Patient Protection and Affordable Care Act

6/22/2010
Health Reform.gov Patients_Bill_of_Rights

BC/BS Employer
Summary of Health Reform

Regulations HHS.Gov

Affordable Care Act - California CHCF.org

What Californian's should know.

UHC Resource Center

DOL FAQ's Implementation

Health Net FAQ's 11/2010

Health Net Broker Guide to Health Care Reform 1/2011

SMALL BUSINESS TAX CREDITS—Offers tax credits to small businesses to make employee coverage more affordable. Tax credits of up to 35 percent of premiums will be available to firms that choose to offer coverage. Effective beginning calendar year 2010. (Beginning in 2014, the small business tax credits will cover 50 percent of premiums.)
NO DISCRIMINATION AGAINST CHILDREN under 19 WITH PRE-EXISTING CONDITIONS—Prohibits new health plans in all markets plus grandfathered group health plans from denying coverage to children with pre-existing conditions. Effective 6 months after enactment. (Beginning in 2014, this prohibition would apply to all persons.)
CA Assembly Bill 2244
HELP FOR UNINSURED AMERICANS WITH PRE-EXISTING CONDITIONS UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH-RISK POOL)—Provides access to affordable insurance for Americans who are uninsured because of a pre-existing condition through a temporary subsidized high-risk pool. Effective in 2010.

National Conference of State Legislatures
Mr. MIP CA Page
Choice Administrators on Exchanges
Christian Science Monitor
Our Website for information quotes
Individuals & Families
Employer Groups 2 - 50
ENDS RESCISSIONS—Bans insurance companies from dropping people from coverage when they get sick. Effective 6 months after enactment.
Blue Cross FAQ's
Blue Cross FAQ's for Small Employer Groups
AB 2470 De La Torre 2010
BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE—Provides a $250 rebate to Medicare beneficiaries who hit the donut hole in 2010. Effective for calendar year 2010. (Beginning in 2011, institutes a 50% discount on prescription drugs in the donut hole; also completely closes the donut hole by 2020.)
medicare.gov/
FREE PREVENTIVE CARE UNDER MEDICARE—Eliminates co‐payments for preventive services and exempts preventive services from deductibles under the Medicare program. Effective beginning January 1, 2011.
EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO 26TH BIRTHDAY THROUGH PARENTS’ INSURANCE—Requires new health plans and certain grandfathered plans to allow young people up to their 26th birthday to remain on their parents’ insurance policy, at the parents’ choice. Effective 6 months after enactment.
HELP FOR EARLY RETIREES—Creates a temporary re-insurance program (until the Exchanges are available) to help offset the costs of expensive premiums for employers and retirees for health benefits for retirees age 55-64. Effective in 2010.
BANS LIFETIME LIMITS ON COVERAGE—Prohibits health insurance companies from placing lifetime caps on coverage. Effective 6 months after enactment.
health care.gov
Blue Cross Flyer
HHS Memo 12/9/2010
BANS RESTRICTIVE ANNUAL LIMITS ON COVERAGE—Tightly restricts the use of annual limits to ensure access to needed care in all new plans and grandfathered group health plans. (Beginning in 2014, the use of any annual limits would be prohibited for all new plans and grandfathered group health plans.)
health care.gov
Blue Shield - info - NOTE definition of Essential Benefits
Blue Cross Flye
FREE PREVENTIVE CARE UNDER NEW PRIVATE PLANS—Requires new private plans to cover preventive services with no co-payments and with preventive services being exempt from deductibles.
NEW, INDEPENDENT APPEALS PROCESS—Ensures consumers in new plans have access to an effective internal and external appeals process to appeal decisions by their health insurance plan. Effective 6 months after enactment.
ENSURES VALUE FOR PREMIUM PAYMENTS—Requires plans in the individual and small group market to spend 80 percent of premium dollars on medical services, and plans in the large group market to spend 85 percent.
COMMUNITY HEALTH CENTERS—Increases funding for Community Health Centers to allow for nearly a doubling of the number of patients seen by the centers over the next 5 years. Effective beginning in fiscal year 2011.
INCREASES THE NUMBER OF PRIMARY CARE PRACTITIONERS—Provides new investments to increase the number of primary care practitioners, including doctors, nurses, nurse practitioners, and physician assistants. Effective beginning in fiscal year 2011.
PROHIBITS DISCRIMINATION BASED ON SALARY—Prohibits new group health plans from establishing any eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage employees. Effective 6 months after enactment.
FAQ's BC/BS
Management Carve Out

Page 17 Section 2716 HR 3590
HEALTH INSURANCE CONSUMER INFORMATION (Web Portal)—Provides aid to states in establishing offices of health insurance consumer assistance in order to help individuals with the filing of complaints and appeals. Effective beginning in fiscal year 2010.
How to Get & Keep your Health Insurance

Section 2793 Page 20 HR 3590
More info on Web Portals Health Care.gov
HOLDS INSURANCE COMPANIES ACCOUNTABLE FOR UNREASONABLE RATE HIKES—Creates a grant program to support States in requiring health insurance companies to submit justification for all requested premium increases, and insurance companies with excessive or unjustified premium exchanges may not be able to participate in the new Health Insurance Exchanges. Starting in plan year 2011.
Health Reform.Gov
Rate Review SB 1163

health care.gov/time line

Blue Shield Timeline

Health Net Pamphlet 22 Pages

Grandfathering Exemption

2014 - Requirement to have Health Insurance

Require U.S. citizens and legal residents to have qualifying health coverage (phase-in tax penalty for those without coverage).
An insurance-less person would have to pony up whichever is greater: $695 for each uninsured family member, up to a maximum of $2,085; or 2.5 percent of household income. (Christian Science Monitor,
Section 1501, 5000A, HR 3590 Page 124,
Section 1002 HR 4872 Page 4)

Government Subsidy calculator

Assess employers with 50 or more employees that do not offer coverage and have at least one full-time employee who receives a premium tax credit a fee of $2,000 per full-time employee, excluding the first 30 employees from the assessment.

Employers with 50 or more employees that offer coverage but have at least one full-time employee receiving a premium tax credit, will pay the lesser of $3,000 for each employee receiving a premium credit or $2,000 for each full-time employee, excluding the first 30 employees from the assessment.

Require employers with more than 200 employees to automatically enroll employees into health insurance plans offered by the employer. Employees may opt out of coverage.

Resources on the New Health Reform Law

The Kaiser Foundation has a new timeline detailing when specific provisions of the health reform law are scheduled to take effect. It reflects the provisions of the Patient Protection and Affordable Care Act, as modified by the Health Care & Education Reconciliation Act. A separate summary of the law is also available, as is an interactive calculator to illustrate the subsidies in the law and a brief explaining how the new law will close the Medicare drug benefit's coverage gap. These resources and more are found on the Health Reform Gateway.