Here’s an underreported story from yesterday that will affect a lot of folks: From now on, the insurance available through your employer must cover your child up to the age of 29.
The health insurance for young adults measure is important because traditionally, young people drop off their parents’ insurance when they reach 19, or when they graduate from college.
From the Governor’s press release:
This law, outlined by the Governor in his State of the State address, requires insurers to allow unmarried children through age 29 Ã¢â‚¬â€œ regardless of financial dependence Ã¢â‚¬â€œ to be covered under a parentÃ¢â‚¬â„¢s group health insurance policy. Young adults ages 19 to 29 represent 31 percent of uninsured New Yorkers. They often become ineligible for coverage under their parentsÃ¢â‚¬â„¢ policies at age 19 or upon high school or college graduation, find themselves in entry-level jobs that do not provide employer-based health insurance, and cannot afford to pay premiums for individual insurance policies Ã¢â‚¬â€œ which are much more expensive than group policies. Under the new law, premiums will be paid for by families, not employers, and would cost less because coverage is under group policies rather than individual policies. The law also requires insurers to offer employers an option to purchase coverage that includes young adults as dependents in family policies through age 29.
Governor Paterson signed that bill and two other health-related bills into law Wednesday in Rochester. From the Rochester Democrat and Chronicle, one of the few articles on the issue:
The changes won’t involve spending any additional tax dollars and should save money in the long run by getting more people insured, Paterson said at a press conference at University of Rochester Medical Center. Insurers might face some additional cost because some loopholes are closing, but, said Paterson, “It will be fair.”
The other changes (again quoting the Governor’s press release) include:
- Allowing laid off or fired workers to buy insurance coverage from their former employer for 3 years instead of just a year and a half;
- Prohibiting insurers from treating an in-network provider as out-of-network simply because the referring provider was out-of-network;
- Extending current protections for consumers in HMOs to consumers in Ã¢â‚¬Å“HMO look-alikeÃ¢â‚¬Â plans Ã¢â‚¬â€œ health plans that operate the same as HMOs but are not licensed as HMOs, such as Ã¢â‚¬Å“exclusive provider organizationsÃ¢â‚¬Â or EPOs;
- Reducing the prompt-pay timeframe from 45 days to 30 days for electronically submitted claims so doctors and hospitals are paid more quickly;
- Reducing the time insurers have to review requests for post-hospital home health care;
- Extending providers a right to request an external appeal of a concurrent denial;
- Extending protections to doctors and hospitals when health insurers seek to recover alleged overpayments. The protections include basic notice and an opportunity to challenge the insurersÃ¢â‚¬â„¢ overpayment recovery efforts.
- Limiting health insurersÃ¢â‚¬â„¢ and HMOsÃ¢â‚¬â„¢ ability to deny or delay payment of claims by sending a coordination of benefits questionnaire;
- Permitting participating health care providers to request reconsideration of a claim that is denied as untimely and limiting penalties for untimely claims;
- Requiring insurers and HMOs to give participating providers notice of adverse reimbursement changes to provider contracts and giving providers an opportunity to cancel the contract;
- Requiring insurers and HMOs who fail to meet a loss-ratio requirement to make efforts to locate and pay dividends or credits to former policy holders;
- Permitting newly licensed providers and providers moving to New York to be provisionally credentialed until the final determination is made; and
- Establishing a new external appeal standard for rare disease treatments.