Health Care Reform Timeline
2010
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Temporary high risk pool
Early retiree reinsurance program
Small business tax credit
Dependent coverage for adult children
until age 26
No pre-existing condition exclusions
for individuals until age 19
Rescissions prohibited except for
fraud or non-payment
Lifetime dollar limits prohibited
Annual dollar limits restricted
Preventive services with no cost
sharing (G)
Pediatricians as PCPs, direct access to
OB/GYNs (G)
ER coverage as in-network, no prior
authorization (G)
Appeals process and external review (G)
Medicare Part D rebate for beneficiaries
in the gap
2014
2012
2011
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• Summary of Benefits and Coverage
and Uniform Glossary
• Expanded woman’s preventive
services (G)
Annual rate review process
• 60 day advance notice of material
Medical loss ratio (MLR): 85% for
modification
large group; 80% for small group and • Accountable Care Organization
individual
requirements
HSAs/HRAs/FSAs: limitations for OTC • Quality bonus begins for Medicare
medications
Advantage plans
Increase penalty for non-qualified
• Administrative simplification begins
HSA withdrawals
• 1st medical loss ratio rebates to be
Small business wellness grants
paid by August (and each subsequent
Annual fee on pharmaceutical manuAugust)
facturers begins
Discounts in Medicare Part D “donut
hole”
Non discrimination rules apply to
insured plans (G) (implementation
delayed)
Auto-enrollment for Groups with
200+ FTEs (implementation delayed)
2013
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• Health benefit marketplace (Individual and small group)
• Guaranteed issue and renewal rules (G)
• No annual limits
Exchange notices to employees
• No pre-existing condition exclusions
Employers to report value of employer• Rating restrictions (G)
sponsored health benefits on W2s
• Individual mandate
FSA contributions limited to $2,500
• Tax credits and subsidies for individuals
High earner tax begins
and small employers
Annual fee on medical device sales
• Essential health benefits
begins
• Waiting period limit (90 days)
Deduction for expenses to the Part
• Mandatory coverage for clinical trials (G)
D subsidy for “qualified prescription
• Reinsurance fee
drug plans” eliminated
• Annual insurance industry tax
Comparative effectiveness fee for
• Cost-sharing limits (G)
certain plans
• Wellness programs
• ICD-10 code adoption
2015 &
BEYOND
• Employer mandate penalties
• States can open Exchange to CHIP
eligibles (2015) and all employers
(2017)
• High-value plan excise tax “Cadillac
Tax” begins (2018)
• Medicare Part D “Donut hole” closed
(by 2020)
Rev. 8/1/2013
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