Health insurers that sell plans with mandated benefits under the Affordable Care Act cannot require people to wait a certain amount of time before they can use those benefits, the CMS reiterated this week in a memo.
The CMS also revised the policy to include pediatric orthodontia. Previously, plans sold to individuals on and off the exchanges and through small groups could impose a waiting period for kids who needed certain dental care.
The ACA prohibits health plans from denying coverage to people based on their age, pre-existing conditions or potential use of medical care. In 2014, the CMS voiced concerns about insurers that imposed waiting periods for specific benefits, saying the practice could “discourage enrollment of or discriminate against individuals with significant health needs” or against people who might need a lot of care in the future.
“For example, a plan that includes a waiting period for any type of transplant would discriminate against those whose conditions make it likely that they would need a transplant: those with kidney disease, heart conditions, or similarly critical and life-threatening ailments,” the CMS said at the time.
The federal government stands by that policy and has now mandated that plans cannot instill waiting periods for pediatric dental benefits. However, because many insurers have already submitted rates and plan designs to state insurance departments for their 2017 plans, the policy related to pediatric orthodontia won't go into effect into Jan. 1, 2018.
People who begin new jobs that offer employer-based health insurance are required to wait no more than 90 days before their coverage goes into effect.