Revisions to Explanations of Benefits for Adverse Claims Determination
As part of the Affordable Care Act, there are new requirements that impact the kind of information provided to members through the explanation of benefits (EOB).
As of July 1, 2011, LifeWise has made minor revisions to the current EOB to comply. Changes to the EOB will apply to non-grandfathered plans for new or renewing groups and individual plans. These changes do not apply to grandfathered plans.
Frequently Asked Questions about this change
Special Open Enrollment Period For Dependent Coverage to Age 26 and Lifetime Maximum
Two provisions in the recently passed Patient Protection and Affordability Act require that health plans offer coverage for dependent children up to age 26 and eliminate lifetime maximums. Health plans must allow individuals who have previously aged off, but are still under age 26 and members who previously met their lifetime benefit maximum and may have dis-enrolled, to re-enroll in their health plan.
Employers must allow employees a period of 30 days to enroll previously ineligible dependent children.
Employers also must allow any employee or family member who had exceeded their lifetime benefit maximum limit and who are still eligible a 30-day period in which they can re-enroll in the health plan. To submit enrollment changes and additions, your group administrator should follow normal change/addition procedures. The changes will take effect on your group plan renewal date.
If you would like assistance in communicating this change to your employees, please feel free to use this example email . For additional questions about these provisions, please contact your producer or account manager.
Helpful Links and Resources
Sign Up For Our Mailing List
