Many health care reform requirements become effective in 2014. As we start the year, see below for a look at new obligations under the Affordable Care Act.
- Individual Mandate. Virtually all U.S. citizens must have appropriate health coverage in 2014 or pay a penalty.
- Elimination of Preexisting Condition Limitations. Almost all plans must eliminate exclusions from coverage based on pre-existing conditions. There are certain exceptions for previously established “grandfathered” individual health plans.
- Annual Dollar Limits. Plans must no longer apply an annual dollar limit on essential health benefits. There is an exception for certain grandfathered individual health plans.
- Exchanges. The health insurance Marketplace is open for health plan enrollment.
- Tax Credits. The small business health tax credit is increased and premium tax credits/cost sharing is available to qualifying individuals who purchase coverage through an Exchange.
- Medicaid Expansion. A few states have opted to expand Medicaid coverage.
- Out of Pocket Maximums. Out of pocket maximum payments for essential health benefits must be limited.
- Community Rating. Insurers may rate by geographic area, family demographics, age and tobacco use. Community rating is applicable to only individual and small group plans.
- Waiting Period. A plan cannot impose a waiting period of more than 90 days.
- PCORI Fee. The Patient Centered Outcomes Research Institute Fee is $2.00 times the average number of covered lives.
Other health care reform requirements are already in effect. These include
- Preventive Services. Plans must cover preventive services for women.
- Summary of Benefits and Coverage. Plans must summarize their coverage in a 4-page format.
- Age 26 coverage. Plans must cover children up to age 26 regardless of dependency status.
- Lifetime Limits. Plans may not pace lifetime limits on coverage.
- Retroactive Rescission of Coverage. Retroactive cancellation of coverage is permitted in only very limited circumstances.
- Essential Health Benefits. Coverage that is deemed “essential” must be offered and covered by health plans (some not effective until 2015).
- Appeal Rights. Plans must offer certain rights in connection with appealing a denial of coverage.
Health care reform seems to be continually evolving, and more changes are likely in the coming years.
