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Monday, April 19, 2010

What health care reform means for Michigan Blues members who buy individual policies

All this week in this space, we’ll be sharing our responses to many of the most commonly asked questions posed by Blues customers who wonder how health care reform will affect their policies and families.

The series is meant as a deeper dive into changes we first discussed in a previous blog post. While many of the provisions cannot be explained in further detail until we get guidance from the federal government, we’ll share with you what we know now.

We’ll start with changes that will affect customers who get their coverage from one of our individual plans.

Q: What changes will apply to my policy and when will they occur?

If you were enrolled in a policy in the individual market by March 23, 2010, some things will change when your plan year starts anew as we currently interpret the Patient Protection and Affordable Care Act. These changes include:

·              Your policy will no longer have a lifetime dollar limit for benefits.
·              Coverage of dependents is extended until their 26th birthday.
o       The Department of Health and Human Services will post regulations about the definition of “dependent.” Currently, the only requirements are that the person must be under the age of 26 and cannot have an offer of coverage from their employer (the dependent can be married).

Q: What happens to my policy if I or one of my dependents has a pre-existing condition?

A: The Michigan Blues has only a six-month exclusion period for pre-existing conditions. As a result, if you were currently enrolled as of March 23, 2010, your pre-existing condition period will have already expired by the time the new changes from the law are effective.

If you remain on this policy and then add a dependent after the effective date for the pre-existing condition prohibitions, your dependent, regardless of age, will still be subject to a pre-existing condition exclusion period based on the date that the policy holder enrolled in coverage. If you enroll in a new individual product any time after Sept. 23, 2010 and include a dependent under the age of 19, there will be no pre-existing condition exclusions.

Tomorrow: ‘Cadillac’ plans, small-business tax credits and other changes for group customers

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