Timeline

March 2010

• Small Group Tax Credit: This is a tax designed to help small businesses maintain the healthcare coverage they already have and even to encourage some of them to offer healthcare for the first time.
• Temporary Retiree Reinsurance Program: Reinsurance for covering early retirees will provide reimbursement for a portion of the cost of providing health insurance. This program will end January 1, 2014 or when the subsidy set aside for it is gone.
• PCIP Program (Pre-existing Condition Insurance Plan Program): Uninsured individuals with pre-existing conditions can obtain health insurance through a temporary high-risk health insurance pool program (until 2014 when exchanges begin).

April 2010

• Medicaid Expansion: Healthcare Reform allows states to expand Medicaid coverage to adults without dependent children.

July 2010

• HealthCare.gov Website: Affordable coverage will be identified by HHS (Health and Human Services) and a website will be established for residents of any state to locate coverage.
• Indoor tanning services: tax imposed.

September 2010

• Lifetime Limits and Annual Restriction Limits: Limits on lifetime dollar value of benefits for any individual covered by group or individual health insurance are eliminated. Annual limits will be restricted at an increased rate until January 2014 when all limits will be eliminated.
• Internal Claims and Appeals Process: Group health plans must adopt an internal and external appeal process for appeals of coverage determinations and claims.
• Discrimination Rules: Fully insured groups must satisfy nondiscrimination rules regarding participation and benefit eligibility. Discrimination based on salary is prohibited.
• Dependent Coverage: Health insurance policies that provide dependent coverage must make coverage available for dependents up to age 26.
• Child Pre-existing Conditions: Pre-existing condition exclusions for dependent children under 19 are prohibited.
• Preventive Coverage: Group or individual cost-sharing obligations for preventive services are prohibited.
• Recisions Prohibited: Cancellations of all new and existing plans will be prohibited (except for fraud or intentional misrepresentation). Plan coverage may not be cancelled without prior notice.
• Emergencies: Coverage for emergency services at in-network cost-sharing level with no prior authorization is mandated.
• Transparency: New health plan disclosure and transparency requirements are created.

January 2011

• CLASS (Community Living Assistance Service and Supports) Program: Voluntary long-term care insurance options avialable for adults who become disabled.  (REPEALED)
• Consumer rebates for excessive medical loss ratios: Insurers must maintain certain minimum medical loss ratios and annually report on the percentage of health premiums used for claims reimbursement if offering group or individual health plans. Rebates must be provided to health plan participants if minimums are not met.
• W-2 Reporting: Employers will be required to report health coverage costs on form W-2. Click here to see and artical on this mandate. NOTE: This madate was set to be effective for tax years 2011, this has now become optional for 2011.
• Standardizing the Definition of Qualified Medical Expenses. The health care reform law conforms the definition of “qualified medical expenses” for HSAs, FSAs and HRAs to the definition used for the itemized tax deduction. Click here to see an article on this mandate also check out August and November’s Newsletters for other articles on HSAs, FSAs and HRAs.
• Sample Cafeteria Plan: The new law creates a Simple Cafeteria Plan to provide a vehicle through which small businesses can provide tax‐free benefits to their employees. This plan is designed to ease the small employer’s administrative burden of sponsoring a cafeteria plan. The provision also exempts employers who make contributions for employees under a simple cafeteria plan from pension plan nondiscrimination requirements applicable to highly compensated and key employees.
• Medicare Part D discounts: Start phasing in varying levels of subsidies for brand-name and generic drugs (50% discount on brand-name drugs) in the in the Medicare Part D “doughnut-hole” coverage gap . Click here to see an article on this program.
• HSA Withdraw Changes: Increase of taxes on withdraws from HSAs (prior to age 65) and Archer MSAs which are not used for qualifed medical expenses. Click here to see an article on this mandate.
• Wellness Programs: Grants will be available to eligible employers who provide employees with access to a new workplace wellness program (those who did not have a program as of March 23, 2010). Click here to see an article on this program.
• Medicare Wellness: Free annual wellness visit for Medicare beneficiaries and elimination of cost sharing.

• Electronic Medical Reporting: Improvements on electronic exchange of health information to reduce paperwork, administratve burdens and costs go into effect.
• Contribution cap on FSAs: Employee contributions for FSAs will be capped at $2,500 annually, with the cap adjusted annually to the Consumer Price Index. Click here to see more on FSA changes.
• Medicare Subsidy: Medicare Part D subsidy deduction eliminated. Click here to see more on Medicare Part D Coverage changes.
• IRS Medical Deductions: Income threshold for claiming itemized deduction for medical expenses increased.
• Research Funding: Employers with self-funded healthcare plans wills start paying a fee to fund a comparative effectiveness research agency. If the healthcare plan is fully insured, the health insurer will be assessed this fee. This charge will be $1 times the average number of covered lives and in 2014, it will be $2 times the average number. This fee ends on September 30, 2019. This is based on Fiscal Year 2013 which starts in 2010.
• Employee Notification: Employers will need to start telling employees about exchanges, premium subsidies and free choice vouchers.
• Excise Tax: Medical devices will be assessed an excise tax.

By 2014 many things may have been changed in the current Healthcare Reform bill, but here are several mandates that will come into effect on January 1, 2014.

• Exchanges: Separate state-based health insurance exchanges will be available for individuals (American Health Benefit Exchanges) and also for small group employers (Small Business Health Options Program or SHOP). Small group employer tax credits will only be available through SHOP. Individuals must obtain health insurance coverage or pay a penalty (some exceptions apply).
• Small group employers redefined: Small group status will go from 2-50 employees to 1-100 employees (States may defer the implementation of the increase to 100 employees until 2016).
• Pre-existing Coverage Expanded: At this time pre-existing condition exclusions will be expanded from children under 19 to everyone covered by group health plans or group health insurance coverage, including grandfathered group health plans. Pre-existing exclusions also extend to individual health insurance coverage, although it does not apply to grandfathered individual policies.
• Rating Changes: Insurance companies will be limited from using rating factors on such things as age and other catagories.
• Fully-Insured Group Fees: A new fee on fully-insured coverage will be assessed.
• Clinical Trial Coverage: A mandate to provide coverage for approved clinical trials will begin.
• Additional Medicaid Expansion: Healthcare Reform establishes a national floor for Medicaid coverage set at 133 percent of the federal poverty level (FPL) ($15,282 for an individual or $31,322 for a family of four in 2013).
• Requirement to offer coverage: Employers with 50 or more full-time employees will be required to offer minimum essential coverage. These plans must cover at least 60% of healthcare costs. Pentalties ranging from $2,000 to $3,000 per employee will be impleminted if an employer does not provide any health insurance to full-time employees or if they provide coverage that is not “affordable.”
• Annual Limits: Annual dollar limits for individual or group health insurance will be eliminated.
• Wellness: The law codifies the HIPAA nondiscrimination rules on wellness programs and increases the incentive cap to 30% of the premium. At the discretion of the HHS secretary these incentives could be increased to 50%.
• Waiting Period: Employers can no longer require waiting periods of more than 90 days from the date-of-hire for group health insurance benefits.
• New Employer Reports:For tax beginning after December 31, 2013, employeers will be required to report annually the following information:
  • Weather minimum essential coverage is offered to full-time employees
  • Any waiting periods for health coverage
  • Monthly premiums for the lowest cost option in every plan enrollment category
  • The employer’s share of the total allowed cost of benefits provided under the plan
  • The number of employees each month
  • The name, address and social security number (or tax ID number) for each employee working full-time and the months the employee was covered by employer provided health insurance.

• High-Cost Tax: The insurer or employer will be responsible for a 40% excise tax on high-cost plans (“Cadillac”) that cost more than $10,200 for single coverage and $27,500 for family coverage.
• Fully-Insured Group Fees: Fees on fully-insured coverage will be raised in 2015 and stay at this level through 2016. Starting in 2017 they will be increased on an annual basis.