YOU ASK:

If I buy from the individual market, will the healthcare reform provide me with consumer protections? If so, what are these consumer protections?

WE ANSWER:

Yes, you can be assured that the healthcare reform bill has stipulations that will ensure that your rights as a consumer are protected, even when you buy your insurance plan from the individual market.

Here are the consumer protections (beginning September 2010) that the healthcare reform will provide to the individual market:

  • No arbitrary cancellations. Insurance companies will no longer be allowed to cancel your health insurance policy when you get sick. They can only cancel the policy if you commit fraud on your application or during a claim.
  • Ban on lifetime limits. Starting September 2010, insurance companies will not be allowed to set lifetime limits on your insurance plan.

    Lifetime limits are sometimes set for a specific illness or condition. When a lifetime limit is set, you can only claim up to the specified limit for any one illness. Although the policy is still in force, once you reach the lifetime limit for a disease, say diabetes, you can no longer claim against this disease. Instead of lifetime limits, what the insurance companies will be allowed to set will be annual benefit limits (under certain restrictions).

  • Child coverage. Insurance providers can no longer deny your child coverage due to his pre-existing condition.
  • Additional benefits. All plans that are sold in the individual market would have additional preventive care services. And these are added without any co-payments or deductibles required.
  • Premium increase. The insurance company cannot just increase their premiums. Also, they will not be allowed to add on a lot of expenses that are not directly related to providing you with medical services.

    The insurance company should ensure that 75% of the premiums are spent on medical-related expenses and not on overhead. Also, come year 2011, insurance companies are required to publicize any proposed premium increases. If these premium increases are not justified, the company may be banned from joining the state-based exchange in order to get your business.

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