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Health care reform and changes to health plan policies

May/June 2011 California Country magazine



The Affordable Care Act, also known as health care reform, is intended to give American families and businesses more control over their health care by providing greater benefits and protections for family members and employees. It also is intended to provide the stability and the flexibility that families and businesses need to make the choices that work best for them.

What you need to know if you have an individual insurance policy

Many changes to benefit coverages are based on whether a plan is considered "grandfathered" or "non-grandfathered." This simply refers to the date on which the plan was effective:

  • A grandfathered plan is an existing group health plan or health insurance coverage (including coverage from the individual health insurance market) in which an individual was enrolled on March 23, 2010.
  • A non-grandfathered plan is a plan effective after March 23, 2010.

For non-grandfathered plans

If you purchased an individual plan effective after March 23, 2010, three main benefits head the list of coverage enhancements:

  • Coverage of recommended preventive services with no out-of-pocket costs. Services include, but are not limited to, an annual preventive physical exam, mammograms, screening colonoscopies and immunizations.
  • No annual dollar limits for essential health benefits.

For all plans

Under the new law, certain benefits are available to you as a health plan member regardless of your plan status. Here is a key benefit available now:

  • Extension of parents' coverage to young adults under 26 years old.
    • Provision applies even if the child is married, but coverage is not extended to the adult child's spouse or child(ren).
    • Adult child is ineligible for coverage to age 26 if he or she is eligible for another employer's sponsored coverage.
    • No lifetime dollar limits on essential health benefits.

If you receive benefits through your employer, contact your employer to understand if and how your benefits have changed. You can find more information on the new law at www.healthcare.gov.

For more information about the California Farm Bureau Members' Health Insurance Plan through Health Net Life Insurance Co., call 1-800-213-6716 or visit www.healthnet.com.

Sam Cole is a regional vice president for Health Net of California Inc. Health Net of California Inc. and Health Net Life Insurance Co. are subsidiaries of Health Net Inc.


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