• Changes for Employers

    Healthcare reform is here. What does it mean for your company's health plan? 

    The Affordable Care Act (ACA) brings a host of changes for employers in 2014 and 2015. Many changes are mandated by ACA while other changes are tied to the choices of the plan sponsor.

    We are committed to giving you the information you need to make the right health care choices for your organization.

    Review the healthcare reform timeline and get detailed information about how healthcare reform will impact your organization.

    Healthcare Reform Timeline

  • 2010

    • Adult child coverage until age 26
    • Annual dollar limits restricted
    • Early retiree reinsurance program (ERRP)
    • Emergency room coverage as in-network, no prior authorization
    • Initial appeals review standards
    • Lifetime dollar limits prohibited
    • Medicare Part D rebate for beneficiaries in the gap
    • No pre-existing conditions for children up to age 19
    • Online consumer information at healthcare.gov
    • Pediatricians as primary care physicians (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


    • Annual fee on pharmaceutical manufacturers begins
    • Annual rate review process
    • Appeals ombudsmen and process documentation
    • Auto-enrollment for groups with 200+ full time employees (implementation delayed until regulations released)
    • Discounts in Medicare Part D “donut hole”
    • Health savings, health reiumbursement and flexible spending accounts (HSA, HRA, FSA): limitations for over-the counter medications
    • Increase penalty for non-qualified HSA withdrawals
    • Minimum medical loss ratio (MLR): 85% for large group; 80% for small group and individual
    • Non-discrimination rules apply to insured plans (implementation delayed until regulations are released)
    • Small business wellness grants (implementation delayed until regulations are released


    • 60-day advance notice of material modifications
    • Accountable Care Organization requirements
    • Appeals provision fully implemented
    • First medical loss ratio rebates to be paid by August
    • New women’s preventive services with no cost sharing
    • Patient-centered Outcomes Research Institute (PCORI) fee ($1per member/year)
    • Quality bonus begins for Medicare Advantage plans
    • Quality of care reporting requirements (implementation delayed until regulations are released)
    • Summary of benefits and coverage (SBC) and the Uniform Glossary


    • Administrative simplification begins
    • Annual fee on medical device sales begins
    • Deduction for expenses allocable to the Part D subsidy for “qualified prescription drug plans”eliminated
    • Employee notification of access to Exchanges
    • Flexibile spending account (FSA) contributions limited to $2,500
    • High earner tax begins (applies to individuals)
    • Patient-centered Outcomes Research Institute (PCORI) fee increases to $2 per member/year
    • W-2 reporting of the value of employer-sponsored health benefits


    • Coverage for all adult children until age 26 including those that have employer coverage (formerly not covered for grandfathered plans)
    • Deductible caps cannot exceed $2,000 for individual and $4,000 for family
    • Essential health benefits required for small employers
    • Guaranteed issue and renewability
    • Health Benefit Exchanges
    • ICD-10 code adoption
    • Individual mandate
    • Insurer fee – permanent
    • Mandatory coverage for clinical trials
    • No annual dollar limits
    • No pre-existing condition exclusions
    • Out-of-pocket limits (OOP) must comply with OOP limits for health savings account (HSA) qualified plans
    • Rating restrictions / Adjusted community rating
    • Tax credits and subsidies for individuals and small employers
    • Transitional reinsurance fee (2014-2016)
    • Waiting period limits
    • Wellness programs

    2015 and beyond

    • Employer mandate - must offer health coverage to 70% of their full-time employees:
      • Employers with 100 or more employees (2015)
      • Employers with 50-99 employees (2016)
    • Employers must offer health coverage to at least 95% of their full-time employees (2016)
    • High-value plan excise tax begins (2018)
    • Medicare Part D “donut hole” closed by 2020
    • States can open Exchange to CHIP eligibles (2015) and all employers (2017)