PATIENT PROTECTION AND AFFORDABLE CARE ACT – HEALTH
INSURANCE REFORMS APPLICABILITY
(Note: In third column, if only applicable to Large Group will be noted; If “QHP”
stated, only applies to qualified health plans not non-QHP’s)
Individual
Provision
Citation(s)
Effective
Date
Immediate Health Insurance Reforms
Annual
PHSA §2711 Sept. 23, 2010
Lifetime
Limits
Ban on
PHSA §2712 Sept. 23, 2010
Rescissions
Coverage of
PHSA §2713 Sept. 23, 2010
Preventive
Health
Services
Extension of
PHSA §2714 Sept. 23, 2010
Adult
Dependent
Coverage
Uniform
PHSA §2715 Mar. 23, 2011
Explanation of
– Standards
Coverage
Documents and
Mar. 23, 2012
Standardized
– Uniform
Definitions
Documents
Provision of
PHSA§2715 Sept. 23, 2010
Additional
A
Information
Prohibition on PHSA §2716 Sept. 23, 2010
Discrimination
Grandfather
ed Policies
New Plans
Small Group (1-50)
Grandfather
ed Policies
New Plans
Large Group (51+)/SelfFunded
Grandfather
New Plans
ed Policies
Yes; except
for annual
limits
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
No
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
No
Yes
No
Yes
No
No
No
Yes
No
Large Group
Only
Individual
Provision
Citation(s)
Effective
Date
Based on
Salary
Ensuring
PHSA §2717 Mar. 23, 2012
Quality of Care
(Data reporting
requirements)
Medical loss
ratio
requirements
Appeals
Processes
(Internal and
external
review)
Patient
Protections
(Choice of
primary
provider;
Coverage of
emergency
services;
access to
pediatric care;
access to
OBYN care)
Ensuring that
Consumers get
Value for their
Dollars
(Federal
review on
increases)
Grandfather
ed Policies
New Plans
Small Group (1-50)
Grandfather
ed Policies
New Plans
Large Group (51+)/SelfFunded
Grandfather
New Plans
ed Policies
No
Yes
No
Yes
No
Yes
Yes
Yes
Yes
Yes
Large Group
Only
Large Group
Only
PHSA §2719 Sept. 23, 2010 No
Yes
No
Yes
No
Yes
PHSA§2719
A
Yes
No
Yes
No
Yes
Yes
No
Yes
No
Large Group
Only
PHSA §2718 Jan. 1, 2011
Sept. 23, 2010 No
PHSA §2794 2010 plan
year
No
Individual
Provision
Citation(s)
2014 Market Reforms
Guaranteed
PHSA §2702
Issue
Guaranteed
PHSA §2703
Renewal
No Preexisting PHSA §2704
Condition
Exclusions
Rating
PHSA §2701
Reforms
Waiting
PHSA §2708
Periods
Essential
PHSA §2707
Health Benefits
ACA §1302
StateACA §1311,
Mandated
1315
Benefits
(State must
defray costs of
state-mandated
benefits which
are not part of
essential health
benefits)
Actuarial
ACA §1302
Value,
Precious Metal
Tiers
Clinical Trials PHSA §2709
Risk
ACA §1343
Adjustment
Reinsurance
ACA §1341
Effective
Date
Grandfather
ed Policies
New Plans
Small Group (1-50)
Grandfather
ed Policies
New Plans
Large Group (51+)/SelfFunded
Grandfather
New Plans
ed Policies
Jan. 1, 2014
No
Yes
No
Yes
No
Large Group
Only
Large Group
Only
Yes
Jan. 1, 2014
No
Yes
No
Yes
No
Jan. 1, 2014
No
Yes
Yes
Yes
Yes
Jan. 1, 2014
No
Yes
No
Yes
No
Jan. 1, 2014
Yes
Yes
Yes
Yes
Yes
Large Group
Only
Yes
Jan. 1, 2014
No
Yes
No
Yes
No
No
N/A
No
QHP
No
QHP
No
QHP
Jan. 1, 2014
No
Yes
No
Yes
No
Yes
Jan. 1, 2014
Jan. 1, 2014
No
No
Yes
Yes
No
No
Yes
Yes
No
No
Yes
Yes
Jan. 1, 2014
to Dec. 31,
No
Yes
No
Yes
No
Yes
Individual
Provision
Risk Corridors
Prohibiting
Discrimination
Against
Individual
Participants
and
Beneficiaries
Based on
Health Status
NonDiscrimination
in Health Care
Citation(s)
Grandfather
ed Policies
New Plans
Small Group (1-50)
Grandfather
ed Policies
New Plans
Large Group (51+)/SelfFunded
Grandfather
New Plans
ed Policies
Effective
Date
2016
ACA §1342 Jan. 1, 2014
to Dec. 31,
2016
PHSA §2705 Jan. 1, 2014
No
QHP
No
QHP
No
QHP
No
Yes
No
Yes
No
Yes
PHSA §2706 Jan. 1, 2014
No
Yes
No
Yes
No
Yes