The Patient protection and Affordable Care Act (PPACA) guidelines must be enacted by September 23rd, 2010 (6 months from the date it was passed)

September 23rd guidelines:

-Dependent children will be permitted to remain on their parents' insurance plan until their 26th birthday.

-Insurers are prohibited from discriminating against any individuals under the age of 19 based on pre-existing medical conditions.

-Insurers are prohibited from charging co-payments or deductibles for Level A or Level B preventive care and medical screenings on all new insurance plans. For full list see article below.

-Individuals affected by the Medicare Part D coverage gap will receive a $250 rebate, and 50% of the gap will be eliminated in 2011. The gap will be eliminated by 2020.

-Insurers' abilities to enforce annual spending caps will be restricted, and completely prohibited by 2014. This is also called unlimited lifetime maximums.

-Insurers are prohibited from rescinding policyholders when they get sick unless fraud was committed on the application.

-Insurers are required to reveal details about administrative and executive expenditures.

-Insurers are required to implement an appeals process for coverage determination and claims on all new plans.

-Indoor tanning services are subjected to a 10% service tax.

-Enhanced methods of fraud detection are implemented.

-Medicare is expanded to small, rural hospitals and facilities.

-Companies which provide early retiree benefits for individuals aged 55–64 are eligible to participate in a temporary program which reduces premium costs.

-A new website installed by the Secretary of Health and Human Services will provide consumer insurance information for individuals and small businesses in all states.

-A temporary credit program is established to encourage private investment in new therapies for disease treatment and prevention

Effective by January 1, 2011

-Employers must disclose the value of the benefits they provided beginning in 2011 for each employee's health insurance coverage on the employees' annual Form W-2's.

-Insurers will be required to spend 85% of large-group and 80% of small-group and individual plan premiums (with certain adjustments) on health care or to improve health-care quality, or return the difference to the customer as a rebate. Although we are still waiting on additional clarifications from HHS at present these do not include any administration costs, salaries, benefits, rent, or commissions. This is NOT 20% profit. Future rate increases or decreases will be based on this formula.

-Companies will be required to issue 1099 forms to any vendor of services or rental property to which the business has paid more than $600. Form 1099 is also sent to the IRS. Under the existing law, businesses issued the Form 1099 only to individuals who provided services or property to a business. The health care law included the same form be issued to corporations as well, and that the form be issued to individuals and corporations that provide property to the business.Only business related payments are reportable, personal payments not.There are a number of exceptions, for example: payments for merchandise, telephone, freight, storage, payments of rent to real estate agents are excepted.The health care bill mandate aims to collect lost revenue from companies that under-report on their tax returns. The provision is expected to raise $17 billion over 10 years.

-The Centers for Medicare and Medicaid Services is responsible for developing the Center for Medicare and Medicaid Innovation and overseeing the testing of innovative payment and delivery models.

Grandfather status:

All health insurance policies issued before March 22nd, 2010 will be grandfathered (exempt) from most of the requirements. Plans issued between March 22nd and Sept 22nd, 2010 will not have these benefits included now but they MUST be brought to compliance and added by 1/1/11. Any significant changes made to a grandfather policy, IE: increasing the deductible, increasing out of pocket maximums, will result in the loss of grandfathered status.

Later developments:

2014:

-All insurance companies will have to guarantee issue coverage (no one can be turned down) regardless of health conditions.

-Health insurance Exchanges will be set up that will provide assistance to buy insurance based on % of Federal poverty levels.