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21-11-2012 | Article

Insurers get clearer picture of ACA expectations


HHS release

medwireNews: The Obama administration has provided much anticipated details about implementing provisions of the Affordable Care Act (ACA), specifying three key regulatory measures of the US healthcare overhaul that was signed into law over 2 and half years ago.

One proposed rule prevents health insurance companies from discriminating against individuals based on pre-existing or chronic conditions, gender, or occupation. Rates can still change depending on age, tobacco use, and where a patient lives, but the administration outlined parameters in this regard as well. For example, insurers cannot charge older people more than three times what younger people are charged, and everyone over the age of 63 years should pay the same rates for services.

Another provision outlines "essential health benefits," which establishes a core standard of coverage made up of 10 broad categories, including emergency services and hospitalizations. Individual states are then left to choose the benefits they deem best to use and that local insurers can provide. The required benefits help pave a path toward creating a more consistent way for consumers to compare evidence-based plans in the individual and small-groups markets.

"The Affordable Care Act is building a health insurance market that works for consumers," said Health and Human Services (HHS) Secretary Kathleen Sebelius in a news release. "Thanks to the health care law, no one will be discriminated against because of a pre-existing condition."

The implementation and expansion of employment-based wellness programs, which allow employers to compensate employees who take part in workplace initiatives that aim to lower blood pressure, weight, or cholesterol levels, have also been provided for in these latest ACA updates. The current maximum permissible reward of a 20% reduction in health coverage cost will be upped to 30%, while involvement in programs to reduce tobacco use will earn up to 50% in discounted coverage.

The ACA contends that wellness programs avoid unfairness by allowing workers who find it difficult to meet a particular goal to qualify for rewards through other health initiatives.

"The Affordable Care Act recognizes that well-run, equitable workplace wellness programs allow workers to access services that can help them and their families lead healthier lives," said Secretary of Labor Hilda Solis in the press release. "Employers, too, can benefit from reduced costs associated with a healthier workforce."

Insurers, consumer groups, and the public have 30 days to comment on the provisions that address discrimination and essential health benefits and will have until January 25 to have a say on employee wellness programs.

By Peter Sergo, medwireNews Reporter