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Change in Healthcare and Insurance Standards
The PPACA includes regulations that set standards for insurance companies, employers, and providers. Some are specified in the law, others are subsequently established by the Secretary of Health and Human Services. Among these new standards are a ban on the ability to drop policyholders if they become sick, a ban on price discrimination on the basis of pre-existing conditions or gender through a partial community rating, require providers to ensure the quality of care and reduction of errors through preventative care, as well as allowing children and dependents to remain on their parents' insurance plan until their 26th birthday.

Obesity is now considered a disease. According to the CDC, conditions related to obesity include:
• Heart disease
• Type 2 diabetes
• Cancers of the endometrium, breast and colon
• High cholesterol
• High blood pressure
• Stroke
• Liver and gallbladder disease
• Sleep apnea
• Osteoarthritis
• Gynecological issues such as abnormal menses and infertility

Obesity is a disease that currently plagues 69.7% of the total population of the United States of America. In the corporate environment known as “Corporate America”, Obesity is crippling 85% of the total population.
Research shows it costs about $1,400 more a year to treat an unhealthy individual as compared with a person at a healthy weight and composition. With all of the “new” changes in healthcare it is imperative to know and understand what is exactly included in your coverage and how to get the best help possible for achieving your wellness, health, and fitness goals today.

Under the Act
The bad news is, under the Act, companies are allowed to increase the surcharges to employees with medical conditions to 30 percent of their health insurance premiums for an average charge of about $1,620 per year.
In effect this allows companies to punish their employees for pre-existing conditions. Large increases in insurance premiums of up to $5,000 for a family of four which also results in un-insurance or switches to cheap but stingy high deductible insurance plans (with very high up-front payments of up to $12,000 before medical care is covered).
The good news is under the new health care law, employers offer a variety of different options to patients, from working with registered dietitians and health coaches to group sessions with a professional teaching lifestyle changes, to a hotline with a Professional Health Counselor who answers questions.
Plans vary widely in what they will do. Some insurers are offering telephone counseling, others cover visits with a health coach, and some cover group sessions that offer lifestyle advice. Under the health care law, plans can have doctors do the weight-loss counseling or "use medically appropriate" alternatives to meet the requirement. Insurance companies are also paying for memberships or offering discounts or reimbursements. Among those who are already obese, offer respectful long-term behavioral programs that reduce a few realistic pounds at a time, rather than fining those who fail to achieve what are nearly impossible goals.

365|Health & Fitness Inc. Independant Provider Solutions Resolve All Compliance to:
Patient Protection and Affordable Care Act, Section 2713 and Section 2717

‘‘(a) IN GENERAL.—A group health plan and a health insurance issuer offering group or individual health insurance coverage shall, at a minimum provide coverage for and shall not impose any cost sharing requirements for— ‘‘(1) evidencebased items or services that have in effect a rating of ‘A’ or ‘B’ in the current recommendations of the United States Preventive Services Task Force; ‘‘ (2) immunizations that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved; and ‘‘(3) with respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration. ‘‘ (4) with respect to women, such additional preventive care and screenings not described in paragraph (1) as provided for in comprehensive guidelines supported by the Health Resources and Services Administration for purposes of this paragraph. ‘‘(5) for the purposes of this Act, and for the purposes of any other provision of law, the current recommendations of the United States Preventive Service Task Force regarding breast cancer screening, mammography, and prevention shall
124 STAT. 132 PUBLIC LAW 111–148—MAR. 23, 2010
be considered the most current other than those issued in or around November 2009. Nothing in this subsection shall be construed to prohibit a plan or issuer from providing coverage for services in addition to those recommended by United States Preventive Services Task Force or to deny coverage for services that are not recommended by such Task Force. ‘‘(b) INTERVAL.— ‘‘(1) IN GENERAL.—The Secretary shall establish a minimum interval between the date on which a recommendation described in subsection (a)(1) or (a)(2) or a guideline under subsection (a)(3) is issued and the plan year with respect to which the requirement described in subsection (a) is effective with respect to the service described in such recommendation or guideline. ‘‘(2) MINIMUM.—The interval described in paragraph (1) shall not be less than 1 year. ‘‘ (c) VALUE-BASED INSURANCE DESIGN.—The Secretary may develop guidelines to permit a group health plan and a health
insurance issuer offering group or individual health insurance coverage to utilize value-based insurance designs.
(a)(1) IN GENERAL.—
(A) improve health outcomes through the implementation of activities such as quality reporting, effective case management, care coordination, chronic disease management, and preventative medication and care compliance initiatives, including through the use of the medical homes model as defined for purposes of section 3602 of the Patient Protection and Affordable Care Act, for treatment or services under the plan or coverage;
(B) implement activities to prevent hospital readmissions through a comprehensive program for hospital discharge that includes patient-centered education and counseling, comprehensive discharge planning, and post discharge reinforcement by an appropriate health care professional;
(C) implement activities to improve patient safety and reduce medical errors through the appropriate use of best clinical practices, evidence based medicine, and health information technology under the plan or coverage; and
(D) implement wellness and health promotion activities.
(b) WELLNESS AND PREVENTION PROGRAMS.—For purposes of subsection (a)(1)(D), wellness and health promotion activities may include personalized wellness and prevention services, which are coordinated, maintained or delivered by a health care provider, a wellness and prevention plan manager, or a health, wellness or prevention services organization that conducts health risk assessments or offers ongoing face-to-face, telephonic or web-based intervention efforts for each of the program’s participants, and which may include the following wellness and prevention efforts:
(1) Smoking cessation.
(2) Weight management.
(3) Stress management.
(4) Physical fitness.
(5) Nutrition.
(6) Heart disease prevention.
(7) Healthy lifestyle support.
(8) Diabetes prevention.

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