The Patient Protection and Affordable Care Act (PPACA), H.R. 3590, and the Health Care and Education Affordability Reconciliation Act of 2010 were signed into law on March 23, 2010. Many portions of the law won’t be implemented until 2014, but some parts of the law were effective starting in the fall of 2010.
Read the National Center for Policy Analysis publication, “What Does Health Reform Mean for You? A Consumers Guide“.
You can read a Summary of the provisions or view a Reform Timeline for implementation of key provisions. Our National Association of Health Underwriters has also prepared a Paper (warning, political content) with views about the legislation and what might be improved. There’s a possible 35% tax CREDIT for qualifying small employers. To read more about this, refer to the IRS webpage. For a quick estimate of your credit, try the Tax Credit Calculator.
One of the first, and best publicized, portions of the law to be implemented is the continuation of coverage for dependent children up to age 26, without the requirement of “full time student status”. For most small group plans, this was effective on the group’s first renewal date following 6 months after the passage of the bill, or October 1, 2010 renewals and later.
Another key provision is coverage of preventive services without deductibles or copayments. Under the regulations, plans must cover without copay, coinsurance or deductible — certain preventive services that have “strong scientific evidence of their health benefits.” On July 14, 2010 the Departments of Treasury, Labor and Health and Human Services jointly released Interim Final Rules (IFRs) for group health plans and health insurance issues related to coverage of preventive services. Since these are “Interim” Final Rules, the final rules may eventually differ, but these are the best we have at this point.
General highlights of new regulations:
General list of services to be offered without copay, coinsurance or deductible:
Evidence-based preventive services: This list of items is taken from the current recommendations of the United States Preventive Services. They are included only if they have a rating of A or B. This broad list generally includes:
Routine vaccinations: A list of immunizations – recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention – are included in the rule. They are considered routine for use with children, adolescents, and adults and range from childhood immunizations to periodic tetanus shots for adults.
Prevention for children: The rule includes preventive care guidelines for children – from birth to age 21 – developed by the Health Resources and Services Administration with the American Academy of Pediatrics. Services include regular pediatrician visits, vision and hearing screening, developmental assessments, immunizations, and screening and counseling to address obesity.
Prevention for women: The regulation mandates certain preventive care measures for women. These recommendations will be in place until new requirements for prevention for women are issued by the United States Preventive Services Task Force or appear in comprehensive guidelines supported by the Health Resources and Services Administration.
Full list of covered preventive services issued as part of the Interim Final Regulations: http://www.healthcare.gov/center/regulations/prevention/taskforce.html
Billing and Office Visits
If a recommended preventive item or service is billed separately from an office visit, then cost-sharing may be applied to the office visit
If a recommended preventive item or service is not billed separately from an office visit and the primary purpose of the office visit is not the delivery of the preventive item or service, them cost-sharing made be applied to the office visit.
This information regarding Grandfathered Plans as it relates to Health Care Reform is intended to be a brief announcement only. Please refer to the links at the bottom of this page for more details.
Health Care Reform – What Are and Are Not “Grandfathered Plans”?
-e.g. January 1, 2011 for calendar year plans
Permissible Changes (No Loss of Grandfather Status)
Not Permissible Changes (Will Cause Loss of Grandfather Status)
Eligibility and Enrollment Rules
*Grandfathered plans are still required to conform to the new rules regarding annual and lifetime limits, dependent coverage to age 26, rescission, pre-existing condition exclusions, waiting periods, employer mandates and tax provisions.