Durbin Announces Provisions of Health Care Reform Going into Effect Today

47,000 young Illinoisans now eligible for coverage under parent's plan

[WASHINGTON, D.C.] – U.S. Senator Dick Durbin (D-IL) today announced that new protections to prevent health insurance companies from denying Illinois families coverage when they need it most are going into effect today, six months after the health care reform legislation’s enactment.

“We will now see the tangible benefits from the groundbreaking healthcare reform bill we passed earlier this year. As a result of the new law, insurance companies will no longer be able to deny children coverage because of pre-existing conditions or place annual limits on benefits, rationing care when patients need it most,” Durbin said.


An explanation of the provisions going into effect today and their impact on Illinois is below:


  • Coverage of pre-existing conditions for children – Children under 19 cannot be denied coverage because of a pre-existing condition for policy years beginning on or after September 23, 2010. Eliminating pre-existing conditions exclusions for children will allow the nearly 3.2 million children in Illinois who were previously denied healthcare to receive coverage.

  • Ban on rescissions – All health plans are banned from dropping people from coverage because of an omission or incorrect information in their application. Illinois insurance companies lead the nation in dropping people from coverage. Between 2004 and 2008, the insurance industry dropped 5,632 Illinoisans from their rolls.

  • Ban on lifetime limits – Insurance companies will no longer be able to place a lifetime limit on the coverage they provide, which will make certain that Illinoisans don’t losing their coverage when they need it most. Starting today, the 7.5 million Illinois residents who are insured in the private market will no longer have to worry about their coverage running out when they get sick.

  • Limitations on the use of annual limits – The bill restricts the use of annual limits on insurance coverage to ensure access to needed care in all group plans and all new individual plans. Annual limits are scheduled to be eliminated in 2014. The 6.9 million residents with insurance through their employer or who sign up for a new individual health insurance plan will have greater protection from insurance companies try to limit annual benefits.

  • Requirement for coverage of free preventive care – New plans offered after September 23, 2010 must offer coverage for recommended preventive services without imposing any cost- sharing requirements. This could mean access to such services as: blood pressure, diabetes, and cholesterol tests; cancer screenings; counseling; routine vaccinations; flu and pneumonia shots; and regular well-baby and well-child visits, from birth to age 21.

  • Extension of coverage for young adults – Plans and issuers that offer coverage for dependents must offer coverage to enrollees’ adult children until age 26, even if the young adult no longer lives with his or her parents, is not a dependent on a parent’s tax return, or is no longer a student. In Illinois, 47,000 young adults now will be eligible for coverage through their parents’ plans.

  • Independent appeals process – New insurance plans beginning on or after September 23, 2010 must implement an internal appeals process. The internal appeals process will guarantee a venue where consumers may present information their health plan might not have been aware of, giving families a straightforward way to clear up misunderstandings. In July, Illinois implemented a state law requiring all health insurance policies to provide the right to an internal appeal and independent, external review of denied health insurance claims.


“This bill has already begun to end insurance company abuses that prevent people from getting the healthcare they need,” Durbin said. “The provisions that go into effect today will ensure that patients aren’t dropped from their insurance plan when they get sick and will lower health care costs by emphasizing prevention and healthy lifestyles.”


Many other provisions of the healthcare reform legislation have already taken effect. Earlier this summer, Medicare began sending $250 rebate checks to Illinois seniors who have fallen into the Medicare Part D coverage gap known as the “donut hole.” By the end of the year, roughly 150,000 Illinoisans will have received these checks, and as a result of the health care law, the donut hole will be cut in half in 2011 and will be completely eliminated by 2020.