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Parts of Health Care Reform Begin in California This Week

The national health care reform law was signed by President Obama six months ago, and a few provisions of that law go into effect in California and the rest of the nation this week, beginning Sept. 23.

In California, many of the laws recently passed in the Legislature are similar or even identical to federal reform — maternity care mandates, coverage for dependents till age 26, coverage of pre-existing conditions, for instance — so a question arises:

Why do we even need all of those matching state laws?

“Traditionally, any regulation of health care and health care insurance has been a state regulation,” Anthony Wright of Health Access California said. “This is the first time we have had a federal cop on the beat, and now we have to adapt state law to conform with it.”

Primarily, Wright said, state law has to fit with federal law to cut down on bureaucratic confusion and eliminate legal loopholes.

“Also, sometimes federal law gives broad requirements, but leaves a level of detail to the state,” Wright said. “This gives regulators rights under state law to act, and backs them up in court to have state law aligned with federal law.”

The six-month marker is Sept. 23, but health plans are only required to institute the new policy on the annual renewal date, which could be anytime in the next year, though most health insurance plans renew on Jan. 1.

There are a number of changes in federal health care law that are about to go into effect:

  • Lifetime caps will be lifted. These are the overall ceilings imposed on health benefits by health plans and insurers.
  • Annual policy limits can’t dip below $750,000 for essential benefits. That includes maternity services, drugs, hospital stays and emergency services.
  • Children with a serious pre-existing medical condition cannot be refused coverage on employer plans. That applies to anyone younger than 19, and to new policies purchased for a child.
  • Dependents may now stay on their parents’ health insurance plans till age 26. (They still can be refused coverage for a pre-existing condition, however — if they’re 19 or older.)
  • New plans that take effect from Sept. 23 on have additional restrictions and responsibilities, as well. They must allow women to see an obstetrician without a referral, and they have to cover the cost of some preventive services that are labeled “highest recommendation” by the federal government. Also, health plans cannot charge members higher co-pays for out-of-network emergency services.

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