Health Reform Timeline 2010 • Temporary high risk pool • Early retiree reinsurance program (ERRP) • Small business tax credit
2011
2012
• Annual rate review process
• Appeals provision fully implemented*G
• Appeals ombudsmen and process documentation
• 60-day advance notice of material modifications (March) *G
• Dependent coverage until • Minimum medical loss age 26*G ratio (MLR): 85% for • No pre-existing conditions large group; 80% for for kids until age 19*G small group and • Rescissions prohibited individual except for fraud or non • HSAs/HRAs/FSAs: payment *G limitations for OTC • Lifetime dollar limits medications prohibited*G • Increase penalty for • Annual dollar limits non-qualified HSA restricted*G withdrawals • Preventive services with • Small business no cost sharing* wellness grants • Pediatricians as PCPs, direct access to OB/GYNs* • ER coverage as in-network, no prior authorization*
• Annual fee on pharmaceutical manufacturers begins
• Pre-enrollment coverage documentation • Accountable Care Organization requirements
• Online consumer information at healthcare.gov
• Uniform coverage documents and standard definitions*G • Employers to report value of employersponsored health benefits on W2s • FSA contributions limited to $2,500 • High earner tax begins
2014
2015 & beyond
• Health benefit exchanges • Guarantee issue and renewal rules • No annual limits* • No pre-existing condition exclusions* • Rating restrictions • Individual & employer requirements
• Quality bonus begins for Medicare Advantage plans
• Annual fee on medical device sales begins
• Tax credits and subsidies for individuals and small employers
• Comparative effectiveness fee imposed on plan sponsors ($1 per member/year)
• Deduction for expenses allocable to the Part D subsidy for “qualified prescription drug plans” eliminated
• Standardized essential health benefits
• Comparative effectiveness fee increases to $2 per member/year
• Annual insurance industry tax
• Administrative simplification begins
• Discounts in Part D “donut hole”
• States can open Exchange to all employers (2017) and CHIP eligibles (2015) • High-value plan excise tax begins (2018) • Insurance industry tax through 2018 • “Donut hole” closed by 2020
• Waiting period limits* • Mandatory coverage for clinical trials*
• Employer mandate
• ICD-10 code adoption
• Initial appeals review standards* • Part D rebate for beneficiaries in the gap
2013
*Applies to self-funded & fully insured GApplies
to “Grandfathered Plans”
Property of UnitedHealthcare. Rev. 4/6/11