Provisions That Took Effect in 2010
- Elimination of lifetime dollar maximums on essential health benefits
- Dependent coverage age extension
- Elimination of pre-existing condition restrictions on children under age 19
- Prohibition on retroactive coverage rescissions except in cases of fraud
- Prohibition on cost-sharing for preventive care services
- Coverage of emergency room treatment for emergency medical conditions
- Coverage of obstetrical and gynecological care without pre-authorization or referral
- Expansion of Medicaid to cover people, who are not eligible for Medicare, whose income is at or below the 133% FPL
- Extension of CHIP benefits for eligible children (effective immediately)
- $250 rebate when Medicare beneficiaries hit the coverage gap for prescription drugs
- Small Business Health Care Tax Credit
- Creation of the Early Retiree Reinsurance Program (ERRP)
- States must establish a temporary high-risk pool to provide health coverage for individuals who cannot get coverage elsewhere due to pre-existing conditions
- Grandfather Provision, which allows already existing plans to remain substantially the same
Provisions Taking Effect in 2011
- Medical Loss Ratio reporting and rebates
- New over-the-counter drug reimbursement rules and taxes
- A new appeals process, including external review
- Small business grants to provide comprehensive wellness programs
Provisions Taking Effect in 2012
- Four-Page Summary of Benefits
- W-2 Reporting—employers must include aggregate cost of employer-sponsored health coverage on annual W-2 form (informational only)
- Quality of Care Reporting
Provisions Taking Effect in 2013
- Employee notice of State Exchanges provided by employer
- $2,500 cap on FSA contributions
- Creation of Consumer Operated and Oriented Plan (CO-OP) programs which will create nonprofit health insurance companies that will operate in the states
- New HIPAA electronic standards
- Increase in medical deduction threshold
Provisions Taking Effect in 2014
- Individual mandate that all U.S. citizens and legal aliens get health insurance
- Operation of health benefit exchanges where there will be cost sharing subsidies for people between the 133% and 400% of the federal poverty level
- Health benefit exchanges will be required to offer 4 tiers of coverage plans (bronze, silver, gold, and platinum) and a catastrophic plan
- Required guaranteed issue and renewability and allow rating variation based on age, geographic location, family composition and tobacco use
- Elimination of annual dollar maximums on essential health benefits
- Elimination of waiting periods exceeding 90 days
- Elimination of pre-existing condition restrictions for all enrollees
- Automatic Enrollment of employees where the employer has over 200 employees
- No more underwriting based on health-status factors (medical underwriting)
- Transparency in coverage reporting
- Fair health insurance premiums
- Play-or-pay tax
- Coverage for clinical trials
- Comprehensive health insurance coverage
Provisions Taking Effect in 2017
- Large employers are allowed to enter State Exchanges
Provisions Taking Effect in 2018
- Increased taxes on “Cadillac plans”
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