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Patient’s Bill of Rights Summary
September 23, 2010 marks six-months since we passed health care reform. It’s also marks the start of the new Patient’s Bill of Rights, a set of key patient protections designed to put decision making power back in the hands of the American people and not insurance companies.
If your “plan year” begins on or after September 23, 2010, you will have the following new rights: (Meaning that the Patient’s Bill of Rights will be in effect during your next open season in your employer plan or the next time you re-enroll in or purchase a policy from an insurer.)
Your health coverage cannot be arbitrarily cancelled if you become sick
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- Up until now, insurers could cancel your coverage if you got sick or if there was a mistake on your initial paperwork.
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- Insurers will only be allowed to cancel coverage as a result of fraud or an intentional misrepresentation
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Your child cannot be denied coverage due to a pre-existing condition
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- Each year, thousands of children who were either born with or develop a costly medical condition are denied coverage by insurers.
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- Health insurers are prohibited from denying coverage to children based on a pre-existing condition.
- Health insurers cannot exclude treatments for pre-existing conditions.
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Your child can stay on your health plan up to age 26
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- Young people are the most likely to be uninsured – with currently one in three young people having no health coverage. Up until now, most plans dropped your child’s coverage when they graduated from college.
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- Your child can maintain their coverage on your insurance until they turn 26. Your child does NOT need to be financially dependent on you, nor are they required to live with you, be unemployed, unmarried or a student.
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You have the right to choose your own doctor
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- Previously, insurance companies haven’t always made it easy to see the provider you choose.
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- You have the guaranteed right to choose your own primary care doctor.
- You can choose a pediatrician as your child’s primary care doctor.
- Women have right to see an OB-GYN without having to obtain a referral first.
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Your health plan cannot put an annual or lifetime limit on your health coverage
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- Until now, millions of Americans who suffered from costly medical conditions were in danger of having their health insurance coverage vanish when the costs of their treatment hit their annual or lifetime limits.
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- Lifetime limits are banned for all plans and annual limits will be phased out.
- If you’ve previously hit your annual or lifetime limit, you will be able to access coverage again.
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You have the right to both an internal and external appeal
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- Today, if your health plan tells you it won’t cover a treatment your doctor recommends, or it refuses to pay the bill for your child’s last trip to the emergency room, you might not have any options, depending on your plan and the state you live in.
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- You have a guaranteed right to an “internal appeal.”
- Also, insurance companies will be prohibited from denying coverage for needed care without a chance to appeal to an independent third party, also known as an “external appeal.”
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If you purchase a NEW plan starting on or after September 23, 2010, you will have the following new rights:
You have the right to access preventive services without deductible or co-payments
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- Today, too many Americans do not get the high-quality preventive care they need to stay healthy, avoid or delay the onset of disease, and lead productive lives.
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- Insurance companies must cover recommended preventive services, including mammograms, colonoscopies, immunizations, and pre-natal and new baby care, without charging deductibles, co-payments or co-insurance.
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You have the right to access to out-of-network emergency room care at in-network cost-sharing rates
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- Many insurers charge unreasonably high cost-sharing for emergency care by an out-of-network provider.
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- Health plans will not be able to charge higher cost-sharing for emergency services that are obtained out of a plan’s network.
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