Insurance Reform

What Should Employers Do Now?

  • Review plan documents, summaries and SPDs.
  • Determine eligibility for Retiree reinsurance program.
  • Determine whether there are any children who were previously excluded for pre–existing conditions.
  • Determine whether any adult dependents who were removed from the plan.
  • Revise health FSA, HSA and HRA open enrollment materials.

Resources

Contact

Jim Young
Director, Strategic Communications & Congressional Relations
Government & Public Affairs
Associated General Contractors of America
2300 Wilson Boulevard, Suite 400
Arlington, VA 22201
USA
Phone: (202) 547-0133
Fax: (202) 547-1635
http://www.agc.org

The health care bill makes significant insurance reforms and modifications to employers current benefit plans.

Effective in 2010

There are some targeted changes before the end of 2010 but most changes do not begin until 2014.

  • Temporary high–risk pools will be created for adults with pre–existing condition and have been uninsured for 6 months (those receiving COBRA are not eligible).
  • Dependents will be allowed to stay on parents’ policies until age 26 (if child doesn’t receive coverage from employer).
  • Prohibitions on lifetime cost limits, insurers prohibited from making rescissions and denying coverage to children under age 19 who have pre–existing conditions.

Effective in 2011

Individuals prohibited from using HSA, FSA or MSA accounts to purchase over–the–counter medications.

Effective in 2013

FSA accounts are capped at $2,500.

Effective 2014

Most changes affecting the broader population are effective beginning in 2014.

  • Insurers prohibited from imposing any pre–existing condition exclusion.
  • Rating on health status will be prohibited and insurers can only modify–vary premiums based on age, geography, family composition and smoking.

Exchanges

Bill creates state–based exchange for individuals as well as ones for small businesses. The exchanges must offer for possible benefit tiers.

  • In 2014 state–based exchanges will offer health benefit plans. The minimum plan offered must provides a comprehensive set of services that cover at least 60 percent of the actuarial value of the covered benefits and limits the annual cost sharing and premiums.
  • Small groups up to 100 employees will be allowed access to exchange in 2014. In 2016 states can allow larger business to participate in the exchange.

Waiting PeriodsBeginning in 2014 waiting periods cannot exceed 90 days.

Grandfathered Pans

Grandfathered health plans may maintain existing coverage if they were in effect on March 23, 2010 but they are still subject to certain provisions of insurance market reform.

  • New employees or dependents joining the plan will not change “grandfathered” status.
  • Beginning in September 2010 grandfathered plans must change their plans by:
    • Eliminating pre–existing conditions for children under age 19.
    • Allow dependents to stay on parents’ policy until age 26 (if child doesn’t receive coverage from employer).
    • Prohibits the use of lifetime limits and rescissions.
  • Beginning in 2014 there are additional compliance requirements for grandfathered plans:
    • Allow dependents to stay on parents’ policy until age 26 (even if child receives coverage from employer).
    • Waiting period can not exceed 90 days.
    • Eliminate the use of annual limits on benefits.