Improving health is our policy
Amended by section 10103 of the Manager’s Amendment. Stipulates that premiums in the individual and small group market can vary only by family structure (individual or family), rating area established by the State and reviewed by HHS), age (no more than 3 to 1), tobacco use (no more than 1.5 to 1). Applies these rules to large employers if States permit them in...
Provides that each health insurance issuer that offers health insurance coverage in the individual or group market in a State must accept every employer and individual in the State that applies, with certain allowances for special or open enrollment periods. Effective for plan years beginning on or after January 1, 2014.
Requires issuers to renew or continue in force individual or group coverage at the option of the plan sponsor or the individual. Effective for plan years beginning on or after January 1, 2014.
Amended by section 10103 of the Manager’s Amendment. Prohibits a group health plans and issuers offering group or individual coverage from imposing any preexisting condition exclusions. Effective for plan years beginning on or after January 1, 2014. Additionally, applies prohibition on pre-existing conditions exclusion for those under age 19 – including to grandfathered group plans – for plan years beginning on...
Precludes group health plans and health insurance issuers offering group or individual health insurance coverage from establishing eligibility rules, including for continued eligibility, based on specified health status-related factors ranging from claims experience to genetic information. Permits premium variation of up to 30 percent – with HHS, Labor and Treasury discretion to increase the threshold to 50 percent – for certain...
Bars discrimination by a group health plan and issuer offering group or individual coverage against any healthcare provider who is acting within the parameters of that provider’s license or certification under applicable State law while noting that the section does not require plans to contract with any willing provider or prevent quality-based payment. Applies the provisions of ACA section 1558 –...
Requires issuers in the individual or small group market to cover ACA essential health benefits. Stipulates that group health plans observe EHB annual cost-sharing limitations. Specifies that if issuers offer any level of coverage in Exchanges, they must offer such coverage in that level as a child-only plan. Provides an exemption from these requirements for dental-only plans. Effective for plan and...
Amended by section 10103 of the Manager’s Amendment. Precludes group health plans and group health insurance issuers from applying any waiting period (as defined in section 2704(b)(4)) exceeding 90 days. Effective for plan years beginning on or after January 1, 2014.
Added by section 10103 of the Manager’s Amendment. Provides that group or individual plans may not deny individuals participation in a clinical trial, deny or limit coverage for routine costs or discriminate on the basis of such participation. Specifies conditions for inclusion of routine patient costs and defines qualified individual and approved clinical trial. Notes that a plan or issuer may...
Amended by section 10103 of the Manager’s Amendment and section 2301 of HCERA. Affirms no requirement to terminate existing coverage. Generally provides that subtitle C (“insurance market reforms”) and subtitle A (“immediate improvements”) and their amendments do not apply to a group health plan or health insurance coverage in which an individual was enrolled on March 23, 2010, regardless of...
Specifies that a standard or requirement adopted by a State pursuant to this title, or any amendment made by this title, shall be applied uniformly to all health plans in each applicable insurance market. Effective for plan years beginning on or after January 1, 2014.
Requires that by March 23, 2011, the Department of Labor prepare an annual report to Congress with general information on self-insured group health plans, including plan type, number of participants, benefits offered, funding arrangements and benefit arrangements, as well as data from the financial filings of self-insured employers.
Added by section 10103 of the Manager’s Amendment. Requires that by March 23, 2011, HHS report to Congress on the fully insured and self-insured group health plan markets, examining such issues as the characteristics of employers, health plan benefits and financial solvency and the extent to which new insurance market reforms are likely to cause adverse selection in the large group market...
Amended and re-designated by section 10103 of the Manager’s Amendment. Notes that this subtitle and the amendments comprising it are effective for plan years beginning on or after January 1, 2014, except that section 1251 takes effect upon enactment; section 2704 of the Public Health Service Act (as amended by section 1201), as applicable to enrollees who are under age...
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