The Affordable Care Act

Date of Enactment

March 23, 2010

Grandfathering
Rate review
Medicare Part D rebate
Small business tax credit

Ninety Days After Enactment

June 23, 2010

Temporary national high risk pool program
Temporary employer reinsurance program for early retirees

Health and Human Services (HHS) web portal

July 1, 2010

Plan/Policy Years Starting Six Months
After Enactment

September 23, 2010

Coverage of children to age 26
No lifetime dollar limits on essential health benefits
No annual dollar limits on essential health benefits
Certain preventative services without cost sharing
No pre-existing conditions for enrollees under age 19
Limits on rescissions
Coverage standards for Emergency Room (ER) services
No discrimination in favor of highly compensated individuals
Direct access to obstetrician of gynecologist (OB/Gyn)
Choice of Primary Care Physician (PCP) / Pediatrician
Internal claims and appeals / external review process
Medical Loss Ratio (MLR) reporting

January 1, 2011

Medical Loss Ratio (MLR) Rebate
Health Savings Account (HSA) changes begin (effective date depends on provision)
W-2 Reporting (delayed, optional for 2011)

U.S. Supreme Court Ruling on Challenges to ACA

The Supreme Court to consider the constitutionality of ACA, including the individual mandate, which requires almost all citizens to have health insurance coverage or pay a penalty, and the expansion of eligibility for the Medicaid program.

Uniform Summary of Benefits Coverage

The Affordable Care Act requires health insurers and group health plans to provide consumers an accurate summary of benefits coverage at the time of application, enrollment, and yearly upon re-enrollment.

Essential Benefits defined

The Department of Health and Human Services will define what benefits must be included in products sold on the exchanges and in ungrandfathered plans.

W-2 Reporting

Employers are required to report the cost of health insurance coverage for calendar year 2012 on employees' 2013 W-2 forms.

Student Health

Student health insurance plans would be allowed to have annual dollar limits on essential health benefits of no less than $100,000 for policy years beginning before September 23, 2012.

Medical Loss Ratio (MLR) Rebates

Starting August 2012, premium rebates are provided to enrollees if their insurer does not spend 80 to 85 percent of premium dollars on medical care and health care quality improvement, rather than on administrative costs.

MLR Reporting

To determine MLRs and potential rebates due, health insurance companies collect information from each employer group on their average number of employees during the preceding calendar year.

Research Fund Fee

Fees paid by health insurers and sponsors of self-insured health plans will be used to fund the Comparative Effectiveness Research Institute, created by the Affordable Care Act to determine health outcomes and the clinical effectiveness of medical treatments. The fee applies to calendar policy years beginning or after Sept. 23, 2012 and continues through 2018.

Plan years ending before Oct. 1, 2013: Paid by the plan sponsor, the fee is $1, multiplied by the average number of lives covered under the plan, for plan years ending before Oct. 1, 2013.
Plan years ending on or after Oct. 1, 2013: The fee increases to $2 for plan years ending on or after Oct. 1, 2013.

FSA Changes

Beginning on Jan 1, 2013, contributions to FSAs will be capped at $2,500 per year. The threshold for deducting medical expenses on taxes goes from 7.5 percent to 10 percent of income.

Employer Notice Requirements

Beginning March 1, 2013, employers must provide employees written notice:

Of the existence of the state health insurance exchange;
Of their potential eligibility for federal assistance if the employer's plan is "unaffordable";
And that they may lose the employer's contribution to health coverage if they purchase health insurance through the state health insurance exchange.

Minimum Essential Coverage

All U.S. citizens are required to maintain minimum essential health coverage each month or pay a penalty. Employers with an average of at least 50 full-time employees in the prior year must offer minimum essential coverage to employees.

Guaranteed Issue

All carriers in the individual and small group markets will be required to offer coverage to any individual or group that applies, and plans/policies are guaranteed renewability.

Public Exchange

State individual and small group health insurance exchanges become operational. For states that do not establish an exchange, a federal exchange will be operated in their state.

Tax Credits

Affordable Care Act increases the small business tax credit to 50% of employer cost for providing employee health coverage (35% for tax-exempt employers).Credits will only be available on plans offered through health insurance exchanges. Tax credits are also provided to individuals purchasing coverage on the exchanges.

Coverage for Clinical Trials

If a "qualified individual" is in an "approved clinical trial," the plan cannot deny coverage for related services.

Essential Benefits

No more lifetime or annual dollar limits are allowed on essential health benefits.

Waiting Periods

Waiting periods cannot be longer than 90 days.

Pre-existing Conditions

No exclusions of some or all benefits allowed due to pre-existing conditions.

Provider Non-discrimination

Health care providers will not be prevented from participation in an insurer's provider network if willing to abide by the terms and conditions for participation and are acting within the limits of their medical license or certification.

Public Exchanges Opened to Large Group

Larger Group may be allowed to use exchange beginning in 2017 if a state allows it.

"Cadillac Plan" Tax

Affordable Care Act imposes a 40% excise tax on high-cost employer sponsored health coverage, or plans with an annual cost exceeding $10,200 for individuals or $27,500 for a family.