Health Care Reform Timeline for Self-Funded Plans

2012 Through 2018

Annual maximums for essential bene ts* prohibited.

DIRECT IMPACTS

Waiting periods greater than 90 days prohibited. Free Rider Penalty begins. If one employee buys insurance through HIE & is subsidized, them Employer pays $2,000 x number of FTEs. Employers with 200+ employees must automatically enroll all eligible employees, and each employee must be given the option to opt out of the plan. Employer-sponsored vouchers begin. Vouchers are available for employees with incomes less than 400% of FPL and employee contribution is between 8.0% and 9.8% of their annual income. Employer Responsibility Mandates established. Health FSA contributions will be limited to $2,500 per year. Tax deductions for employers who maintain RX plans to subsidize their Part D eligible retirees will be eliminated.

Beginning with plans renewing on October 1, 2012, levies $1 per participant per year tax on all plans for the funding of Comparative Effectiveness Research. $2 in 2013 through 2019.

Dropping coverage or restricting routine care for participants in clinical trials prohibited. Pre-existing condition exclusions prohibited. States can provide premium assistance for Medicaid bene ciaries who are eligible for employer-sponsored coverage. 40% Excise Tax on Cadillac Plans.

2012

2013
Secretary of HHS to implement a plan comparing physician performance available to all via the Internet. Startup loans and grants for CO-OP plans are allowed for individual and small group market in state where licensed.

2014
Health Insurance Exchanges/Shop Exchanges will open in each state for individual and small group markets. Sliding scale federal subsidies will be available for those under 400% of FPL. An $8.0B annual fee on US Health Insurance providers will be levied. Non-ederly who earn 133% or less of the FPL will be eligible for Medicaid. All health insurance will become Guarantee Issue & Guarantee Renewable. Health Insurance market is limited to rating restrictions based on area, age, family composition and tobacco use. Individual mandates are established.

2015
An $11.3B annual fee on US Health Insurance Providers will be levied.

2016
An $11.3B annual fee on US Health Insurance Providers will be levied.

2017
An $13.9B annual fee on US Health Insurance Providers will be levied. Coverage through Health Insurance Exchanges may be purchased by large employers and MEWAs.

2018
An $14.3B annual fee on US Health Insurance Providers will be levied.

EXTERNAL IMPACTS

* Essential Bene ts are bene ts related to ambulatory patient services, emergency services, hospitalizations, maternity & newborn care, mental health and substance abuse disorder services, prescription drugs, rehabilitation and habilitative services, preventative and wellness services and chronic disease management and pediatric services, including oral and vision care.

Featured on PayerFusion CEOs Blog at http://payerfusion.com/ceos-blog July 2012