Timeline - Health Reform, Covered California

Health Reform Timeline

• 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

• 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

• 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

• 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