Patient's Bill of Rights
One of the major goals of the Affordable Care Act, the healthcare reform legislation Congress passed earlier this year, was protecting consumers from the most egregious practices of the health insurance industry, such as dropping patients because they become sick or denying coverage due to a pre-existing condition.
Today, I'm very proud to inform you that a slate of key patient rights and protections from the law are now in effect. This new Patient's Bill of Rights is designed to help you and your doctors make the choices that will work best for you and your family, instead of health insurance companies controlling important health decisions. These reforms will help improve both health care coverage available through your employers and the individual health insurance policies you purchase from insurers.
Here's how the Patient's Bill of Rights puts you in charge of your health care:
- Your health coverage cannot be arbitrarily cancelled.
The new law prohibits insurance plans from rescinding your coverage when you get sick, except in cases of fraud or an intentional misrepresentation of facts. (Applies to all insurance plans.) - Your child cannot be denied coverage due to a pre-existing condition.
Insurance plans are prohibited from both denying coverage and limiting benefits for children based on a pre-existing condition. This applies to all employer plans and new individual plans. - Your health plan cannot put a lifetime limit on your health coverage.
The new law outlaws lifetime limits. No longer will a family go broke or lose their home just because a loved one has an accident or becomes ill. This applies to all insurance plans. - Your health plan's annual limits will phase out.
Over the next three years, the new law phases out annual limits ensuring that the coverage of hundreds of thousands of Americans will no longer be cut off right when they need it most. This applies to all employer plans and new individual plans. - Your child can stay on your health plan up to age 26.
Insurance plans that offer family coverage will be required to allow young people up to their 26th birthday to remain on their parents' insurance plan, at the parent's choice. This applies to young people who do not have access to their own employer-sponsored coverage. - You have the right to choose your own doctor.
Patients are guaranteed their choice of primary care doctor within their plan's network of doctors, including OB-GYNs and pediatricians without a referral. This applies to new plans. - You have the right to access out-of-network emergency room care.
Insurance plans will not be able to charge higher cost-sharing for emergency services that are obtained outside of a plan's network. This applies to new plans. - You have the right to appeal denied coverage.
Insurance companies are prohibited from denying coverage for needed care without a chance to appeal to an independent third party. This applies to new plans.
All of these provisions become effective for the next plan year, starting on or after today. This means they will be in effect during your next open season in your employer plan, or the next time you re-enroll in or purchase a policy from an insurer.
Many of these reforms will be expanded over time. Once the Exchanges become operational in 2014, for example, the prohibition against denying coverage for pre-existing conditions for children will be extended to adults, and annual limits on coverage will be completely prohibited.
It gives me great pleasure to see the Patient's Bill of Rights become reality and make a difference in people's lives. You can find more information about the Affordable Care Act, including benefits and coverage options, at Healthcare.gov, a federal website managed by the Department of Health and Human Services.
If you have any questions or comments, let me hear from you. I'm proud to represent a Congressional District where my constituents are informed and ask serious-minded, thoughtful questions, and provide me with valuable feedback. If you know someone who you think will find this E-Newsletter helpful, do share it with them by using the buttons on the right.
All my best,
Anna G. Eshoo
Member of Congress