Chronic illness has shaped my career. Kairol Rosenthal is a fellow traveler who found that illness can lead you in new directions-if you let it. I’ve asked her to guest post this week because her information is so critical for all of us.
Kairol Rosenthal was diagnosed with cancer at 27 and discovered two days later she had been dropped by her insurance. She has spent the last decade fighting for her own health insurance, and researching and writing Everything Changes: The Insider’s Guide to Cancer in Your 20s and 30s.
Living with chronic illness is hard enough without the dizzying language of health insurance red tape. I wanted to make the Sept. 23 health insurance changes easier for all of us to understand, so I’ve adapted the Campaign for Better Health Care Guide with a bent on chronic illness.
Feel free to ask questions in the comment section below. Remember, these new regulations are now law. You should hold insurance companies accountable so you can get the maximum protection and coverage guaranteed to you.
The below changes apply to plans beginning or renewed after September 23, 2010. For many people this means the provisions actually take effect when they renew their plans in early 2011.
1. NO MORE RESCISSIONS (A.K.A. GIVING YOU THE BOOT)
Insurance companies can no longer cancel your coverage for unjust reasons, a practice known as rescission. Before, if an insurance company got hit with a big claim, they could find an unintentional error on your application (even from years ago) and use it as a basis to deny you coverage; not anymore. This applies to all insurance plans. FYI: If you intentionally commit fraud or hide something on your application, your insurance company can still rescind your coverage. Your insurance company must give you 30 days notice before rescinding coverage to give you time to appeal.
2. RIGHT TO APPEAL INSURANCE COMPANY DECISIONS
You’ll now have the right to appeal decisions your insurance company makes about your health care (such as refusing coverage) to an independent, third party reviewer. This appeals process will vary by state and by plan. FYI: This doesn’t apply to grandfathered plans. Learn what qualifies as a grandfathered at FamiliesUSA, Number 4 under ‘Big Picture’.
3. NO MORE LIFETIME CAPS
Insurers are now not allowed to set limits on your lifetime benefits coverage, no exceptions. You will no longer have to worry about “capping out” on your coverage. FYI: There are still annual benefits caps that have been raised to $750,000. These will be fully eliminated in 2014.
4. FREE PREVENTIVE CARE
Your insurance plan must cover preventive services and screenings, without co-pays or deductibles. The full list is long and includes mammography, colorectal and cervical cancer screening, depression screening, counseling for sexually transmitted infections, many adult immunizations, and many forms of pregnancy care. FYI: “grandfathered” plans don’t have to comply with this rule.
5. COVERAGE FOR YOUNG ADULTS
If you’re a YA without health insurance, you can be covered under your parent’s plan up until your 26th birthday. This includes YAs who are married and YAs who aren’t students. FYI: Young adults that already have a health insurance offer through an employer may not be eligible.
6. NO DENYING KIDS WITH PRE-EXISTING CONDITIONS
Insurers are required to provide coverage to children (up to age 19) with pre-existing conditions, like asthma or hemophilia. This applies to families with group plans and “non-grandfathered “individual plans. FYI: “grandfathered” individual plans don’t have to comply with this provision (though group plans do), and some insurance companies will no longer offer child-only policies.
For tips on how to cope with everything from managing medical debt to chronic illness and sexuality check out Kairol’s blog Everythingchangesbook.com