What does this
new protection mean for your child?
Since 1994 Maine consumer protections have prevented health insurance plans from refusing to sell or canceling coverage because of a "pre-existing" condition. Maine plans could exclude coverage of anything related to a diagnosed pre-existing condition for up to 12 months. Under the ACA, plans can no longer impose those pre-existing condition waiting periods for a child.
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more information? Email
us
or call 1-800-965-7476. And don't forget to look through
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(orange menu on the right) for current health care
programs and resources.
Does this new protection
apply to your plan?
This new protection applies to all employment-based health plans and to "individual" (outside a workplace) plans purchased after March 23, 2010. This protection may not apply to individual health plans purchased on or before March 23, 2010, because that plan may be "grandfathered" (exempted) from this part of the ACA. Your health plan must state in its plan materials whether it considers itself to be a grandfathered plan and must also tell you whom to contact for more information.
Want
more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care
programs and resources.
How will the new
protection affect medical care for your child?
The new protection can help your child receive covered benefits without a pre-existing condition waiting period. Look on the back page for definitions. For example: On October 1, 2010, Sally purchased a new individual health policy for herself and her 13-year-old child, Miranda, who has been treated for asthma in the past. On November 1, 2010, Miranda was hospitalized for an asthma attack. The insurer can't deny payment for the hospitalization based on Miranda's pre-existing asthma condition because:
- Miranda is under the age of 19.
- Sally bought her individual policy after March 23, 2010.
Want
more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care
programs and resources.
What about adults
with pre-existing conditions?
Does the ACA offer
them the same protection it offers children?
The ACA will prevent pre-existing condition waiting periods for adults, starting with "plan year" or "policy year" that begin on or after January 1, 2014. Right now, in Maine there is a new health coverage option for eligible adults called the Pre-Existing Condition Insurance Plan.
Want
more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care
programs and resources.
Definitions
What
is the Affordable Care Act (ACA)?
The Affordable Care Act is the name given to the comprehensive
health care reform law enacted on March 23, 2010. The
new law protects coverage for your child, whether or
not your child's health problem or disability was discovered
or treated before you applied for coverage.
Want
more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care
programs and resources.
What
is a pre-existing condition?
If your child went without health insurance for 90 days
(in most cases) before enrolling in a health plan, any
diagnosed physical or mental health condition, disability,
or illness is a pre-existing condition.
Want
more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care
programs and resources.
What
is an "individual" health insurance plan?
An "individual" health insurance plan is purchased
directly by an individual - not something offered by
a workplace. "Individual" plans can be purchased
for one person, a couple, or a family with children.
Want
more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care
programs and resources.
What
is a "grandfathered" plan?
A "grandfathered" plan is one that was created
or purchased on or before March 23, 2010 that have not
been changed in ways that would cause them to lose grandfathered
status. If a plan is grandfathered, some new health
care reform rules will not apply.
Want
more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care
programs and resources.
What
is a "plan year" or "policy year"?
A plan year refers to a 12-month period of benefits
coverage-which may not be the same as the calendar year.
This period is called a policy year for individual health
insurance. To find out when your plan or policy year
begins, you can check your plan or policy documents
or contact your employer or insurer. For example: if
your plan has a calendar plan year, the new rules would
apply to your coverage beginning January 1, 2011.
Want
more information? Email
us
or call 1-800-965-7476. And don't forget to look through
our Online Health Care Guide
(orange menu on the right) for current health care
programs and resources.
