A series of new provisions of health care reform took effect recently, as the Patient Protection and Affordable Care Act reached its six-month milestone since passage.

While some health plans may meet the grandfathered status – and thus not have to meet certain requirements of the health overhaul – there are a number of new provisions that will require compliance from all private health plans.

For plans beginning on or after Sept. 23 of this year, all private plans, including grandfathered plans, will have the meet the following criteria:

--Lifetime limits on the dollar value of benefits are now prohibited.

--Annual benefit limits on coverage will now be limited to non-essential benefits for plans beginning before Jan., 1, 2014. Annual limits following 2014 will be prohibited altogether.

--The age cutoff for dependents on health plans must increase to 26. For grandfathered plans, however, coverage for such dependents will only be required if the dependent has no other source of health insurance, such as an employer-sponsored plan, through January 2014.

--Rescission, or retroactive cancellation, of health plans will be prohibited, except in cases of fraud or intentional misrepresentation.

--And grandfathered individual plans will be required to cover preexisting conditions for children less than 19 years of age, starting on or after six months of enactment of the policy.

Brokers said the recent changes may increase the premiums costs by 2 percent to 5 percent.


Petaluma-based Tangram Insurance Services announced last week that it would offer the CompWest workers’ compensation program to small and mid-sized businesses in California.

CompWest offers online claims and loss control services and “an extensive medical provider network,” according to Tangram.

Members of the California Manufacturing and Technology Association are eligible for a five percent premium discount, Tangram said in the offering announcement. CompWest can assist with numerous areas of coverage for a wide range of companies, among them manufacturers, wineries, florists, physicians, schools and hotels.

“We think it’s a perfect fit for our clientele of small and mid-sized firms,” said Rekha Skantharaja, Tangram’s senior vice president.


With the new provisions of health care reform kicking in, the North Coast Association of Health Underwriters, along with the Santa Rosa Chamber of Commerce and Sutter Pacific Medical Foundation, will conduct a seminar for businesses trying to navigate the changes in health care compliance.

Victor McKnight, an underwriter for Sitzmann Morris Lavis and a past president of the NCAHU, will lead the seminar.

“There is a lot of confusion and a lot of questions,” Mr. McKnight said. “So we’re hoping to help them. We’re hoping employers of all sizes show up.”

The seminar is Oct. 19, from 7:45 a.m. to 9:30 a.m. at Sutter’s offices at 3883 Airway Drive, room 15, in Santa Rosa.


Employers may express confusion over the new health care changes, but one sector of health care delivery is celebrating the six-month anniversary of reform – federally qualified health centers.

West County Health Centers, joining the National Association of Community Health Centers, issued a release detailing how the new elements of health care reform will benefit patients as well as health centers in general.

A key provision of the new law will significantly expand such centers, which will in turn provide a medical home for thousands while providing more affordable care. Health centers are seen as key players in preventative care and keeping patients out of emergency rooms for treatable ailments.

“When people have a place to go for regular care, they use it and stay healthy,” said Mary Szecsey, executive director of West County Health Centers. “The prescription is simple: Treat people with good preventative care before they get sick.”

Health centers will save up to $122 billion nationwide as they expand rapidly and reach medically underserved communities, particularly in rural communities, between 2010 and 2015, according to the five-site West County centers, which operate in Sebastopol, Occidental, Guerneville, and Forestville.


Submit items for this column to Dan Verel at dverel@busjrnl.com, 707-521-4257 or fax 707-521-5292.