As the nation faces a change in administrations, the Patient Protection and Affordable Care Act (sometimes called Obamacare) faces an uncertain future. It seems like a good time to take a look at the changes in New York health care coverage which came as a result of these laws.
A number of consumer protections under the federal Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, went into effect Sept. 23, 2010.1 In 2011 New York amended various sections of its Insurance Law and Public Health Law to implement many of the reforms required by the federal law.2 The changes included:
• Prohibiting lifetime dollar limits and restricting annual dollar limits on essential health benefits in insurance plans;
• Requiring health insurance plans that provide dependent coverage to make it available until a child turns 26;
• Prohibiting plans from retroactively cancelling coverage, except in the case of a fraud or intentional misrepresentation;
• Requiring coverage of specified preventive health services without copayments, coinsurance, or deductibles;
• Prohibiting plans from imposing preexisting condition exclusions on individuals under age 19;
• Where a health insurance plan covers emergency services, it must cover such services without prior authorization, and regardless of whether the provider participates in the plan’s network;
• Insurance plans must allow subscribers to designate any available participating primary care provider (PCP) as their provider and plans must allow parents to choose any available participating pediatrician to be their children’s PCP;
• Prohibiting insurance plans from requiring a referral for obstetrical or gynecological (OB/GYN) care.