Phase 1 2010-2011

The first phase of mandatory plan changes are effective at the beginning of a Plan Year, after September 23rd, 2010.    For example, if you are on a April 1st Plan Year, your changes to not have to be implemented until April 1st, 2011.    A January 1st Plan Year, will need to have the changes made by January 1st, 2011.

The following changes must be made to all health plans:

Lifetime Limits - Plans may not impose lifetime limits on essential benefits offered.

Annual Limits - Plans may only impose restricted annual limits on essential benefits as determined by the Department of Health and Human Services (HHS).

Coverage of Adult Children - Plan must provide coverage for dependent children until age 26, but only if such adult child is not eligible under another employer sponsored plan.

Pre-Existing Exclusions for Children - Plans may not impose pre-existing condition exclusions or limitations on children under age 19.

Uniform Summary of Benefits - A four (4) page summary must be provided to all new applications and each application at open enrollment. This is in addition to the SPD requirement. Until the secretary of HHS issues regulations, no action is necessary

Some definitions have yet to be defined, however more guidance is expected later in 2010.