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New health reform rules unveiled

By Jay MacDonald · Bankrate.com
Wednesday, November 28, 2012
Posted: 6 pm ET

The federal government has unveiled proposed rules under health care reform that will have broad implications for states, health insurance companies, small businesses and uninsured Americans within the next 12 months.

In a conference call with reporters last week, Secretary of Health and Human Services Kathleen Sebelius spelled out the long-awaited "essential health benefits" that insurers must include in their individual plans when state health insurance exchanges open Jan. 1, 2014. Insurers have been anxiously awaiting the definitions in order to finalize the policies they'll offer when open enrollment begins next October.

The rules specify that 10 categories of benefits be included in all individual and small-group policies but leave it to each state to set its own benefit minimums. The categories include: ambulatory services; emergency services; hospitalization; laboratory services; maternity and newborn care; mental health and substance abuse services; pediatric services; prescription drugs; preventive and wellness care and chronic disease management; and rehabilitative and "habilitative" services for conditions such as autism and cerebral palsy.

The rules also prohibit insurers from denying coverage due to a preexisting condition or charging higher premiums due to occupation, current or past health problems, or gender. Studies show that women often pay more for health insurance than men.

The feds have provided more guidance to employer-based wellness programs, giving employers greater leeway to offer larger rewards to employees who quit smoking or adopt healthier lifestyles. And the rules protect employees from unfair underwriting practices that could reduce their benefits because of health issues.

In addition, Sebelius extended until Dec. 14 the deadline for states to inform HHS whether they plan to set up their own state health exchanges, which are designed to offer individuals and small businesses easy-to-shop-for health insurance at subsidized rates. To date, roughly 17 states have committed to set up their own exchanges. Those that don't can choose to partner with the federal government or allow the feds to establish and operate the state's exchange, which is required under health care reform.

About half of the nation's 30 million uninsured are expected to purchase health insurance through the exchanges, while the remainder would be covered under the federal-state Medicaid program for low-income Americans.

Recent reports from states that have opposed the Affordable Care Act indicate that some may be reassessing their options now that the law's sponsor-in-chief, President Barack Obama, has been re-elected.

Want to become involved? You have 30 to 60 days to comment on the proposals before they become final.

Follow me on Twitter: @omnisaurus.

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288 Comments
FRED YOUNG
November 29, 2012 at 8:10 pm

All of you that were defeated in the past election learn to live with defeat.Just as you spoke against the President then you speak once again. You have been living with a lot of things for a long time four more years will not kill you. Bush did not kill you neither will OBAMA.

Janice
November 29, 2012 at 7:57 pm

LAUGHING won't be laughing when GOD sends her to Hell! Barack HUSSEIN Obama, is SATANS OBVIOUS PLAN! You ARE a FOOL!

Janice
November 29, 2012 at 7:34 pm

LAUGHING,isn't going to be laughing when GOD sends her to HELL! Barack HUSSEIN Obama, is SATANS OBVIOUS PLAN, you stupid FOOL!

Glenn
November 29, 2012 at 7:26 pm

This reform is great for our country. Were not looking for a free ride. We want the Insurance companies to stop gouging and picking through clients. Pick only the health and disregard the sick. I think back on the Bush Era. It see alot of homes lost jobs lost and a war we were scared into. If not for Obama there would be no reform on Home Modicafication or Health care. Thank you Mr Obama. I got a job and my Home modified.

John
November 29, 2012 at 7:18 pm

I keep hearing about all these new taxes, would anyonone like to share any real factual information about these new taxes? If not maybe you all should do some research before commenting about things you don't know anything about, thanks.

GO_Flyers
November 29, 2012 at 7:08 pm

The pathetic Obama supporters are following in lock step.This country has tasted and loves freedom. We allowed our freedoms to be used against us and we will not stand for it. Those who think that they are owed their existence will be the first to find out the harsh realities. We are a generous nation and we do care for our sick and weak. But to turn that around and take away our other freedoms and diminish this nation is treachorous.When those checks can't be cashed because of our debt and unemployment those who think that they are owed or try and take what's not theirs will not be judged on an "Obama Curve!"

Harlow
November 29, 2012 at 6:44 pm

Hillary was a pushy, ambitious, mediocre lawyer with no training in healthcare nor economics. This plan was drafted by idiot feminists like herself.

WILLIAM
November 29, 2012 at 6:30 pm

OBAMACARE WILL DISTROY THIS COUNTRY IN NEW TAXES AND MORECOMPANIES WILL REDUCE FULLTIME EMPLOYMENT THANKS TO YOUNG VOTERS. THEY WILL SEE WHEN THEY ARE FORCED TO BUT HEALTH INSURANCE ALL THAT WAS NEEDED WAS A MEDICAID DIVISION FOR LOW INCOME WORKERS TO BUY IN AT A REASONABLE RATE INSTEAD OF 23002 PAGES OF THE BILL

William
November 29, 2012 at 6:11 pm

Judy. For all of you who think it was Romney care first, you were wrong, and you were wrong during the campaign. Did you not ever hear about Hillary care back in the early 90's that went down in a massive defeat. Obama care is just a continuation of Hillary Care with huge tax additions and health care limitations. Liberals never quit when they lose, they just bring it up at another time until they can force it down your throat.

Angela
November 29, 2012 at 6:03 pm

Roger, it's sad to say, but you're right. I think everyone should have watched Obama 2016 then maybe, just maybe, they would have had a wake-up call. It doesn't take a rocket scientist to figure out his true motives.