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The U.S. Department of Health and Human Services (HHS) has just released rules to implement the provisions of the health care law to reduce discrimination against people with pre-existing conditions, help consumers compare their coverage options, and allow the implementation of equitable workplace wellness programs. These proposed rules, to take effect in January 2014, will change the Ohio health insurance scene in many ways.
- Universal coverage: Up to 32 million Americans, including about 1.5 million uninsured Ohioans, will now have the chance to gain coverage. The new regulations will extend the health care safety net for the low income population as well as those who were deemed too sick to be provided coverage by insurers. People with pre-existing conditions can no longer be denied health insurance and can access catastrophic coverage in the individual market.
- Fairer health insurance premiums, but rise in costs for younger persons: Insurers can no longer charge higher premiums based on factors such as pre-existing conditions, health status, claims history, duration of coverage, gender, occupation, and small employer size and industry. Ohio health insurance companies are allowed to vary premiums only based on age, tobacco use (the rate cannot vary by more than 1.5 to 1), family size, and geography.
- States offered flexibility for Essential Health Benefits: All the states have been informed of the requirements of outlining policies and standards for coverage of essential health benefits (EHB). Ohio health plans are expected to cover a core package of items and services, but the state will have the flexibility to decide how EHB are defined. Ohio will have to choose a benchmark plan and ensure that plans offering EHB adhere to the benefits offered by the benchmark plan.
- Promotion of employer wellness programs: Another newly released proposal allows employers to offer discounts on insurance premiums to employees enrolling in job-based wellness programs. Under these programs, employees can benefit from reimbursement for the cost of membership in a fitness center, and rewards for attending a monthly, no-cost health education seminar or completing a health risk assessment. Employer will have to offer other options for employees who have a physical condition that makes it unreasonably difficult for them to participate.