The timeline summarizes important dates in the implementation of the Affordable Care Act between 2010 and 2018. Key provisions include: - 2010-2011: Dependent coverage must be offered until age 26 and pre-existing conditions can be covered through high-risk pools. - 2011-2013: Medical loss ratio and electronic transactions rules apply, health care exchanges are established. - 2014: Most individuals must have coverage or pay a penalty and health insurance market reforms take effect. - 2015-2018: Additional taxes and fees are imposed on health plans, and remaining ACA provisions are implemented.

1. HEALTH CARE REFORM TIMELINE
2010 2011 2013 2014 2015-2018
Health plans that provide dependent coverage must make Medical loss ratio (MLR) rules apply to Improvements on HIPAA’s electronic Individuals must obtain Health insurance
coverage available for dependents up to age 26 how health insurers spend their transaction rules start to be phased in health insurance coverage or provider fee imposed in
premium dollars (consumer rebates pay a penalty (some 2015 and increased
must be paid by Aug. 1 each year exemptions apply) annually
starting in 2012)
Uninsured individuals with pre-existing conditions can Employers must report health coverage Salary reduction contributions to FSAs are Employers with 50 or more High-cost plan excise
obtain health insurance through a high-risk health costs on Form W-2 (optional for 2011; limited to $2,500 employees must offer tax established in 2018
insurance pool program mandatory for later years, except small coverage to their employees
employers do not need to comply until (that is affordable and
further guidance issued) provides minimum value) or
pay a penalty
HHS established a website for residents of any state to OTC medicine and drugs are “qualified Medicare Part D subsidy deduction Health insurance exchanges
identify affordable health insurance coverage options in medical expenses” for HSAs, FSAs and eliminated to be established
their state (www.healthcare.gov) HRAs only if they are prescribed (insulin
is an exception)
Early retiree reinsurance program provides reimbursement Simple cafeteria plan provides small Income threshold for claiming itemized Health insurance companies
for a portion of the cost of providing health coverage for businesses with an easier way to deduction for medical expenses increased will not be able to
early retirees. Program was available for claims incurred sponsor a cafeteria plan discriminate against
before Jan. 1, 2012 individuals based on health
status
Lifetime dollar limits on essential health benefits are Medicare Part D drug discounts start to Medicare hospital insurance tax rate for Individual health care tax
prohibited. Annual dollar limits are restricted until 2014 be phased in for beneficiaries in the high wage workers increased credits available for certain
when all annual dollar limits on essential health benefits “donut hole” until the coverage gap is individuals
are prohibited filled in 2020
Pre-existing condition exclusions are eliminated for Penalty taxes increase on withdrawals Medical device excise tax established Second phase of small
children under age 19 from HSAs (prior to age 65) and Archer business tax credit
MSAs that are not used for qualified
medical expenses
Non-grandfathered health plans must cover certain Free annual wellness visit for Medicare By March 1, 2013, employers must provide Insured plans in the small
preventive care services without cost-sharing beneficiaries and elimination of cost a notice to employees regarding the group and individual market
sharing for preventive care services insurance exchanges. On Jan. 24, 2013, must provide comprehensive
the DOL announced that employers will benefits coverage (does not
not be held to the March 1, 2013 deadline. apply to grandfathered
They will not have to comply until final plans)
regulations are issued and a final effective
date is specified.
Rescissions are prohibited in most cases; plan coverage By Dec. 31, 2013, employers must certify No limits on annual dollar
may not be retroactively cancelled without prior notice to compliance with certain HIPAA electronic value of essential health
the enrollee 2012 transactions benefits
Fully insured group health plans must satisfy Plans must provide summary of benefits Pre-existing condition
nondiscrimination rules regarding participation and benefit and coverage starting with the open exclusions prohibited for
eligibility (Note: delayed for regulations) enrollment period beginning on or after adults
Sept. 23, 2012. For other enrollments, it
must be provided starting with the plan
year beginning on or after Sept. 23, 2012
Plans and issuers must adopt an improved internal claims For plan years beginning on or after Health plans cannot impose
and appeals process and comply with external review Aug. 1, 2012, plans and issuers must waiting periods longer than
requirements (some rules were delayed until plan years cover additional preventive care 90 days
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2. beginning on or after Jan. 1, 2012) services for women without cost-
sharing. Exceptions to contraceptive
coverage apply to religious employers
First phase of the small business health care tax credit For plan years ending on or after Oct. 1, Reforms related to the
2012, issuers and self-insured health allocation of insurance risk
plans must pay comparative through reinsurance, risk
effectiveness research fees. corridors and risk
adjustment become effective
Rebates for the Medicare Part D “donut hole” Non-grandfathered health
sent to eligible enrollees plans will be subject to cost-
sharing limits
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