Health Insurance Reform Is Law

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Jul 15, 2009 No Comments ›› admin

July 15, 2009

“I am 24 years old and my job doesn’t provide health insurance,” the young man told me. “What do I need to do to qualify for my parents plan?”

Recently the Governor signed into law my proposal to require insurance companies to cover adult children up to age 27 on their parents plan. The new law, which goes into effect next February, is part of my five point plan for health insurance reform.

Under the new law parents will be able to add or continue to cover adult children on their policies.  Adult children must be unmarried and must not be offered a less expensive plan through their employer.  Insurance companies can charge no more than what they charge for under-age children.  Parents must file paperwork each year verifying their child qualifies.

College students, whose education is interrupted for active duty in the National Guard or the Reserves, upon their return home and to school can be covered on their parents insurance regardless of age.  This is a small way we can say ‘Thank you” to our returning heroes who interrupted their education plans to answer the call to duty.

People age 19 to 29 are the least likely to have insurance. This age group is also the most likely to stay healthy so insurance is the least expensive. 

Adding choice for parents and their adult children was one part of what I sought to do with the five point health insurance reform plan. Another part was providing choices to people when renewing their policies. Insurance companies must now allow you to change policies within the same company without additional underwriting. If you want to raise your deductible or move to a different type of insurance product, you can do so with out worrying about being denied the new policy.

Consumer protections are also part of the reform.  For many years insurers had very little restriction on defining or excluding pre-existing conditions. Insurance companies could say to a person “You should have known you were going to get heart disease – you had a high cholesterol test ten years ago – therefore we are not going to pay for your heart attack. We call it a ‘pre-existing condition’.”

This practice of looking back and using what lawyers call a ‘prudent person’ standard – the ‘you should have known’ – will now be illegal. Only a doctor’s diagnosis written in your medical record will count as a pre-existing condition.

Insurance companies will not be able to deny claims related to pre-existing conditions for longer than one year. According to the Kaiser Family Foundation, twenty-three other states limit pre-existing exclusions to one year.

If you have a dispute with an insurance company over a claim or a dropped policy, frequently your only option is an appeal to the company itself. Under the new health insurance reform I crafted, you can appeal to an ‘independent review organization’ free of charge. Having an independent group review the claim or rescission will give consumers a fighting chance to have disputes resolved in a quick and fair manner.

Other parts of my five point plan now law include a uniform application form for health insurance policies and regular reporting to help the state track policy denials and recessions. The Commissioner of Insurance will craft a uniform application form which will make things easier for applicants and insurance agents alike. Regular reporting will help us know more about consumers being denied or losing insurance.

Washington is moving forward on big picture health reform and I continue working to support these efforts.  In the meantime, with my health insurance reform plan as law, Wisconsin has taken immediate achievable steps to bring increased coverage and certainty to buying health insurance.


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