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ACA Timeline

 

2014

 

  • Small Business Subsidy Phase II: For up to two years, businesses eligible to purchase coverage through the Small Business Health Options Program (SHOP) Exchange may receive a tax credit of up to 50% of the employer's contribution if the employer contributes at least 50% of the total premium. Full credit available to employers with 10 or fewer employees and average annual wages of less than $25,000. Credit phases out as firm size and average wage increases. 

  • Guarentee Issue: All insurers offering non-grandfathered health plans must guarentee coverage and renewability: can not apply pre-existing conditions or health status rating adjustments.

  • Community Rating Rules: In California, rates can vary only by age (3:1 ratio), family size and geographic area. Federal guideline permits tobacco (1.5:1 ratio) as a rating variable.

  • Essential Health Benefits (EHBs): Each state required to establish an essential minimum benefit plan in which all health plans, individual and small group markets, must include coverage for 10 benefit categories; annual limists removed.

  • Individual Mandate: All U.S. citizens are required to maintain coverage or pay penalty; waivers apply for certain individuals.

  • State- Based Exchange: Covered California must be operational beginning January 2014. Must be self- sustaining by 2015. 

  • Insurance Carrier Fee: Insurance industry must pay annual fee of $8 billion (increases in subsequent years).

  • Small Group: Redefined as 1-100. California, however, has opted to maintain Small Group as 2-50 until 2016.

  • 90-Day Waiting Period: In California, no waiting period for coverage may exceed 90 days. 

  • Auto- Enroll: Employer with 200+ employees required to auto-enroll employees in heatlh benefits.

  • Clinical Trials: Coverage for routine patient costs for clinical trials of life-threatening diseases. 

 

2015

 

  • Pay or Play: Employers with 100+ full time equivalent employees not providing coverage to at least 70% of their full time employees (increases to 95% in 2016) must pay a fine if offering coverage that is deemed unaffordable or not meeting a 60% actuarial value. The penalty is only triggered if an employee receives a subsidy through Covered California to buy insurance.

  • Reporting Requirements to IRS and Employees: Employers to file information with the IRS.

 

2016

 

  • Pay or Play: Employers with 50+ full time equivalent employees not providing coverage to at least 95% of their full time employees must pay a fine if offering coverage that is deemed unaffordable or not meeting a 60% actuarial value. The penalty is only triggered if an employee receives a subsidy through Covered California to buy insurance. 

  • Minimum Essential Coverage: Penalty increases to greater of 2.5% of taxable income or $695, for those not having coverage.

 

2017

 

  • Employer Participation in Exchange: Employers with 100+ employees may participate in exchange, if permitted by state.

 

2018

 

  • Cadillac Tax: 40% excise tax applied on health plans valued at more than $10,200 for individual coverage and $27,500 for family coverage; dental and vision excluded.

 

 

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