GHLIT adapts insurance coverage after health care reform

Published on
information-circle This article is more than 3 years old

Passage of the Patient Protection and Affordable Care Act ushered in an era of unprecedented change for the health insurance market, change focused on overhauling the nation's health care system and guaranteeing access to medical insurance for millions of Americans.

At the heart of the new law are a number of mandates that will impact coverage provided by the AVMA Group Health and Life Insurance Trust under various medical plans beginning Jan. 1, 2011.

"As a result of provisions within the PPACA, some AVMA GHLIT medical plan participants will see benefit enhancements and fewer restrictions," said Dr. Robert L. Hatch, GHLIT chair. "In some cases, no changes are necessary because the Trust was already offering several protections now required under health care reform, as part of our commitment to providing veterinarians and their families with high-quality coverage and outstanding service."

One of the key changes that GHLIT plan participants can expect to see in 2011 is elimination of the lifetime and annual dollar limits for "essential health benefits," which fall within the following categories:

  • Ambulatory patient services.
  • Emergency services.
  • Hospitalization.
  • Maternity and newborn care.
  • Services relevant to mental health and substance-use disorders, including behavioral health treatment.
  • Prescription drugs.
  • Rehabilitative and habilitative services and devices.
  • Laboratory services.
  • Preventive and wellness services and management of chronic diseases.
  • Pediatric services, including oral and vision care.

The GHLIT also will enhance preventive-services coverage in response to the PPACA.

Starting in 2011, coverage will include maternity benefits. Maternity benefits have been available as an option on some GHLIT PPO medical plans.

Plan participants will not have to pay any deductible, co-payment, or co-insurance for a number of preventive services—including services with an "A" or "B" rating from the U.S. Preventive Services Task Force and immunizations that follow recommendations from the Centers for Disease Control and Prevention.

For children, preventive-services coverage will expand to include care and screenings per comprehensive guidelines from the Health Resources and Services Administration.

Other notable plan changes will include coverage of emergency services without restrictions to network providers. The GHLIT also will eliminate limitations on coverage of pre-existing conditions for dependent children under age 26.

Among the PPACA protections already provided by GHLIT is the right to appeal decisions or actions taken by New York Life Insurance Co., the Trust's underwriter, to reduce, deny, or terminate a medical claim. The GHLIT also already guarantees that it will issue coverage to AVMA members, regardless of pre-existing conditions, and allows plan participants to extend coverage to dependents until age 26.

"We remain dedicated to providing medical coverage that meets or exceeds industry and legal standards," Dr. Hatch said.

Information on GHLIT's benefits is available at Veterinarians and veterinary students can obtain more information—including plan details, rates, exclusions, limitations, eligibility, and renewal provisions—or find a GHLIT agent by calling the Trust office at (800) 621-6360.