(Most of these do not apply to grandfathered plans)
Text Highlighted in Red = Requires action by the employer
o Mandate to cover specific benefits in the small group market – preventive, no preexisting for children, no lifetime limit, limitedannual maximum, no rescission, dependent to age 26 – 2010
o Existing plans grandfathered as of date of enactment from some, but not all, of the new plan requirements – 2010
o Non-discrimination requirements for insured plans – 2010
o An internal and external appeals process – 2010
o No prior authorization for emergency services – 2010
o Plans must allow designation of a primary care provider – 2010
o Small employer tax credits (for those who qualify) – 2010
o FSA, HSA, HRA definition of medical expenses – 2011
o Increase to 20% penalty for non-health withdrawals from an HSA or Archer MSA – 2011
o Wellness grants ‐ 2011 through 2015
o Increase Medicare payroll tax by 0.9% on earned income in excess of $200,000/$250,000 (unindexed); wages received after December 31, 2012
o Impose fee on health insurance and fully self-funded employer plans to fund comparative effectiveness research – 2012
o 3.8% investment tax on unearned income for taxpayers with AGI in excess of $200,000/$250,000
(unindexed) – taxable years after December 31, 2012
o Uniform explanation of coverage – November 1, 2012 (Fully Insured Clients – Carrier
o Notice of material modifications – September 2010
o Elimination of tax deduction for retiree drug subsidies to employers – 2013
o Employee Notification of the Exchange – March 1, 2013 (This regulation was delayed as of 1/23/13 – ETA late 2013)
o Limit salary deferrals to FSAs to $2,500 – 2013, then indexed to inflation
o Eliminate deduction for Medicare Part D employer subsidy – 2013
o Raise 7.5% adjusted gross income (AGI) floor on medical expense deduction to 10% – 2013
o No preexisting condition exclusions for all participants – 2014
o Guaranteed issue – 2014
o Guaranteed renewability – 2014
o Must cover minimum benefit package – 2014
o Allows HIPAA wellness discount up to 30%(50%at Secretaries’ discretion) – 2014
o Limits on out-of-pocket cost sharing, maximum deductibles – 2014
o Coverage of routine costs associated with clinical trials – 2014
o Prohibition on waiting periods more than 90 days – 2014
o Must provide a minimum actuarial value for benefits – 2014
o File an annual report with HHS on employer and plan information – 2014
o Eliminate annual limits on benefits – 2014
o Limits premium underwriting – 2014
o Plan disclosure of claims payment policies and rating practices – 2014
o New SHOP Exchange for small-group and individual markets – 2014
o Limits on underwriting – 2014
o W2 reporting – 2013 tracking to be reported 2014; > 250 W-2’s
o IRS reporting – 2014
o 40% excise tax on high-cost plans – 2018
As always, confused? Have questions? Not sure what applies?
Call your Health Care Reform Experts at 916-932-2357.
