Op-Ed from Wayne Goodwin About New Health Insurance Law

Many consumers across North Carolina have questions about what the Patient Protection and Affordable Care Act of 2009, or the health care reform bill, means to their lives and their specific circumstances.

While the N.C. Department of Insurance and other involved agencies are making headway in sorting through the countless details and interpretations included in the health care reform bill, there are still a lot of unknowns.

I wanted to tackle some of the most frequently asked questions that my staff in the Consumer Services Division has received and provide the answers that we know right now. In many cases, the most asked-about issues are also the most immediate changes to be implemented.

The most common inquiry is about the bill's complete elimination of pre-existing conditions for all plans. For children younger than 19, this change will go into effect for plan years beginning on or after Sept. 23, which is six months after enactment. For adults, final implementation won't occur until 2014, but the reform bill established immediate access to health insurance through the establishment of health insurance high-risk pools. States must launch these insurance pools within 90 days.

In North Carolina, we already have a health insurance high-risk pool, called Inclusive Health, that offers coverage to North Carolinians who have medical conditions that prevent them from finding affordable insurance coverage through the traditional market. If you have a pre-existing condition and don't have health insurance, or if you have questions about the high-risk pools, call Inclusive Health for more information at (866) 665-2117, or go to www.inclusivehealth.org.

We've also heard that consumers are worried they will be forced to give up their existing health insurance plans. This is not the case. If you are satisfied with the coverage you currently have, you do not have to switch plans or make any changes.

Another common question focuses on the extension of adult dependent coverage, which also goes into effect for plan years beginning on or after Sept. 23. Right now, we know that dependent adult children age 26 or younger can be added to their parents' group plan, as long as the existing plan allows for dependent coverage. There is still some guidance needed from the federal government on who exactly qualifies as a dependent and the definition of "plan year" for individual policies.

Beware of scams

Unfortunately, we've also heard of increased health insurance scams, some that were problems before health care reform and some that are new. Consumers need to be on alert so they don't fall victim to unscrupulous scam artists or buy insurance products they don't understand. Be on the lookout for these red flags:

Unlicensed agents going door-to-door selling "ObamaCare" insurance policies or claiming there is a limited open-enrollment period to buy health insurance. Some of these scam artists have even set up bogus toll-free numbers to sell policies. While the reform bill is making a lot of changes, there are no changes that require your immediate action and no immediate deadlines or limited enrollment periods to follow.

Health care discount cards. These discount cards are not insurance and generally do not process or pay medical claims. Instead, cardholders are responsible for paying their health care providers, supposedly being entitled to a discount off of the providers' regular fees. Discount plans often exaggerate the potential savings, and not all providers accept or honor these cards.

Fake insurance companies that are not licensed by the N.C. Department of Insurance will collect premiums and then close down without paying claims. Fake health insurance is typically sold at unusually low rates by companies that do not have the funds or intent to pay all "covered" claims. These fraudulent schemes are often advertised and marketed through Web sites, telemarketing calls and unsolicited "blast faxes."

Required membership in questionable associations. Many membership associations offer their members various insurance benefits, including health insurance. Unfortunately, some associations may appear legitimate but exist mainly to profit (by collecting membership dues) from consumers who need health insurance. A consumer shopping for individual insurance might actually be required to join an association while applying for the insurance. Sometimes the dues and premiums are charged separately; however, sometimes the dues and health insurance premiums are bundled into a single lump-sum "membership cost." This makes it difficult to know how much you're paying for the insurance versus the association membership.

A good rule of thumb when purchasing any type of insurance is to confirm that the insurance company, agent and product are licensed or approved through the N.C. Department of Insurance and in good standing

; you also should read all materials carefully before you buy. A quick call to our Consumer Helpline can save you a lot of time, trouble and money. To confirm your insurance before you buy, call (800) 546-5664.

Again, there are many changes that will be implemented in the coming months and years, but consumers need to realize that no changes made by the Patient Protection and Affordable Care Act of 2009 will require immediate action or changes on their part. If you have any questions about the health care reform bill or you encounter suspicious or potentially fraudulent activity, I encourage you to call the Department of Insurance's Consumer Helpline at (800) 546-5664. You also can visit the department's website, www.ncdoi.com, for insurance information and ongoing updates about the health care reform bill.

Fully implementing the health care reform bill will take several years, and I want you to know I will make consumer education and public awareness a priority as more information and updates are available.

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Wayne Goodwin is North Carolina insurance commissioner.