Ppca Policy Case Study

How does the PPACA policy address this topic?
Before the ACA, students that did not have health insurance could obtain it from their college or university. As plans vary from school to school and benefits restricted for particular plans, many students were not entirely protected leaving them vulnerable to unexpected medical expenses. The current proposed rule has provided individuals with an equal opportunity improving health insurance protection for students. These students would have the protection of all the benefits that offered under the new consumer protections, which allows them to perceive their plan and its coverage as well as their rights. Now, the ACA gives students the freedom and opportunity as other consumers to purchase insurance with the same protection outlined in the Patient’s Bill of Rights (Centers for Medicare and Medicaid, 2011). The current regulations help the students to buy and maintain their coverage.

Required limitations and special rules
Ensures annual limits: The students no longer have a set limit of the amount of their plan. Today, the annual limit guarantees the continued accessibility of coverage for students and banned annual limits to the minimum essential benefits (CMS, n.d.).
Guarantees medical loss ratio: Guarantees that the students obtain the value for their premium dollars. “Many insurance companies spend a substantial portion of consumers’ premium dollars on administrative costs and profits, including executive salaries, overhead, and marketing” (CMS, n.d., para. 1). As a requirement of the regulation rule, the guarantors are authorized to present proof of the premium dollars expense. The insurance companies obligated to spend a specific percentage on medical care of 80% or more and if failure to abide by these rules, the consumer will receive a refund (CMS, n.d.).

Guarantees availability/renewability of coverage: The proposed rule assures the convenience of students to gain access to coverage in several ways. An individual is guaranteed coverage if they had a prior pre-existing medical condition before applying for health coverage, it protects them from being turned down for health insurance (Norris, 2015). Also, if a student has not reached the age limit of 26, in spite of school status or if they a tax dependent of their guardian, can extend coverage being on their guardian health plan (Norris, 2015). Also, a student that pays their premium cannot lose their coverage and the underwriter must continue to offer coverage to them. Nevertheless, an underwriter can longer refuse or terminate students health coverage under these conditions.

Disclose of notice requirement: The stated rule demands that underwriters or insurers share relevant information that pertains to the policy or related materials that does not meet the criteria of the minimum annual limits (CMS, n.d.).
The insurer must ensure transparency by disclosing all valid information to the consumer before selling a health policy to individuals. Also, the students that are 26 and younger must obtain notification of eligibility to maintain coverage as a dependent under their parents plan. However, when disclosing this information, the students should be able to comprehend this information without any complicated and confusing
words.