–Certain preventive care to be included in all health plans
–Adult unmarried children to be covered to age 26
–A summary of benefits on 4 pages in clear language is to be provided for all health plans.
–4 page Summary of Benefits must be provided upon enrollment, policy delivery, and 60 days prior to any changes.
–Federal standards usurp state standards.
–All health plans must use standard definitions of terms for such things as deductibles, copays, hospitalizations, preferred providers.
–No discrimination permitted for higher-salaried employees.
–Reporting requirements and special programs, including wellness and prevention programs, to ensure the quality of care.
–Group plans are required to pay 80% of premiums in claims, while individual plans are required to pay 75%.
–Hospitals have to make public a list of their standard charges.
–Effective appeals process when claims are denied.
–Consumer assistance offices to guide consumers through programs.
–HHS and States shall establish a process for the annual review of unreasonable increases in premiums.
–States can make recommendations to the State Exchange about whether particular health insurers should be excluded from participation in the Exchange based on a pattern of excessive or unjustified premium increases.
–Federal Temporary high risk pool (2010-2014) $5 billion allocated to insure those with pre-existing conditions until all provisions are in full force.