Health Care Reform
Safe Harbor is committed to helping our clients navigate the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act (HCERA), collectively referred to as the "Healthcare Reform Law," by providing the best information we can gather on your behalf.
The legislation is subject to change and we may not be able to update our timeline immediately with each amendment. We suggest visiting healthcare.org for the most up-to-the-minute information.
March
- Patient Protection and Affordable Care Act (PPACA) signed into law
- Health Care and Education Reconciliation Act (HCERA) signed into law
June
- Small business under 25 employees eligible for tax credit (retroactive to 1/1/2010)
- Temporary reinsurance program for employers who provide coverage to early retirees
- Provides immediate access to high risk pools for uninsured (pre-existing conditions)
- Seniors will receive a $250 rebate to help fill the Medicare "donut hole"
Plan Years beginning after September 23, 2010
- Bans pre-existing conditions exclusions for dependents under age 19
- Prohibits lifetime/restrictive annual dollar maximums
- Mandates dependent coverage at age 26 for those not eligible for other group coverage
- Prohibits rescissions except for fraud
Non-Grandfathered New Plans
- Preventive care covered without cost sharing
- Group plans must cover ER services without prior authorizations and in-or-out-of-network
- Group plans must allow designation of OB/GYN or pediatrician as PCP
- Employer plans must have HHS approved external appeal process
- Insured group health plans subject to nondiscrimination rules re: highly compensated individuals
- Employers required to disclose value of health benefits on W-2
- OTC drugs without prescription no longer eligible under FSA, HRA, or HSA
- Higher penalty on withdrawal of HSA funds for non-medical expenses
- Employers with less than 100 employees are eligible for wellness grants (up to 5 years)
- New Federal voluntary LTC program established (CLASS ACT)
- Requires insurers to annually report percent of premiums spent on medical services; if less than 80% must provide rebate to enrollees (large group plan must spend 85%)
- Employers required to provide employees with Uniform Summary of Coverage (24 months post-enactment)
- Plans must report annually to HHS and participants regarding improving quality care (24 months post-enactment)
- Caps FSA contribution to $2,500/year
- Imposes an additional hospital insurance tax of .9 percent on high income individuals ($200,000 individual, $250,000 joint filers)
- Imposes an additional 3.8% Medicare payroll tax on unearned income for high income Individuals ($200,000 individual, $250,000 joint filers)
- Imposes a comparative effectiveness fee of $2 per participant for insurers/self insured plans
- Employers required to provide written notice to employees about Exchange and subsidies
- Employers with more than 50 employees must offer coverage or pay free rider penalty
- Employers required to offer free choice vouchers to qualified employees
- Ban pre-existing condition exclusions for all individuals
- Bans waiting periods greater than 90 days
- Employers permitted to offer employees wellness incentive rewards of up to 30 percent of health plan premium
- Employers must report on provision of minimum essential coverage and EE contributions exceeding 8% of wages
- Requires individual mandate to obtain health care coverage
- Provides subsidies for families earning up to 400 percent of the poverty level or, under current guidelines, about $88,000 a year to purchase health insurance
- State based insurance Exchanges operational for individuals and small groups; expanded To large groups in 2017 Auto-enrollment of new hires for employers with more than 200 employees (likely effective when HHS regulations issued)
Non-Grandfathered New Plans
- Cost sharing limits for group health plans - annual OOP limits cannot exceed HSA limits, deductibles cannot exceed $2,000 single $4,000 family coverage
- Health plans must cover routine costs for clinical trial participants
- Group plans/insurers cannot discriminate against any provider with regard to plan participation
- Imposes a 40% excise tax on high cost health plans that exceed $10,200 for individual and $27,500 for family coverage
