Universal Health Care Blogging - Part 2

Title I - Protections and Standards for Qualified Health Benefits Plan:



Subtitle A, Sec. 101: Requirements reforming health insurance marketplace:



(b) Requirements for Qualified Health Benefits Plans - On or after the first day of Y1 (Y1, Y2, Y3, etc. represent years beginning 2013 and subsequent years, respectively. Y1 will be 2013), a health benefits plan shall not be a qualified health benefits plan under the division unless the plan meets the applicable requirements of the following subtitles for the type of plan and plan year involved:



(1) Subtitle B (relating to affordable health care coverage);

(2) Subtitle C (relating to essential benefits);

(3) Subtitle D (relating to consumer protection).



*Folks, I have no idea how the the aforementioned Subtitles B, C, and D are defined. When you look up the link, it refers you to a Article section and provision which are not conveniently located in the physical bill.



(c) Terminology:



(1) Enrollment in Emloyement-Based Health Plans (You will be

considered "enrolled" with an employer if you are either a participant or a

beneficiary).



(2) Individual and Group Health Insurance Coverage - Individual and

group health care insurance mean health insurance offered in the individual

market as it pertains to Section 2791 of the Public Health Service Act (This is

the type of stuff I cannot trace down and define here at the house on my

own. I need to have access to the law firm's library at work before I can

figure out what this means. The authors of this bill were not kind enough to

put it in her for us, best I can tell).





Sec. 102: Protecting the Choice to Keep Current Coverage:



(a) Grandfathered Health Insurance Coverage - an individual health care coverage that is in force and effect before the first day of Y1 (2013) under these preconditions:



(A) IN GENERAL: One will not be considered enrolled if the first

effective date of coverage is on or after the first day of 2013.



(B) DEPENDENT COVERAGE PERMITTED: A subsequent dependent

of an enrolled person as in (A) is not subject to that subsection. (In my

understanding this would mean a new baby, adopted child, or spouse.

However, I am not certain of that).



(2) Limitation on Changes and Terms or Conditions: ...the issuer

does not change any of its terms or conditions, including benefits and

cost-sharing, from those in effect as of the day before the first day of

Y1 (2013).



(3) Restrictions on Premium Increases: "The issuer cannot vary the

...increase in the premium for a risk group of enrollees in specific

grandfathered health care coverage without changing the premium for

all enrollees in the same risk group at the same rate (if one is affected,

all must be)."



(b)(1) GRACE PERIOD (for Current Employment-Based Health Plans)



(A) IN GENERAL: The Commissioner shall establish a grace period

whereby, for the years beginning at the end of the 5-year period beginning

with Y1, an employment-based health plan in operation as of the day before

the first day of Y1 must meet the same requirements as apply to a qualified

health benefits plan under Section 101, including the essential benefit

package requirement under Section 121.



I'm signing off here, folks. This stuff will cook your brain like an egg after so long.