Health care law addresses how federal and state governments control health insurance and ensure the rights of patients. These laws and regulations are complex, and it is advisable to obtain the assistance of a Health Care Attorney if you have questions or concerns. View qualified Medical Law Firms in your area to find Medical Malpractice Lawyers.
Health Plan Disclosures
Thanks to federal laws like ERISA, health benefit plans must provide their participants with the following information:
- Annual and lifetime limits on plan benefits
- Coverage for preventative measures
- Premiums, deductibles and co-pay amounts
- The existence and amount of coverage for drugs, tests, devices and procedures
- Coverage rates and policies for in-network an out-of-network services
- Coverage for emergency services
- Selection of primary care providers and referral policies
- Pre-authorization requirements
- Appeals process
Right to Continue Coverage
The most well-known of these laws is COBRA which provides that coverage may continue or change for covered employees and their families in the following circumstances:
- Separation or divorce
- Reduced work hours
- Entitlement to Medicare
- Employment termination
- No longer a dependent child
HIPAA expanded protection for workers and their family members by:
- Allowing individuals to enroll for coverage in even more circumstances
- Guaranteeing that insurance is available for smaller businesses
- Prohibiting health-status based discrimination
- Limiting exclusions for pre-existing conditions
HIPAA also defined a preexisting condition as one that had care, diagnosis, treatment or advice given or suggested within 6 months of enrollment.
The Newborns’ and Mothers’ Health Protection Act mandates that maternity coverage include at least a 48-hour hospital stay following childbirth.
The Mental Health Parity Act provides that in many circumstances annual and lifetime limits on mental health benefits be the same as those for medical and surgical benefits when offered by a group health plan.
The Women’s Health and Cancer Rights Act applies to health plans that cover medical and surgical benefits for mastectomy and mandates that reconstructive surgery also be covered as well as prostheses.
Public Health Insurance
Medicare is a federal program that provides health insurance at reduced or no cost to:
- The disabled (who have received Social Security disability benefits for 2 years) and
- The elderly (age 65 and entitled to Social Security benefits)
Others may be eligible including:
- Those who are age 65, do not qualify for Social Security benefits but purchase coverage
- Those eligible for Social Security benefits and need a kidney transplant
Medicare provides a variety of programs to cover costs for:
- Home health and hospice care
- Hospital care
- Doctor’s services
- Supplies and equipment
Medicare also provides optional coverage with additional service plans, including the prescription drug benefit which helps with those costs.
Medicaid differs and is run by both the states and federal government. It provides coverage similar to Medicare (although it differs between the states) to:
- The disabled and blind
- Families with dependent children
- Elderly with low-income
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