Health Reform Timeline

Provisions Taking 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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