Ins. Briefs (2010)

Health Reform - Insurance Descriptions by Effective Date


Events Prior to Date of Enactment (Back to HRN 2010 Ins Chart)


• Insurance & Medicaid: State Medicaid programs must offer premium assistance for the purchase of employer-sponsored health insurance and must also provide wrap-around benefits to such coverage (i.e., Medicaid-covered services not included in such employer-sponsored plans) when the cost to Medicaid for such coverage is less than the expected cost of providing full Medicaid benefits directly through the traditional Medicaid program. The statute’s effective date for this provision is February 4, 2009. (Sec. 2203)


March 23, 2010 (Date of Enactment) (Back to HRN 2010 Ins Chart)


Insurance: Deadline for the Secretary to establish a process to annually review “unreasonable” premium increases for health insurance coverage. HHS may award up to $250 million in grants to State Insurance Commissioners to provide HHS with information about premium increase trends and (until 2014) make recommendations as to whether particular health insurance issuers should be excluded from the Exchange based on a pattern of excessive or unjustified premium increases. (Sec. 1003; Sec.1004)  


Insurance: Deadline for the Secretary to award grants ($30 million for the first fiscal year; such sums as necessary going forward) to States that create ombudsmen programs or offices of consumer assistance, which will help consumers file inquiries, complaints or appeals on health insurance problems, enroll in health plans, and report to the Secretary data on the presented problems and inquires. The Secretary shall share this information with State insurance regulators and the Secretaries of Labor and Treasury for use in their enforcement activities. (Sec. 1002; Sec. 1004) 


May 22, 2010 (60 days after the date of enactment) (Back to HRN 2010 Ins Chart)


Insurance: Deadline for the Secretary to develop a standard format to describe information about health care coverage options (including private insurance, Medicaid, Medicare and State high-risk pools). Information shall be provided on the percentage of total premium revenue spent on nonclinical costs, eligibility, availability, premium rates and cost-sharing. These standards will be used by the Secretary to present the information on a Web site starting July 1, 2010.

(Sec. 1103)  


June 21, 2010 (90 days after the date of enactment) (Back to HRN 2010 Ins Chart)


Insurance: Deadline for the Secretary to establish a temporary $5 billion high-risk health insurance pool program to provide coverage for individuals who have been without coverage for more than six months and have a pre-existing condition as defined by the Secretary. The funding would be used to cover claims and administrative costs associated with operating the high-risk pool. HHS could operate the program either directly or through contracts with States or other eligible entities. States with programs already in place will have to continue their current funding levels in order to receive funding. Program terminates January 1, 2014. (Sec. 1101) 


Insurance: Deadline for the Secretary to establish a temporary $5 billion re-insurance program to reimburse partially employers (including State and local government employers) for costs associated with health plans for retirees ages 55-64 and eligible family members. Employers will receive 80 percent of claim costs that exceed $15,000 but are less than $90,000. Program terminates January 1, 2014. (Sec. 1102) 



July 1, 2010 (Back to HRN 2010 Ins Chart)


Insurance: Deadline for the Secretary to establish a mechanism, including a Web site, through which a resident of any State may identify health coverage options, including private insurance, Medicaid and State high-risk pools. (Sec. 1103)  


HHS launches website July 1 to help consumers choose insurance plans
This Thursday July 1, 2010, will go live offering consumers links to information about insurance plans, with a phase two enhancement in October to include comparative quality and pricing information.



September 23, 2010 (6 months after the date of enactment) (Back to HRN 2010 Ins Chart)


Insurance: Start date for new requirements on insurance companies (Note: requirements apply for plan years beginning on or after 6 months after enactment; for most plans, this date is likely January 1, 2011).

All insurance companies may not:

o impose lifetime limits on essential health benefits (Sec. 10101 / H.R. 4872 Sec. 2301) or

o rescind coverage except in instances in which an individual commits fraud (Sec. 1001 and H.R. 4872 Sec. 2301) 

All insurance companies must allow “children” to remain on their parent’s health plan until age 26, if the “child” is not eligible to enroll in an employer-sponsored health plan). (Sec. 1001 and H.R.4872 Sec. 2301).
Group health plans and new individual plans may not:

o exclude payment for treating a pre-existing condition for any child under 19. (H.R. 4872 Sec. 2301)

o impose unrestricted annual limits on “essential health benefits” as defined by the law and the Secretary. (Sec. 1001 and H.R.4872 Sec. 2301) 

All insurance companies that are not grandfathered (i.e., all new plans) must:

o cover – without cost-sharing requirements – preventive services as graded “A” or “B” by the U.S. Preventive Services Task Force, certain immunizations; preventive services for infants, children, adolescents and women as provided in guidelines developed by HHS’s Health Resources and Services Administration. (Sec. 1001); and

o implement an internal and external appeals process for coverage determinations and claims. (Sec. 1001)