12.14.09

The Amended Title XXVII of the Public Health Service Act (really wonky stuff)

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The Senate bill enacts its health insurance reforms primarily by amending Part A of Title XXVII of the Public Health Service Act. Conforming amendments in section 1562 apply Part A to ERISA plans (except for sections 2716 and 2718 and others that don’t apply to group health plans), and to insurers in the individual market. The Senate bill renumbers the existing provisions of Part A of Title XXVII (some of them twice), and amends others. The amendments primarily expand the scope of existing provisions to cover the individual market. A list of the provisions of the final Part A of Title XXVII, as amended, as best as I can parse it, follows. With each section are identified the health plans or insurers to which it applies:

PART A OF TITLE XXVII OF THE PUBLIC HEALTH SERVICE ACT AS AMENDED BY HR 3590

  • Sec. 2701. Fair health insurance premiums, limiting rating to age, geographic area, individual or family unit, and tobacco use. (health insurance issuers for individual and small group market. Also insurers of large groups if offered through exchange.)
  • Sec. 2702. Guaranteed availability of coverage. (health insurance issuers offering individual and group coverage.)
  • Sec. 2703. Guaranteed renewability of coverage. (health insurance issuers offering individual and group coverage.)
  • Sec. 2704. Prohibition of preexisting condition exclusions or other discrimination based on health status. (group health plans and health insurance issuers offering group and individual health insurance coverage.)
  • Sec. 2705. Prohibiting discrimination against individual participants and beneficiaries based on health status. (group health plans and health insurance issuers offering group and individual health insurance coverage.)
  • Sec. 2706. Non-discrimination in health care. This section both prohibits discrimination by insurers against providers operating within their scope of practice, and against individuals in violation of section 1558, which prohibits retaliatory action against employees who complain about actions their employers take in violation of the reform act ( group health plans and health insurance issuers offering group and individual health insurance coverage.)
  • Sec. 2707. Comprehensive health insurance coverage. Requires insurance issuers in the individual and small group market provide essential benefits under sec. 1302(a) and that group health plans comply with the cost sharing requirements of sec. 1302(a)
  • Sec. 2708. Prohibition on excessive waiting periods (over 90 days). (group health plans and health insurance issuers offering group and individual health insurance coverage.)
  • Sec. 2709 . (Formerly 2713). Disclosure of information by health insurance issuers.
  • Sec. 2711. No lifetime or annual limits (group health plans and health insurance issuers offering group and individual health insurance coverage, more permissive rules for self-insured and large group plans.)
  • Sec. 2712. Prohibition on rescissions. (group health plans and health insurance issuers offering group and individual health insurance coverage.)
  • Sec. 2713. Coverage of preventive health services. (group health plans and health insurance issuers offering group and individual health insurance coverage.)
  • Sec. 2714. Extension of dependent coverage. (group health plans and health insurance issuers offering group and individual health insurance coverage.)
  • Sec. 2715. Development and utilization of uniform explanation of coverage documents and standardized definitions. (Secretary to develop standards. To be applied by health insurance issuers and sponsors of self-insured plans.
  • Sec. 2716. Prohibition of discrimination based on salary. (Plan sponsors of group health plans other than self-insured plans.)
  • Sec. 2717. Ensuring the quality of care. (group health plans and health insurance issuers offering group and individual health insurance coverage.)
  • Sec. 2718. Bringing down the cost of health care coverage. (health insurance issuer offering group or individual health insurance coverage. Does not apply to self-insured plans.)
  • Sec. 2719. Appeals process. (group health plans and health insurance issuers offering group and individual health insurance coverage.)
  • Sec. 2722. (Formerly 2721). Exclusion of certain plans (i.e. governmental plans).
  • Sec. 2723. (Formerly 2722). Enforcement provisions.
  • Sec. 2724. (Formerly 2723). Preemption, state flexibility, construction.
  • Sec. 2725. (Formerly 2704) Drive through delivery. (group health plan and health insurance issuer offering group and individual coverage.)
  • Sec. 2726. (Formerly 2705). Mental health parity (group health plan and health insurance issuer offering group and individual coverage.)
  • Sec. 2727. (Formerly 2706). Reconstructive surgery following mastectomies. (group health plan and health insurance issuer offering group and individual coverage.)
  • Sec. 2728. (Formerly 2707). Coverage of dependent students during medically-necessary leave of absence. (group health plan and health insurance issuer offering group and individual coverage.)
  • Sec. 2731. (Formerly 2711). Section rewritten as a limitation on guaranteed coverage based on network or financial capacity and transferred to 2702
  • Sec. 2732. (Formerly 2712). Guaranteed renewability of coverage in small group market. (revised and transferred to section 2703.)

Thanks to Sergio Munoz at the National Senior Citizens’ Law Center for help in compiling this list.

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