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2010 |
Eliminates lifetime limits on the dollar value of coverage for fully insured, self insured and individual health plans. |
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Requires dependent coverage through age 26 for all individual and group policies. Grandfathered group plans do not have to offer coverage through age 26 until January 2014 if the dependent has another source of employer-sponsored health insurance. |
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Coverage recessions are prohibited except in cases of fraud. |
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Eliminates cost sharing for preventive services rated A or B by the U.S. Preventive Services Task Force for non-grandfathered plans for in network providers. |
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Provides tax credits for small employers with no more than 25 employees and average annual wages of less than $50,000 that provide health coverage for their employees. |
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Prohibits discrimination based on salary. |
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2011 |
Health plan MLRs that are less than 85% for large group plans and 80% for small group (up to 100 employees) and individual plans will result in consumer rebates for the difference. |
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Provide grants for up to five years to small employers who establish wellness programs. |
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Exclude over-the-counter drugs from reimbursement through FSAs and HRAs and on a tax-free basis for HSAs unless prescribed by a physician. |
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Increase tax on HSA distributions that are not for qualified medical expenses to 20% of the disbursed amount (up from 10%). |
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CLASS program (Community Living Assistance Services and Supports) effective 1/1/2011. Details regarding benefits, premiums and enrollment procedures of this voluntary, national long term care insurance program are not due before Q3 2011. |
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Employers can begin to report health coverage costs on employee W-2 forms. This is optional for 2011 tax year. |
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2012 |
Employers required to report health coverage costs on employee W-2 forms for 2012 tax year. |
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Health plans and health insurance issuers must provide uniform explanation of coverage documents to plan participants that use standard language and formats developed by Health and Human Services. |
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Health plans and health insurance issuers must provide 60-day notice to participants of material modifications made to a plan if that modification has not already been incorporated into the uniform explanation of coverage. |
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2013 |
Employers required to start notifying employees about exchanges, premium subsidies and free choice vouchers. |
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New rules for health insurance administration to simplify processes for eligibility verification and claim status. |
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Create the CO-OP program – Consumer Operated and Oriented Plan – which fosters the creation of non-profit, member-run insurance companies in every state. |
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Increase itemized tax deduction for medical expenses to 10% of adjusted gross income (up for 7.5%). |
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Impose FSA contribution limit for medical expenses to $2,500 |
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Eliminate employer tax deductions for those who receive Medicare Part D subsidies. |
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2014 – When It All Happens! |
All US citizens and legal residents are required to purchase coverage. A penalty will be assessed for those that do not comply. |
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Employers with more than 50 employees that do not offer coverage but have at least one full time employee receive a premium tax credit will be assessed a fee of $2,000 for every full time employee above 30. |
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Employers with more than 50 employees that do offer coverage but still have at least one full time employee receive a premium tax credit will be assessed a fee the lesser of $3,000 per employee receiving a tax credit or $2,000 for each full time employee. |
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Employers with more than 200 employees must automatically enroll all of their employees into their health insurance plan. Employees may opt out. |
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States must have Exchanges operational. These will be for individuals and small businesses (up to 100 employees). |
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Require guarantee issue and renewability and allow rating variations based only upon age, geographic location, and family tier for individual and small group market and in the Exchanges. |
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Mandates essential health benefits for small group or individual plans offered inside a state Exchange – AND – on all new small group or individual plans outside the Exchange. |
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Eliminates annual limits for new and grandfathered group plans. |
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Limit deductibles in the small group market to $2,000 for individuals and $4,000 for families. Employers may contribute to off-set these deductible amounts. |
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Waiting periods may not exceed 90 days. |
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Allow employers to offer employees rewards of up to 30% (up from 20% currently) of the cost of coverage for participating in a wellness program. |
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Annual insurer fees begin. |
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2015 |
Group health plans must use electronic systems for processing health claims, enrollment and premium payments and certify to the government that their systems comply. This applies to grandfathered plans as well. |
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2017 |
States may allow employers with more than 100 employees to purchase insurance in Exchanges. |
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Mandates "qualified" health plan with essential health benefits for all large group plans (except for self-insured plans) offered in a State Exchange. |
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2018 |
High-value, “Cadillac” employer-provided group health plans taxed. |
Many details about the provisions contained in the law are provided by a number of agencies and are updated on a regular basis. For more information, visit the following Web sites:
National Association of Insurance Commissioners
www.naic.org/index_health_reform_section.htm
US Department of Labor — Employee Benefits Security Administration
www.dol.gov/ebsa/
Internal Revenue Service
www.irs.gov/newsroom/article/0,,id=220809,00.html?portlet=6
US Department of Health and Human Services
www.hhs.gov/ociio/regulations
FOR MORE INFORMATION, CONTACT:
Lundy Insurance Services
(858) 408-1404
This email address is being protected from spambots. You need JavaScript enabled to view it.
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