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| Author : | Paul Winn, CLU, ChFC |
| Course Length : | Pages: 36 ||| Review Questions: 27 ||| Final Exam Questions: 45 |
| CPE Credits : | 9.0 |
| IRS Credits : | 0 |
| Price : | $80.95 |
| Passing Score : | 70% |
| Course Type: | NASBA QAS - Text - NASBA Registry |
| Technical Designation: | Technical |
| Primary Subject-Field Of Study: | Specialized Knowledge - Specialized Knowledge for Course Id 649 |
| Description : | The course entitled Healthcare Reform: Pre-Existing Conditions, Benefit Limits, Rescission & Patient Protection Rules provides important information for insurance agents and other advisers who are counseling clients on certain requirements imposed on group health plans and individual insurance coverage by the Act and Regulations. The course begins with a discussion of “grandfathered” health plans, their definition and the implications of grandfathered status for the timing and applicability of the Act’s provisions. The requirements of the Act and Regulations addressed in this course are those relating to ensuring patient protections—specifically, protections related to their ability to choose healthcare professionals and the provision of emergency services—and the ability of health plans to:
• Impose annual and lifetime benefit limits for essential health benefits; and • Rescind health coverage. |
| Usage Rank : | 12000 |
| Release : | 2014 |
| Version : | 1.0 |
| Prerequisites : | Although no specific course prerequisite is necessary for a full understanding of the material presented in this course, students should possess a solid, working knowledge of group and individual health insurance. |
| Experience Level : | Overview |
| Additional Contents : | Complete, no additional material needed |
| Additional Links : |
Healthcare Reform Pre Existing Conditions Benefit Limits Rescission
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| Advance Preparation : | None |
| Delivery Method : | QAS Self Study |
| Intended Participants : | Anyone needing Continuing Professional Education (CPE) |
| Revision Date : | 01-Mar-2024 |
| NASBA Course Declaration : | Participants must complete the final examination within one year of purchase and with a minimum passing grade of 70% or better to receive CPE credit unless otherwise noted on the Course History page (i.e. California Ethics must score 90% or better). After logging in click on the Course History links on your My Courses page for the Begin date and Expire date for the Final Exam. |
| Approved Audience : | NASBA QAS - Text - NASBA Registry - 649 |
| Keywords : | Specialized Knowledge and Applications, Healthcare, Reform, PreExisting, Conditions, Benefit, Limits, Rescission, Patient, Protection, Rules, cpe, cpa, online course |
| Learning Objectives : |
Course Learning Objectives Upon completion of this advanced course, the student should be able to:
• describe the effective dates and rules governing the use of pre-existing condition exclusions in group and individual health insurance plans; • discuss the annual and lifetime benefit limit rules applicable to essential health benefits under healthcare reform legislation; • identify the conditions that would permit an insurer to rescind health insurance coverage and the applicable notice requirements; and • explain the patient protection provisions of healthcare reform. Chapter 1
• identify the requirements for a grandfathered health plan’s maintaining its grandfathered status; • describe the provisions of the Act that are inapplicable to grandfathered health plans; • discuss the Act’s provisions that apply to health plans whether or not they are grandfathered health plans; • list the actions that will cause a grandfathered health plan to lose its grandfathered status; and • explain the types of changes to a health plan that will not affect its status as a grandfathered health plan. Chapter 2
• explain the requirements of the Act and Regulations as they apply to pre-existing conditions exclusions; and • describe the types of health plans to which the prohibition of pre-existing condition exclusions apply and the impact of a plan’s status as a grandfathered health plan. Chapter 3
• explain the applicability of the Act’s provisions concerning annual and lifetime health benefit limits to grandfathered health plans; • describe the restricted annual benefit limits applicable to essential health benefits permitted during the phase-in period ending in 2014; • define the term “essential health benefits”; and • identify the requirements applicable to health plans and health insurance coverage with respect to individuals who have reached a lifetime benefit limit before the effective date of the Regulations. Chapter 4
• describe the grounds permitted under the Act on which coverage under a health plan or group or individual health insurance may be rescinded; • identify the components of fraud under the common law; • define the meaning of “material fact”; and • explain the Act’s requirements concerning notice when coverage will be rescinded. Chapter 5
• describe the required access available to female participants in network plans to obstetrical and gynecological care; • explain the content and timing requirements of disclosures concerning the patient protection provisions of the Act; • identify the Act’s requirements related to out-of-network emergency services; • define “emergency services”; and • describe the factors that must be considered when determining the reasonableness of a health plan’s or insurer’s payment of benefits for out-of-network emergency services. |
| Course Contents : | Course Learning Objectives How You Will Learn Why This Information Is Important and How You Can Use It Chapter 1 - Grandfathered Status Chapter Learning Objectives Patient Protection and Affordable Care Act Grandfathers Certain Coverage Certain Act Provisions Inapplicable to Grandfathered Health Plans Many Act Provisions Apply to Grandfathered Health Plans The Consequences of Grandfathering in Brief Grandfathered Health Plan Status Unaffected by Certain Changes Grandfathered Health Plan Status May Be Lost Maintaining Grandfathered Health Plan Status Special Rules Applicable to Collectively Bargained Plans Losing Grandfathered Health Plan Status Transitional Rules Changes Made On or Before March 23, 2010 Changes Made After March 23, 2010 and Adopted Before Regulation Issuance Losing Grandfathered Status in Brief Summary Chapter 1 Review Questions Chapter 2 - Pre-existing Condition Exclusion Chapter Learning Objectives Pre-existing Condition Exclusion Defined Exclusion of Coverage for All Participants Not a Pre-existing Condition Exclusion Pre-existing Condition Exclusions Prohibited Under Act Effect of Grandfathered Health Plan Status Effective Dates for Pre-existing Exclusion Prohibition Summary Chapter 2 Review Questions Chapter 3 - Benefit Limits Chapter Learning Objectives Benefit Limits Essential Health Benefits Condition-Based Exclusions of Coverage Permitted under the Act Annual Benefit Limits Prohibited Lifetime Benefit Limits Prohibited Benefit Limit Rules in Brief Summary Chapter 3 Review Questions Chapter 4 - Coverage Rescission Limits Chapter Learning Objectives Contract Rescission Legal Elements of a Contract Post-Claims Insurer Review of Health Coverage Coverage Rescission Limited under Act Rescission Differs from Prospective Cancelation Regulations Apply Broadly Contestable Period End Not a Bar to Rescission Fraud as Basis for Rescission Intentional Misrepresentation of Material Fact as Basis for Rescission Rescission Notice Requirement Examples Rescission Rules in Brief Summary Chapter 4 Review Questions Chapter 5 - Patient Protections Chapter Learning Objectives Choice of Healthcare Providers for In-Network Plans Designation of Primary Care Provider Designation of Pediatrician as Primary Care Provider Patient Access to OB/GYN Care Patient Protection Disclosure Requirements Coverage of Emergency Services Emergency Services Defined Out-of-Network Cost-Sharing Requirements Effective Date Grandfathered Plans Patient Protection Rules in Brief Summary Chapter 5 Review Questions Appendix I - Grandfathered Status at a Glance Appendix II - PPACA Provisions at a Glance Glossary |
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