Durbin Announces Provisions of Healthcare Reform Going into Effect

[SPRINGFIELD] – New protections to prevent health insurance companies from denying Illinois families coverage when they need it most will go into effect this week, U.S. Senator Dick Durbin (D-IL) said today. Seven provisions of the Patient Protection and Affordable Care Act will go into effect on September 23, six months after the healthcare reform legislation’s enactment.


“We’re now starting to see 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.


Provisions going into effect this week include:


  • Eliminating pre-existing conditions exclusions for children, allowing nearly 3.2 million children in Illinois who were previously denied healthcare to receive coverage;

  • Prohibiting health insurance companies from rescinding existing health insurance policies when a person gets sick as a way of avoiding covering the costs of enrollee’s healthcare needs;

  • Banning lifetime limits, which will make certain that Illinoisans don’t losing their coverage when they need it most;

  • Restricting the use of annual limits, to ensure access to needed care in all group plans and all new individual plans;

  • Requiring coverage of preventive health services without imposing any cost-sharing requirements;

  • Extending coverage for young adults, allowing dependents to stay on their parents’ plans until they are 26; and

  • Obligating health insurers to institute effective internal appeals processes for coverage determinations, to make it easy for enrollees to dispute the denial of a medical claim.


“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 this week 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.”


The provisions implemented this week will bring an end to several abuses. Currently in Illinois, health insurers can deny or reduce claims based on a pre-existing condition within two years of a policy’s effective date for an individual or family plan and within one year of enactment for an employer-based plan. Likewise, insurers can rescind a health insurance policy within two years of the effective date if the company finds an omission or incorrect response on the an application—regardless of whether it was intentional or not. Lifetime and annual benefit limits also are not currently prohibited.


Illinois law requires insurers to provide preventative benefits such as mammograms and other cancer screenings. Other preventative benefits may not be included in a health insurance plan and the ones that are may be subject to significant cost-sharing. As a result of the new provisions going into effect this week, individuals should have access to services such as routine vaccines and regular well-baby and well-child visits.


Another provision will allow young adults to stay on their parents’ health insurance plans until the age of 26. This provision strengthens a similar Illinois law by removing several exceptions to the measure. Also, insurance companies will be required to implement an internal appeals process that gives consumers access to information about a denied claim and ensures a fair review of a denial.


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.