Introduction to Health Care Reform in 2010
On March 23, 2010, the President signed into law H.R. 3590, the Patient Protection and Affordable Care Act (PPACA). The Act, as amended by the Health Care and Education Reconciliation Act of 2010 on March 30, 2010, implements sweeping health care changes that affect individual and employer-sponsored health plans. While many of the provisions will not take effect until 2014, a number of reforms take place this year.
Some of the highlights of the legislation include:
- Tax credits starting in 2010 for qualifying small businesses that provide health coverage,
- Dependent coverage up to age 26,
- Prohibitions on pre-existing condition exclusions and limitations for children under 19, and in 2014 for adults,
- Prohibitions on lifetime caps, and a restriction and eventual ban on annual caps,
- Prohibitions on rescissions of coverage, absent fraud or intentional misrepresentation,
- State-administered exchanges through which qualified individuals and small businesses can purchase health plans,
- Subsidies for individuals unable to receive affordable coverage from work,
- Penalties for employers with 50+ employees that do not provide certain coverage, and
- A requirement that most U.S. citizens and legal residents acquire health coverage.
This Section also includes information on:
HSAs & Health Care Reform
For a summary of key changes to Health Savings Accounts and similar plans under the Affordable Care Act, please the HSA, HRA, FSA and MSA Section by clicking here. You can also view a flyer from the IRS on these changes by clicking here.
DOL Releases Additional FAQs on Affordable Care Act Implementation
The U.S. Department of Labor (DOL) has released a new set of Frequently Asked Questions (FAQs) regarding implementation of the market reform provisions of the Affordable Care Act. The FAQs, entitled " FAQs About the Affordable Care Act Implementation Part II," were prepared jointly by the Departments of Health and Human Services, Labor and the Treasury. The FAQs cover the following topics:• Grandfathered Health Plans;
• Dental and Vision Benefits;
• Preventive Health Services; and
• Clarification Relating to Policy Year and Effective Date of the Affordable Care Act for Individual Health Insurance Policies
The Departments state that the ongoing guidance reflects their approach to implementation, which emphasizes assisting (rather than imposing penalties on) plans, issuers and others that are working diligently and in good faith to understand and come into compliance with the Affordable Care Act. The Departments anticipate issuing further responses to questions and other guidance under the Affordable Care Act in the future.
The U.S. Department of Health and Human Services (HHS) has announced the establishment of a new Pre-existing Condition Insurance Plan (PCIP) that will offer coverage to uninsured individuals who have been unable to obtain health coverage because of a pre-existing health condition.
The Pre-Existing Condition Insurance Plan, which will be administered either by a state or HHS, will provide a new health coverage option for those who:
- Have been uninsured for at least 6 months,
- Have been unable to get health coverage because of a health condition, and
- Are a U.S. citizen or are residing in the United States legally.
Starting July 1, 2010 and lasting until 2014, the national Pre-Existing Condition Insurance Plan (PCIP) is open to applicants in the 21 states where HHS is operating the program. To learn more, including options available to residents of your state and how to apply, visit www.HealthCare.gov. A Fact Sheet on the PCIP is available here. An informational pamphlet on the Pre-Existing Condition Insurance Plan can be found at: http://www.healthcare.gov/center/brochures/pcip.pdf. To view an interim final rule on the high risk pool, please click here.
Interim Final Rules
The U.S. Departments of Treasury, Labor and Health and Human Services have issued interim final rules under the Affordable Care Act. These rules relate to preexisting condition exclusions of children under 19 from coverage under group or individual health plans, lifetime and annual limits, rescissions of coverage, and certain other provisions.
The rules contain an overview of how the Affordable Care Act impacts a number of other related laws, including the Public Health Service Act, ERISA, HIPAA and the Internal Revenue Code. For example, the rules clarify that the Affordable Care Act’s annual limit rules do not apply to health flexible spending arrangements (health FSAs) medical savings accounts (MSAs) or health savings accounts (HSAs). The Departments request comments regarding the application of annual limits to stand-alone Health Reimbursement Arrangements (HRAs) that are not retiree-only plans. The new rules also include model language for a new disclosure requirement for plans that require the selection of primary care physicians, and rights to obtain obstetrical or gynecological care without prior authorization. For group coverage, the notice must be provided whenever the plan or issuer provides a participant with a summary plan description (SPD), or other similar description of benefits under the plan or health coverage.
There is also data on insurance market trends, an accounting table of benefits and costs, and a variety of examples of these covered provisions.
The rules issued are now available for public comment at www.regulations.gov.
To view a Fact Sheet on the rules, please click here.
New Office of Consumer Information and Insurance Oversight
The Department of Health and Human Services (HHS) has been entrusted with the responsibility for implementing many major provisions of the health care reform bill, the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010. Accordingly, the Office of Consumer Information and Insurance Oversight (OCIIO) has been established to help HHS implement many of the provisions of the legislation that address private health insurance.
OCIIO is responsible for ensuring compliance with the new insurance market rules, such as the prohibitions on rescissions and on pre-existing condition exclusions for children that take effect this year. The Office will oversee the new medical loss ratio rules and will assist states in reviewing insurance rates. OCIIO will provide guidance and oversight for the state-based insurance exchanges. It will also administer the temporary high-risk pool program and the early retiree reinsurance program, and compile and maintain data for an internet portal providing information on insurance options.
The OCIIO website contains information on Initiatives and Programs of the Office, such as medical loss ratios and the high-risk pool program, Regulations and Guidance, including requests for comments, Gathering Insurance Information, and FAQs about the Office. To visit the OCIIO website, please click here.