Proposed New Rules Implementing Key Provisions of Obamacare Published for Public Comment

Proposed New Rules Implementing Affordable Care Act will Stop Insurance Companies from Discrminiating based on Pre-Existing Conditions or Gender; Define Essential Benefits required to be offered in insurance policies, and Incentivize Wellness ProgramsThe U.S. Department of Health & Human Services (HHS) announced proposed new rules implementing three key areas of the Patient Protection & Affordable Care Act (which some call “Obamacare”).

The proposed rules were officially published in the Federal Register on November 26, 2012, starting a period for public comment on the proposed text of the new rules.

 
The new rules will:
 

  • End insurance company discrimination and denial of coverage based on pre-existing conditions, gender, and other discriminatory practices;
  • Define “Essential Benefits” required to be offered in insurance policies; and
  • Provide incentives for non-discriminatory wellness programs in group health plans.

According to a news release issued by HHS on November 20, the proposed new rules would “would make it illegal for insurance companies to discriminate against people with pre-existing conditions. The provisions of the Affordable Care Act also would make it easier for consumers to compare health plans and employers to promote and encourage employee wellness.”

Contents of the Proposed New Rules

As described by HHS in its news release, the newly proposed rules would implement provisions of the Patient Protection and Affordable Care Act in the following three key areas:

  • Health Insurance Market Reforms, Prohibiting Insurance Companies from Discriminating or Denying Coverage based on Pre-Existing Conditions or Other Discriminatory Practices:

    “A proposed rule that, beginning in 2014, prohibits health insurance companies from discriminating against individuals because of a pre-existing or chronic condition. Under the rule, insurance companies would be allowed to vary premiums within limits, only based on age, tobacco use, family size, and geography. Health insurance companies would be prohibited from denying coverage to any American because of a pre-existing condition or from charging higher premiums to certain enrollees because of their current or past health problems, gender, occupation, and small employer size or industry. The rule would ensure that people for whom coverage would otherwise be unaffordable, and young adults, have access to a catastrophic coverage plan in the individual market. For more information regarding this rule, visit: http://www.healthcare.gov/news/factsheets/2012/11/market-reforms11202012a.html.”

  • Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation:

    “A proposed rule outlining policies and standards for coverage of essential health benefits, while giving states more flexibility to implement the Affordable Care Act. Essential health benefits are a core set of benefits that would give consumers a consistent way to compare health plans in the individual and small group markets. A companion letter on the flexibility in implementing the essential health benefits in Medicaid was also sent to states. For more information regarding this rule, visit http://www.healthcare.gov/news/factsheets/2012/11/ehb11202012a.html.”

  • Incentives for Nondiscriminatory Wellness Programs in Group Health Plans:

    “A proposed rule implementing and expanding employment-based wellness programs to promote health and help control health care spending, while ensuring that individuals are protected from unfair underwriting practices that could otherwise reduce benefits based on health status. For more information regarding this rule, visit: http://www.healthcare.gov/news/factsheets/2012/11/wellness11202012a.html.”

Official Publication of the Proposed Rules; Public Comment Periods

The three proposed new rules implementing the Patient Protection & Affordable Care Act, were officially published in the Federal Register on November 26, 2012.

Under federal law and rules of administrative procedure, official publication in the Federal Register starts a mandatory public comment period, in which interested parties have an opportunity to submit comments on the text of the proposed rules.

The full text of the proposed new rules and information on their comment periods can be found at the following locations in the Federal Register online:

  • Health Insurance Market Rules; Rate Review (the proposed rules ending discrimination and coverage-denial by insurance companies on the basis of pre-existing conditions, gender, and other discriminatory practices):

    Federal Register Document: 2012-28428

    Comment Period: Ends December 26, 2012

  • Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation:

    Federal Register Document: 2012-28362

    Comment Period: Ends December 26, 2012

  • Incentives for Nondiscriminatory Wellness Programs in Group Health Plans:

    FR Document: 2012-28361

    Comment Period: Ends January 25, 2013

Instructions on how to submit public comments on the proposed text of the new rules are found at the respective links above.

More Information

For more information on the Patient Protection & Affordable Care Act, and how it benefits you and others in your state, see HealthCare.gov, an official website of the U.S. Department of Health & Human Services (HHS).

See related HelpingYouCare® reports on:

People on Medicare Can Now Get Information from Pharmacies about New Benefits Available to Them under Affordable Care Act, HHS Announces

8 New Free Preventive Health Services for Women Take Effect August 1, 2012 under Health Care Law

HealthCare.gov Features 5 Prevention Resources for You and Your Family

Over 16 Million Seniors on Medicare received Free Preventive Care under Affordable Care Act in 2012, HHS Announces

Consumers to Receive $1.1 Billion of Premium Rebates from Health Insurers under Affordable Care Act, HHS Announces

President Obama Lays Out Contents of Health Care Law

White House Issues New Report on Benefits of Affordable Care Act & Debunks Myths About It

HHS Notes Successes of Affordable Care Act (Obamacare) on its 2-Year Anniversary

For more news and information about the Patient Protection & Affordable Care Act, President Obama’s signature Health Care Law, and about health care reform, see the HelpingYouCare® resource pages on VoicesForCare™, including:

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Copyright © 2012 Care-Help LLC, publisher of HelpingYouCare®. All rights reserved.

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