Form M300 Mewa Coverage Requirements 760 (Page 3 of 4) in pdf

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760 IAC 1-68-16(b) Every application and coverage form, including certificates of

coverage, must contain in not less than twelve (12) point type the notice, "Your

coverage is issued by a multiple employer welfare arrangement. The multiple

employer welfare arrangement may not be subject to all of the insurance laws and

regulations of Indiana. State insurance guaranty funds are not available for your

multiple employer welfare arrangement."

The following are Patient Protection and Affordable Care Act (PPACA) requirements:

(Section 2714 - PHSA/Section 101 – PPACA)

Extends Dependent Coverage for Children Until age 26: Plans and issuers that

offer dependent coverage must make the coverage available to adult children up to

age 26. Coverage cannot be restricted regardless of financial dependency,

residency, marital status, student status, employment, eligibility for other coverage,

or IRS qualification. This requirement applies to natural and adopted children,

stepchildren, and children subject to legal guardianship.

(Section 2711 – PHSA/Section 1302(b) – PPACA)

Eliminate Dollar Limits on Essential Health Benefits: ALL health plans are

prohibited from applying annual and lifetime dollar limits to Essential Health Benefits.

Essential health Benefits include ambulatory services, emergency services,

hospitalization, maternity and newborn care, mental health and substance abuse

(including behavioral health treatment), prescription drugs, rehabilitative and

habilitative services and devices, laboratory services, preventative and wellness

services and chronic disease management, and pediatric services, including oral and

vision care.

(Section 2704 - PHSA/Section 1201 – PPACA)

Eliminate Pre-existing Condition Exclusions: Prohibits preexisting condition

exclusions on any participant or beneficiary.

(Section 2713 - PHSA/Section 1001 – PPACA)

Coverage of Preventive Health Services: Plans must provide coverage without

cost-sharing for:

1) Services recommended by the US Preventive Services Task Force-

2) Immunizations recommended by the CDC.

3) Preventive Care & Screening for infants, children & adolescents.

4) Preventive care and screenings for women.

Plans that have a network of providers may impose cost sharing delivered by out of

network providers. If billed separately from an office visit, the plan may impose cost

sharing on the office visit.

(Section 2719A - PHSA/Section 10101 – PPACA)

Choice of Health Care Professional: A plan that requires the designation of a PCP

must allow the choice of any in-network PCP who is accepting patients.

(Section 2719A - PHSA/Section 10101 - PPACA)

Access to Pediatric Care: If designation of a PCP for a child is required, the plan

must allow the choice to designate a physician who specializes in pediatrics as the

child’s PCP, if the provider is in-network and is accepting patients.

(Section 2719A - PHSA/Section 10101 – PPACA)

Access to OB/GYNs: Prohibits authorization or referral requirements for OB/GYN

care provided by in-network providers who specialize in obstetrics or gynecology.

(Section 2719A - PHSA/Section 10101 – PPACA)

Form M300 Mewa Coverage Requirements 760 Page 3

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