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15 Things you did not know about health reform law

by Tony Novak, CPA, MBA, MT,     revised October 7, 2012


Many of us are still discovering the details of the complex 2010 federal health reform law and how those new laws will affect us for years to come. Here are 15 little-known details of the health reform law that may affect your health benefits in the near future:

  1. The "Cadillac Plan" tax does not become effective until 2018. The employer, and not the individual, is responsible for calculating and collecting the excise tax on Cadillac health plans.
  2. Health Savings Account plans now have the same level of policy owner risk as other types of health plans. The maximum out-of-pocket expense limitations are now the same for all health plans regardless of whether they include a Health Savings Account option.
  3. Grandfathered plans are exempt from providing preventative care and wellness benefits as well as many of the other coverage provisions that are now included in other health plans.
  4. Employer-provided health benefits will be available to employees who typically work a minimum of 30 hours per week (40 hours per week is typically required for eligibility now).
  5. Rehabilitation services are considered "essential benefits" that must be included in health plans sold on the state insurance exchange.
  6. Chiropractic care is not classified as an "essential benefit" and will not be included in the basic health insurance plans sold on the state insurance exchange.
  7. Employers must provide paid break time for nursing mothers who want to express milk.
  8. Health plans may include lifetime limits on non-essential health benefits.
  9. A referral may not required for OB/GYN care.
  10. The $13,170 adoption credit was a temporary benefit that expired in 2011.
  11. Pre-existing conditions may still be excluded from coverage for adults who have had a significant gap in prior coverage until a waiting period is satisfied.
  12. Businesses with less than 25 employees may be eligible for a tax credit for offering a group health plan.
  13. Employers with more than 200 employees are required to automatically enroll employees in their health plan unless the employee takes steps to opt out.
  14. The long term care insurance provision of the reform law was later abandoned by the U.S. Department of Health and Human Services as being unworkable.
  15.  Some types of health plans are exempt from many provisions of the health reform law. These include grandfathered plans, short term medical insurance plans, small business health plans, uninsured health plans, supplemental health insurance, mini-med or defined benefit health plans and self-funded employer plans.

Remember that state insurance laws significantly impact the application of these federal laws so check with your enrollment adviser on any specific issues that may affect your own anticipated health care planning.

Related resources:

Top ten medical conditions

Affordable Care Act restricts pay to executives

Embracing the state insurance exchange

Consumer health reform timeline

Health care reform summary

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This web site is independently owned and managed by Tony Novak operating under the trademarks "Freedom Benefits", "OnlineAdviser" and "OnlineNavigator". Opinions expressed are the sole responsibility of the author and do not represent the opinion of any other person, company or entity mentioned. Tony Novak is not an agent, broker, producer or navigator for any federal or state health insurance exchange but may provide uncompensated advice, reviews and referrals to these official resources. Novak is compensated as an accountant, adviser, affiliate consultant, marketer, reviewer, endorser, producer, lead generator or referrer to some of the other commercial companies listed on this site. Information is from sources believed to be reliable but cannot be guaranteed.