by Tina Wise, Benefits Manager, Jefferson County Human Resources
comments open from September 1 until September 20

The House of Representatives passed the Senate health care bill and a reconciliation bill on March 21, 2010. Health Care Reform broadly refers to changes in the managed care medical insurance system, in the United States.

With so many mixed messages in the media about Health Care Reform, it has left many of us confused. So what does it all mean? At Jefferson County, we are constantly keeping an eye on these changes and how they will affect our employees. Some of these changes listed below are already in effect here at the county, and some will be removed.

The health-care overhaul will change the way millions of Americans get health insurance and require nearly everyone to have health insurance or face penalties. A number of factors - including income, age, location and family size - will determine how it specifically impacts your life. While the health care reform in its entirety won’t be completely enacted until 2014, there will be some immediate changes for 2010 and 2011.

• An End to Pre-existing Condition Denial
Health Insurers cannot deny children health insurance because of pre-existing conditions. A ban on denying adults will take effect in 2014.

• Small Business Tax Credits
Businesses with fewer than 50 employees will get tax credits covering up to 50% of employee premiums.

• More Young Adults Covered On Parent Plans
The cut-off age for young adults to continue to be covered by their parents' health insurance increases to age 27.

• No Lifetime Caps
Lifetime caps on the amount of insurance an individual can have will be eliminated. Annual caps will be limited, and banned in 2014.

• Flexible Spending Accounts
Over-the-counter drugs such as aspirin or medical-related items such as bandages will require a prescription in order to qualify as expenses for FSA purposes. And, in 2013 the annual limit will be reduced to $2,500.00 per year.

• Adults With Pre-Existing Conditions Covered
A temporary high-risk pool will be set up to cover adults with pre-existing conditions. Health care exchanges will eliminate the program in 2014.

• New Insurance Plans Must Include Preventative Care
New plans must cover checkups and other preventative care without co-pays. All plans will be affected by 2018.

• The End of Recessions
Insurance companies can no longer cut someone's coverage when he or she gets sick.

• Transparency in Insurance Companies
Insurers must now reveal how much money is spent on overhead.

• Customer Appeals Process
Any new plan must now implement an appeals process for coverage determinations and claims.

• Enhanced Fraud Abuse Checks
New screening procedures will be implemented to help eliminate health insurance fraud and waste.

• Medicare Expansions to Rural Areas
Medicare payment protections will be extended to small rural hospitals and other health care facilities that have a small number of Medicare patients.

• Nutrient Content Disclosure
Chain restaurants will be required to provide a "nutrient content disclosure statement" alongside their menu items. Expect to see calories listed both on in-store and drive-through menus of fast-food restaurants sometime soon.

The enactment date for these items can vary from employer to employer. Factors include the employer's annual plan year when Open Enrollment occurs and whether an employer may be 'grandfathered in' from having to make specific changes. As expected, many details of this legislation continue to change as decision-makers iron out the specifics, but we expect that for the most part these items should remain constant.