Day 2 - Table of Contents

The Table of Contents:
Title 1: Quality, Affordable health Care for all Americans
Subtitle A - Immediately Improvements in Health Care Coverage for all Americans
Sec. 1001 . Amendments to the Public Health Service Act
Part A - Individual and Group Market Reforms
Subpart II -Improving Coverage
Sec. 2711. No lifetime or annual limits.
Sec. 2712. Prohibition on rescissions. (def.: cancellations)
Sec. 2713. Coverage of preventive health services.

Section 2711.: NO LIFETIME OR ANNUAL LIMITS.
(a) In General- A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish

‘(1) lifetime limits on the dollar value of benefits for any participant or beneficiary; or

‘(2) unreasonable annual limits (within the meaning of section 223 of the Internal Revenue Code of 1986) on the dollar value of benefits for any participant or beneficiary.

(b) Per Beneficiary Limits- Subsection (a) shall not be construed to prevent a group health plan or health insurance coverage that is not required to provide essential health benefits under section 1302(b) of the Patient Protection and Affordable Care Act from placing annual or lifetime per beneficiary limits on specific covered benefits to the extent that such limits are otherwise permitted under Federal or State law.

Section 2712: PROHIBITION ON RESCISSIONS (cancellations)

A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not rescind (def.: take away) such plan or coverage with respect to an enrollee once the enrollee is covered under such plan or coverage involved, (Dianne's comments: Ins. company cannot cancel your coverage)

(I deleted some explanations of group coverage and individuals)

‘SEC. 2713. COVERAGE OF PREVENTIVE HEALTH SERVICES.

Dianne's comments: below are the minimum coverages of health insurance coverage: there seems to be Task forces and Advisory Committees that have come up with recommendations... i.e. immunizations, mammograms, etc.

‘(a) In General- A group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum provide coverage for and shall not impose any cost sharing requirements for

‘(1) evidence-based items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the United States Preventive Services Task Force;

‘(2) immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved; and

‘(3) with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration.

‘(4) with respect to women, such additional preventive care and screenings not described in paragraph (1) as provided for in comprehensive guidelines supported by the Health Resources and Services Administration for purposes of this paragraph.

‘(5) for the purposes of this Act, and for the purposes of any other provision of law, the current recommendations of the United States Preventive Service Task Force regarding breast cancer screening, mammography, and prevention shall be considered the most current other than those issued in or around November 2009.

Nothing in this subsection shall be construed to prohibit a plan or issuer from providing coverage for services in addition to those recommended by United States Preventive Services Task Force or to deny coverage for services that are not recommended by such Task Force.

‘(b) Interval-

‘(1) IN GENERAL- The Secretary shall establish a minimum interval between the date on which a recommendation described in subsection (a)(1) or (a)(2) or a guideline under subsection (a)(3) is issued and the plan year with respect to which the requirement described in subsection (a) is effective with respect to the service described in such recommendation or guideline.

‘(2) MINIMUM- The interval described in paragraph (1) shall not be less than 1 year.

‘(c) Value-based Insurance Design- The Secretary may develop guidelines to permit a group health plan and a health insurance issuer offering group or individual health insurance coverage to utilize value-based insurance designs.

Dianne's Comments: that's enough for today. :-)