Know Your Rights

The Affordable Care Act includes rules that protect your rights as a health care consumer. Know your rights so you can protect yourself from illegal business practices.

Educate Yourself 

Here are some of the rights that the Affordable Care Act extends to CNMI health care consumers. Note that these rights apply differently to different types of plans. If marked with a Φ, it does not apply to grandfathered plans.

You cannot be denied coverage during open enrollment periods because you have a preexisting conditionΦ.

You have the right to get an easy-to-understand summary about a health plan’s benefits and coverage. Insurance companies and group health plans must provide you with:

  • A short, plain-language Summary of Benefits and Coverage (SBC)
  • A Uniform Glossary of terms used in health coverage and medical care

Insurance companies will be held accountable for rate increasesΦ. Rate increases must be reviewed and approved by the appropriate government agency. Rate increases will also be available for public comment, so you can voice your opinion on rate increases.

Insurance companies can’t cancel your coverage because you get sick. Your coverage can only be cancelled if you don’t pay the monthly payments or commit fraud.

Your choice of doctors is protectedΦ.

Your children are covered under your dependent coverage until they are 26 years old, even if they are married or have a preexisting condition.

Preventive care is included in your health plan at no additional cost to youΦ. This includes things like vaccinations, diabetes screening and birth control.

Annual and Lifetime limits on “essential health benefits” are prohibitedΦ. Prohibition on lifetime limits only for individual grandfathered plans.

Your right to appeal is guaranteedΦ. If your medical claim is denied coverage, you have a right to appeal to your insurance carrier and, if your claim is still denied, can send an appeal to an external review process.

Know your rights so they can’t be violated.

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