Healthcare Reform: Pre-Existing Conditions, Benefit Limits, Rescission & Patient Protection Rules
Professional Recertification (PRCE)
3 credit hours
If purchased today, this course must be completed by:
July 31, 2021
Insurance Continuing Education
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:
- Exclude coverage for pre-existing conditions;
- Impose annual and lifetime benefit limits for essential health benefits; and
- Rescind health coverage.
Accordingly, the course provides information concerning the rules applicable to the ability of a group health plan or a health insurer offering group or individual health insurance coverage to exclude coverage for pre-existing conditions and the effective dates of such rules. In addition, the course discusses the rules governing the ability of a group health plan or a health insurer offering group or individual health insurance coverage to impose dollar limits on essential health benefits. The limited ability of a group health plan or health insurer offering group or individual health insurance coverage to rescind such coverage is also addressed. Finally, the course discusses the protections guaranteed to patients in their choice of available healthcare professionals in plans involving a network of healthcare providers and in the availability of patient emergency services.
Upon completion of this intermediate course, the student should be able to:
- Explain the rules applicable to grandfathered health plans;
- 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.
Rules for American College PRCE (formerly PACE)
- Course material may be downloaded.
- Exam is open book.