HCERA 1005 - Implementation Funding
Establishes an HHS Health Insurance Reform Implementation Fund for ACA implementation purposes. Appropriates $1B.
Improving health is our policy
Establishes an HHS Health Insurance Reform Implementation Fund for ACA implementation purposes. Appropriates $1B.
Re-designates and adds certain sections to title XXVII of the PHSA (summarized individually). Generally effective for plan years beginning 6 months after the date of enactment, September 23, 2010, unless otherwise noted.
Replaced by section 10101 of the Manager’s Amendment, summarized here, and modified by section 2301 of HCERA. Prohibits group health plans – including those that are grandfathered – or health insurance issuers offering group or individual coverage from imposing lifetime or annual limits on the dollar value of benefits. Permits restricted annual limits – to be determined by HHS –...
Amended by section 2301 of HCERA. Prohibits individual and group plans, including grandfathered plans, from rescinding coverage except in cases of fraud or enrollees’ intentional misrepresentation of material fact, and requires prior notice of cancellation to the enrollee.
Requires individual and group health plans to cover preventive services without cost sharing if they: Have a current “A” or “B” rating from the U.S. Preventive Services Task Force; Are immunizations recommended by the CDC’s Advisory Committee on Immunization Practices; Are certain infant, children, and adolescent services recommended by HRSA; or Are certain additional women’s services recommended by HRSA. Establishes a...
Amended by section 2301 of HCERA. Requires group and individual plans, including grandfathered plans, that provide dependent coverage of children to continue making such coverage available for an adult child until the child turns age 26. Does not extend to providing coverage to the child of an adult child. Applies to grandfathered group plans in plan years beginning before January...
Amended by section 10101 of the Manager’s Amendment. By March 23, 2011, requires HHS to develop standards for use by plans offering group or individual health insurance coverage in compiling and providing to applicants and enrollees a summary of benefits and coverage explanation. Requires HHS to consult with the NAIC and a multi-stakeholder working group as well as adhere to...
Added by section 10101 of the Manager’s Amendment. Requires plans not offered through an Exchange to submit information required under section 1311(e)(3) – such as claims payment policies and practices and enrollment/disenrollment data – to HHS and the State insurance commissioner as well as make it available to the public.
Replaced by section 10101 of the Manager’s Amendment, summarized here. Requires group health plans other than self-insured plans to satisfy the requirements of section 105(h)(2) of the Internal Revenue Code of 1986 relating to prohibition on discrimination in favor of highly compensated individuals.
Amended by section 10101 of the Manager’s Amendment. Requires HHS within 2 years of enactment to develop reporting requirements for group health plans and health insurance issuers offering group or individual coverage that address “plan or coverage benefits and health care provider reimbursement structures” that improve health outcomes; prevent hospital readmissions; improve patient safety and reduce medical errors; and involve...
Replaced by section 10101 of the Manager’s Amendment. Requires plans offering individual or group coverage, including grandfathered plans, to report to HHS for each plan year the ratio of the incurred loss plus the loss adjustment expense (or change in contract reserves) to earned premiums. Reports are to be made public on the HHS website. Starting January 1, 2011, requires...
Amended by section 10101 of the Manager’s Amendment. Requires plans offering individual or group coverage to implement an effective process for appeals of coverage determinations and claims meeting specified parameters such as having an internal claims appeal process and notifying enrollees of available internal/external appeals processes. Group health plans and health insurance issuers offering group or individual coverage must comply...
Added by section 10101 of the Manager’s Amendment. Specifies that any available participating primary care provider is permissible for designation by an enrollee if a group health plan or a health insurance issuer offering group or individual coverage requires or provides for designation of such a participating practitioner. Also requires that if a plan covers hospital emergency department services, it does so...
Creates an HHS grant program for States or Exchanges to establish offices of health insurance consumer assistance or health insurance ombudsman programs to assist with appeals, enrollment, receipt of premium subsidies and other activities, conditioning these grants on offices’ collection and reporting of data to HHS on the types of problems and inquiries encountered by consumers. Appropriates $30M for the...
Amended by section 10101 of the Manager’s Amendment. Beginning with the 2010 plan year, working with States, HHS will establish a process for the annual review of unreasonable increases in health insurance premiums, including issuers’ submission to HHS of justification for unreasonable premium increases prior to implementation and public disclosure of this information by issuers and HHS. HHS will award...
As noted in section-specific summaries (sections 1001-1003), immediate reforms in Subtitle A generally are effective for plan years beginning on or after September 23, 2010. Sections 1002 and 1003 are effective upon enactment.
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