Your Source for Health Reform

Topic: Consumer Protections

The ACA requires insurance companies to cover people with pre-existing health conditions, makes it illegal for cancel your policy just because you get sick, and does away with lifetime and yearly dollar limits on coverage of essential health benefits, among other protections.

Nondiscrimination for Transgender Individuals

This July 2014 bulletin from the Illinois Department of Insurance advises private insurers that many insurance plans sold in Illinois may not discriminate against transgender people and must provide them coverage for the same medical treatment available for non-transgender policy holders. The bulletin applies only to plans required to provide essential health benefits, which excludes some large employer plans issued in the state.

How the Affordable Care Act Makes Health Coverage More Affordable

This May 2013 fact sheet from Families USA summarizes the consumer protections and financial assistance to help people purchase coverage. (more…)

Health Insurance Market Reforms: Portability

This March 2013 fact sheet by Kaiser Family Foundation discusses changes to portability of health insurance coverage in individual and group markets under the ACA.

What’s in Reform for Women-Owned Small Businesses?

An October 2011 resource from the Small Business Majority that gives a breakdown of the ACA provisions that make it easier for women-owned small businesses to provide health insurance.

Worry No More: Illinoisans with Pre-Existing Conditions Are Protected

This July 2012 report from Families USA spells out many people with pre-existing conditions live in Illinois and in each county, with a breakdown based on age, income level, and racial or ethnic group. (more…)

Assessing the July 2011 HHS Exchange Regulations

This Community Catalyst fact sheet follows the release by HHS of the first round of exchange regulations in July 2011, and draws on Community Catalyst’s work to help develop state exchanges around the country. The document highlights 10 important priorities for consumers and outlines key areas that require stronger protections or clarification in the federal regulations. It was designed so that state consumer advocates could use it to review the regulations and understand what is at stake for consumers moving forward.

Out-of-Pocket Spending Caps Protect Families in Illinois

In 2011, 590,500 Illinoisans under the age of 65 are in families that will spend more than the out-of-pocket caps for covered services in the Affordable Care Act’s essential benefits package; 72% of them are in working families. Spending by these families will exceed the caps by $1.0 billion in one year alone.

Medical Loss Ratio in Illinois – SB 1618

This March 2010 from the Illinois Department of Insurance describes SB 1618, which was designed to bring Illinois law into conformity with one of the core consumer protections established by the Affordable Care Act.

Explaining the Medical Loss Ratio

This March 2012 fact sheet from the Kaiser Family Foundation explains how the ACA’s MRL provision will affect health insurers and consumers. The provision requires most insurance companies that cover individuals and small businesses to spend at least 80% of their premium dollars on health care (that is, paying medical claims) and quality improvement. (more…)

Grandfathered Plans under the Patient Protection and Affordable Care Act

The Affordable Care Act (ACA) provides many new important protections for consumers who have or who are seeking private health insurance. Grandfathered plans are exempt from requirements to comply with some of the new consumer protections that the law includes. This Families USA fact sheet describes what health plans qualify as “grandfathered plans” and which protections under the ACA apply to them.