Health Care Reform
Additional Resources
Recent health care reform in the United States has been enacted via two bills: the Patient Protection and Affordable Care Act (PPACA), which became law on March 23, 2010 and the Health Care and Education Reconciliation Act of 2010 (HCERA) which became law on March 30, 2010.
Many significant reforms have become effective in 2010. They include certain lifetime and annual limits, pre-existing coverage exclusions for children up to 19, as well as a requirement to offer dependent coverage up to age 26. These changes become effective on the anniversary date of the health policy on or after October 1, 2010.
Looking forward to 2011, insured group health plans become subject to nondiscrimination rules for the first time and are subject to penalties for discriminatory plans. There will also be tax ramifications in 2011 (employer self report on Form 8928). Employers for 2-50 employees are exempt from tax. In 2012, carriers must provide participants with a standardized benefits summary that does not exceed four pages.
A key modification for 2013 changes the reimbursements under health flexible spending accounts (e.g., in cafeteria or flex plans) which will be limited to $2,500 (indexed for inflation). Employers must provide employees hired on or after March 1, 2013 with a written notice of the existence of the health exchanges, subsidy and cost-sharing availability and other issues.
The individual coverage mandate goes into effect in 2014. In addition U.S. citizens and legal residents who fail to secure "minimum essential coverage" through an employer plan, and exchange, or a government program like Medicare must pay sliding scale tax penalties (exceptions for affordability and other reasons may apply).
Gray & Troy Insurance Services, Inc. helps our clients understand Health Care Reform and comply with their responsibilities by conducting ongoing seminars and consults personally with individual and group employers through compliance reviews and personalized action plans. As health care reform evolves, we will continue to update our website with new information as it becomes available. For more information, please contact info@gray-troy.com.
Web Resources
U.S. Department of Labor
Regulations, fact sheets and FAQs on the following topics can be found on the Department of Labor website:
- Affordable Care Act Implementation
- Interim Procedures for Federal External Review
- Interim Final Rules on Internal Claims and Appeals and External Review Processes
- Coverage of Preventative Services
- Pre-Existing Condition Exclusion, Lifetime and Annual Limits, Rescissions, and Patient Protections
- Grandfathered Health Plans
- Extensions of Coverage For Adult Children
- Early Retiree Reinsurance Program
- Pre-Existing Condition Insurance Plan Program
U.S. Internal Revenue Services
News releases, tips, questions and answers, and guidance on the following topics can be found on the Internal Revenue Services website:
- Employer-Provided Health Coverage
- Small Business Health Care Tax Credit
- Adoption Credit
- Changes to Flexible Spending Arrangements
- Health Coverage for Older Children
- Group Health Plan Requirements
- Medicare Part D Coverage Gap "donut hole" Rebate
- Therapeutic Discovery Project Program
- Excise Tax on Indoor Tanning Services
- Additional Requirements for Tax-Exempt Hospitals
U.S. Department of Health & Human Services
The Office of Consumer Information and Insurance Oversight continues to work with the Department of Health & Human Services to issue regulations and implement many of the provisions of the legislation that address private health insurance. Links, proposed regulations, requests for comment and other updates can be found on the Department of Health & Human Services website.