Strengthening Quality, Affordable Health Care
–No lifetime or annual limits on essential benefits beginning January 1, 2011.
–A group health plan cannot discriminate in favor of highly compensated employees.
–A wellness and health activity may not require the disclosure or collection of any information on the lawful ownership or possession of a firearm or ammunition.
–Health insurers are required to pay 85% of premiums for healthcare in large groups, and 80% for small groups and individuals. However, the States may adjust the individual loss ratio if there’s a concern over the individual market of that state.
–Health insurers must have an effective appeals process for coverage determinations and claims. They must provide notice to enrollees of this process and allow an enrollee to review his file and present evidence as part of the appeals process.
–An external review process is also to be made available.
–An enrollee has the right to choose his own primary care physician.
–Emergency services are covered without prior authorization and without regard to contracting status.