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Insurers Promise Some Continued Benefits, Regardless of Supreme Court Decision on PPACA

Posted in Payer/Insurance Reform, PPACA

As we get closer to receiving a decision from the U.S. Supreme Court on the constitutionality of PPACA and its individual insurance mandate, three major insurers have committed to continue some benefits that were required by PPACA.  These announcements address some of the uncertainty being experienced by insureds who don’t know what will happen or how quickly changes may come if the Supreme Court invalidates some or all of PPACA.

Notably, the continuing benefits are those that are very popular, are already in place, and are already factored into the insurers’ business model.  As reported by McClatchy/Kaiser Health News, AP story carried by the New York Times, and the Wall Street Journal, the commitments differ slightly by insurer.  In their press statements, UnitedHealthcare and Humana committed to:

  • allow children to stay on their parent’s insurance until age 26;
  • not go back to lifetime coverage limits;
  • continue preventative screenings and immunizations without requiring a copay;
  • continue third-party appeal processes for denied claims; and
  • not retroactively cancel policies already issued, except in cases of fraud by the consumer.

Aetna has agreed to all of the above, except its statement does not address retroactive cancellation or lifetime limits.

The continued benefits do not address coverage for individuals with preexisting conditions, general affordability issues, or current requirement that insurers reimburse members based on their medical loss rations (if they spend less than 80% or 85% of premium dollars for health-related costs).  The commitments to continued benefits also do not apply to self-insured plans, which are typically offered by large employers and control the benefits provided.