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2010

Small Business Tax Credit (effective January 1, 2010)
A tax credit that provides employers financial assistance to purchase health insurance for their employees. The first round of tax credits are for up to 35 percent of the employer’s contribution to the employee’s health insurance. There is also a credit up to 25 percent for small non-profit organizations. When Health Insurance Marketplaces are operational in 2014, tax credits will increase up to 50 percent of premiums.

Online availability (July 1, 2010)

An easy to use website was created to help consumers compare health insurance coverage options that best fits their needs. This website now exists as www.healthcare.gov

Health Care Fraud (2010)
The new law requires new screening procedures for providers to reduce fraud and waste in Medicare, Medicaid and the Children's Health Insurance Program (CHIP).

Accountability for Premium Increases (2010)
Health plans will be required to justify increases in health plan premiums to both the federal government and the relevant state government for approval.

Primary Care Incentive (2010)
The law will expand the number of primary care doctors, nurses and physician assistants by offering incentives including scholarships and loan repayment for those working in underserved areas.

Pre-existing Condition Insurance Plan (PCIP) ( July 1, 2010)
PCIP will provide Americans with pre-existing health conditions new coverage options through their state. PCIP plans vary depending on the state you reside. Some states have opted to run the programs themselves while others have allowed the Department of Health and Human Services to run theirs. Individuals must have been uninsured for 6 months or more prior to enrollment to qualify. Annual out-of-pocket cost will be capped at $5,950 for individuals and $11,900 for families. Premiums will be regulated. PCIP programs will end when Health Insurance Marketplaces are established and operational in 2014. UPDATE: Enrollment in PCIP ended in March 2013.

Continued coverage to early retirees between the ages of 55 and 65. ( June 1, 2010)
A temporary reinsurance program will be offered to provide reimbursement of expensive premiums for employers providing early retirees and their spouses, surviving spouses and dependents health benefits. This program will end on January 1, 2014. UPDATE: This program is no longer operational.

Several very significant benefits went into effect on September 23, 2010 including:

  • Elimination of Pre-existing Conditions for Children (September 23, 2010)
    Exclusions from coverage due to a child's (under 19) pre-existing condition, regardless of diagnosis, are prohibited. This provision will apply to adults in 2014.

  • Extended Coverage for Dependents (September 23, 2010)
    Dependent coverage will be extended, allowing a parent's plan to maintain health coverage of young adults until age 26. New or grandfathered group health plans and health insurers offering group or individual health insurance coverage that provides dependent coverage for children must make coverage available for young children up to age 26 unless the child has coverage available to them at their employment.

  • Insurers will be prohibited from rescinding health coverage (September 23, 2010)
    Previously, insurers could search for an error or mistake on an application and use it as a basis for denial to a consumer who was recently diagnosed. Insurers are now prohibited from rescinding a policy once the enrollee is covered. Exceptions will be in the case of fraud or intentional misrepresentation. This provision applies to new and grandfathered plans.

  • Medicare Part D Rebate (starting June 2010)
    Medicare beneficiaries who meet their Part D prescription drug coverage cap also referred to as the “donut hole” will receive a $250 reimbursement check to offset the cost of out-of-pocket prescription needs.

  • Annual and Lifetime Limits Regulated (September 23, 2010)
    Lifetime limits on insurance coverage are eliminated and annual limits on insurance coverage will be regulated. This requirement applies to all plans. Annual limits will be prohibited beginning in 2014.

  • No Cost Preventive Care (September 23, 2010)
    Insurers must offer coverage for preventive services and may not impose cost sharing for these services. Preventive services include mammograms, colonoscopies and immunizations. In 2011, Medicare will also provide no cost preventive services.

  • Appeal Coverage Determinations (September 23, 2010)
    Insurers must implement an effective appeals process for coverage determinations and claims, and establish an external appeal process. At a minimum, plans and issuers must have an internal claims process in effect; provide notice to enrollees, in a culturally and linguistically appropriate manner on the internal and external appeals process as well as any available health insurance consumer assistance or ombudsman to assist them.