits. This means that insurance plans cannot limit the maximum dollar amount paid for these benefits during your lifetime.
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We’ve removed the lifetime dollar limits on the amount we’ll pay for all your covered benefits, not just essential benefits. Now, you have greater protection.
This benefit ensures that emergency services will be covered at the same cost share amount whether received in or out of network or without prior authorization. Emergency services include any medically necessary services received in a hospital. All plans that are not grandfathered are required to provide this benefit.
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The last thing you need to worry about during an emergency is where to go for care. Now you can go to the nearest emergency room and know that your benefits are the same.
Health plans cannot set coverage limitations for insured children under age 19 due to a pre-existing condition. Beginning 2014, adults will not be denied access to coverage or have coverage limitations due to a pre-existing condition. Prior to 2014, adults in Florida that cannot obtain Individual insurance can apply for the national Pre-existing Condition Insurance Plan (PCIP), a new health coverage option created by health care reform for people with pre-existing conditions. For more information about PCIP, go to www.PCIP.gov or call 1-866-717-5826
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We're here to answer your questions. When you need help finding coverage, you can talk to us by phone or in person at a Florida Blue Center.
The Mental Health Parity and Addiction Equity Act (MHPAEA) ensures that medical and mental health benefits cost-share amounts are in parity. This change does not apply to Individual policies or group employer plans that cover less than 50 employees.
Beginning September 23, 2012, insurance companies must provide a standard summary of the benefits and coverage offered through a plan to increase the member’s understanding of their coverage. This summary will be provided to you at the time of your application or enrollment in a specific plan.
As of December 31, 2010, non-prescription over-the-counter drugs (other than insulin) that are purchased using funds from a Health Savings Account (HSA), Flexible Spending Account (FSA) or Health Reimbursement Account (HRA) will be assessed a tax penalty of 20%.
Reform established a new process for reviewing rate increases at the state level.
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Our plan rates are regularly reviewed by the State of Florida’s Office of Insurance Regulation (OIR). The OIR approves our rates before we can make our plans available. We have always complied with governmental regulations with your best interest in mind and will continue to do our part in providing affordable care for Floridians.
Insurance companies must meet minimum Medical Loss Ratios (MLRs). An MLR is the percentage of premiums that an insurance company uses for medical costs versus the amount that goes to paying administrative costs. Insurance companies must report MLR annually. If an insurance company does not meet the minimum MLR requirements, it must issue annual rebates to customers
Several criteria on the quality of care will be used as measures on the effectiveness of plans offered by health insurance companies. Insurance companies must submit annual reports to the government and members. These reports will detail how benefits improve health outcomes, prevent hospital readmissions, improve patient safety, and help promote health and wellness activities.
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Quality improvements and reporting have helped us provide affordable health care, value and choice for our members for many years. We strongly support quality improvements required by health care reform to improve quality health care for everyone.
This change ensures that health insurance coverage can only be cancelled due to fraud, an intentional misrepresentation of facts, or failure to pay the premium.
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We have a long-standing practice of not cancelling health insurance coverage. You can count on us for your health needs.
Individuals with pre-existing conditions, who cannot get coverage, may be able to get insurance. They can enroll in the federal high-risk insurance pool if they haven’t had insurance for six months or longer. For information, go to www.PCIP.gov or call 1-866-717-5826.
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We’re here to answer your questions. When you need help finding coverage, you can talk to us by phone or in person at a Florida Blue Center near you.
Insurance companies that offer child-only policies cannot deny coverage for children under age 19. Not all insurance companies offer child-only health insurance policies. By 2014, guaranteed insurance coverage will be expanded to everyone.
This change requires health plans that cover dependents to provide coverage for young adults up to age 26. Your dependents can receive coverage even if they’re married, living outside of Florida, no longer students or financially independent.
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We understand the importance of providing quality health care to your family. That’s why we offer the option to continue dependent coverage up to age 30.
Medicaid, a health insurance program for people and families with low incomes, is expanding to include non-elderly, non-pregnant individuals who are at or below 133% of the federal poverty level based on household income. This expansion takes effect January 1, 2014, for participating states.
An additional $11 billion in funding for Community Health Centers (CHCs) will be provided over the next five years. CHCs deliver quality preventive care to low-income residents. Services can include primary care, dental care, women's health, podiatry, counseling services, health promotion and education, physiotherapy, advocacy and intervention.
Health care reform provides $50 million in state grants for developing alternatives to resolving medical malpractice disputes through lawsuits. Alternative resolutions will emphasize patient safety, disclosure of health care errors and timely resolution.
Have a question about what Health Care Reform means to you? We have answers!
This information is being provided in an effort to share with you some of the changes required under the Patient Protection and Affordable Care Act, otherwise known as Health Care Reform. Please know that plan benefits are subject to change and may be revised based on guidance and regulations issued by the Secretary of Health and Human Services. This information does not cover all of the law’s provisions and should not be used as legal advice for your decisions. We encourage you to seek professional advice regarding how Health Care Reform on how your decisions impact your health insurance.
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