Post January 1, 2014, You Can’t Be Denied Coverage!

There are a lot of challenges in the domain, and, at this moment, there is not much time for tackling all of them. However, at the same time, the advantages and potential benefits coming out of this change are unmatched. One of those impeccable benefits is the right to coverage, or the guaranteed issue section of the act. 

As per this section of the PPACA, no insurance carrier can deny you coverage if you approach them with a request for one. In the past, American citizens have been denied coverage due to a preexisting condition, which could mean an injury or an illness. With the implementation of PPACA, this aspect of medical coverage in USA will be annihilated. Insurance carriers have been issued mandates to provide coverage irrespective of the buyer’s medical history. According to the act, the government has instructed insurance carriers to –
• Not to turn down or limit coverage if the applicant is suffering from any injury or illness, also defined as a preexisting condition.
• Not to discriminate against applicants with preexisting conditions by limiting their coverage or charging higher premiums from them on the account of these preexisting illnesses or injuries.
• Only define premiums on the basis of certain factors and not include any aspect of medical history in premium calculation. The permissible factors for calculating the premium are age, age of family members, location and whether the applicant smokes. 

The government has instructed insurance carriers to weigh every application on the basis of the community it belongs to. This community based calculation puts everyone in the same region under one banner and provides a fair pricing to everyone belonging to that particular area. This reduces the cost across the community and helps calculate the premium rates from a community perspective, thus bringing a balance to health insurance premium rates.

To further corroborate its plan, the government is participating in the premium rate approval procedure for every health insurance exchange in the country. By pitching in, government is regulating the health insurance premiums being quoted by carriers for the new exchange connectivity solution, thus regulating any anomalies and higher premiums. In some cases, government is asking insurance carriers to revisit their rates and provide better prices to function in the marketplace. This proactive approach of the government is functioning as a measure for weeding out proportionally higher premiums and promoting a competitive marketplace.

By implementing this strategy in the PPACA, the government has ensured that no one will be denied affordable coverage in America, thus contributing to the long term goal of having a fully insured country. Over time, as PPACA gets a stronger hold over the health coverage system, the benefits would be more profound and a vast majority of uninsured Americans will be able to take advantage of the fair pricing of the health insurance marketplaces.