The laws explained
- Extension of dependent coverage
- Preventive care coverage
- Lifetime and annual limits
- Pre-existing condition exclusions
- Prohibition on rescission
- Coverage of emergency services
- Primary Care Provider selection
- Salary nondiscrimination in benefits
- Early Retiree Reinsurance Program (ERRP)
- Small business tax credit
- Tax-treatment of OTC drugs
- Grandfathered Health Plans
Coverage of emergency services
- The new law requires all health plans to cover emergency care at out-of-network hospitals at the same copayment or coinsurance level as in-network hospitals.
- Health plans will no longer require prior authorization or a referral for emergency services.
- However, out-of-network providers may balance bill patients. This means a patient may receive a bill for the amount the emergency room charged that is above a "reasonable amount." That's why patients may want to seek services from an in-network emergency department when available.
The law defines emergency services as medical screenings within the emergency department and treatment required to stabilize a patient.
Effective
Applies to all non-grandfathered plans.
Our approach
Priority Health has always covered emergency services for members no matter where they work, live or travel. Learn more.
