• 2010

  2010 Reform Provisions

  • Adult child coverage until age 26*
  • Annual dollar limits restricted
  • ER coverage as in-network, no prior authorization*
  • Early retiree reinsurance program (ERRP)
  • Initial appeals review standards*
  • Lifetime dollar limits prohibited
  • Medicare Part D rebate
  • No pre-existing conditions for kids until age 19*
  • Online consumer information at healthcare.gov
  • Pediatricians as PCPs, direct access to OB/GYNs*
  • Preventive services with no cost sharing*
  • Rescissions prohibited except for fraud or nonpayment*
  • Small business tax credit
  • Temporary high-risk pool
  • *Applies to ASO (self-funded) and fully insured
• 2011

  2011 Reform Provisions

  • Annual fee on pharmaceutical manufacturers begins
  • Annual rate review process
  • Appeals ombudsman and process documentation
  • Auto-enrollment for groups with 200+ FTEs
  • Discounts in Medicare Part D "Donut Hole"
  • HSAs/HRAs/FSAs: Limitations for OTC medications
  • Increase penalty for non-qualified HSA withdrawals
  • Medical Loss Ratio: 85% for large group, 80% for small group and individual
  • Non-discrimination rules apply to insured plans
  • Small business wellness grants
  • *Applies to ASO (self-funded) and fully insured
• 2012

  2012 Reform Provisions

  • 60-day advance notice of material modifications
  • Accountable care organizations
  • Appeals provision fully implemented
  • Comparative effectiveness fee imposed on plan sponsors ($1 per member/year)
  • First medical loss ratio rebates to be paid by August
  • New women's preventive services with no cost sharing*
  • Quality bonus begins for Medicare Advantage plans
  • Quality of care reporting requirements
  • Summary of benefits and coverage (SBC) and the uniform glossary*
  • *Applies to ASO (self-funded) and fully insured
• 2013

  2013 Reform Provisions

  • Administrative simplification begins
  • Annual fee on medical device sales begins
  • Comparative effectiveness fee increases to $2 per member/year
  • Deduction for expenses allocable to the Part D subsidy for "qualified prescription drug plans" eliminated
  • Employee notification of access to Exchanges
  • Employers report value of health benefits on W2s
  • FSA contributions limited to $2,500
  • High earner tax begins
  • ICD-10 code adoption
  • *Applies to ASO (self-funded) and fully insured
• 2014

  2014 Reform Provisions

  • Annual insurance industry tax
  • Coverage for all adult children until age 26, including those that have employer coverage
  • Deductible caps cannot exceed $2,000 for individual and $4,000 for family
  • Guarantee issue and renewal rules
  • Health benefit exchanges
  • Individual and employer mandates
  • Mandatory coverage for clinical trials*
  • No annual limits*
  • No pre-existing condition exclusions*
  • OOP limits must comply with OOP limits for HSA qualified plans
  • Rating restrictions
  • Standardized essential health benefits
  • Tax credits/subsidies for individuals and small employers
  • Waiting period limits*
  • *Applies to ASO (self-funded) and fully insured
• 2015+

  2015+ Reform Provisions

  • High-value plan excise tax begins (2018)
  • Insurance industry tax through 2018
  • Medicare Part D "donut hole" closed by 2020
  • States can open exchange to CHIP eligibles (2015) and all employers (2017)
  • *Applies to ASO (self-funded) and fully insured

Accountable Care Organizations (ACOs)

Accountable Care Organizations for Original Medicare

UnitedHealth Networks Strategies: Value-Based Contracting and ACOs