Federal Health Insurance Reform - Implementation Timeline

(does not include Medicare, Medical Asisstance, CHIP or other non-insurance reforms)



  • Temporary insurance pools established to provide coverage to uninsured individuals who have pre-existing conditions (PA Fair Care began taking applications in August; ending when exchanges are live).
  • Federal and State regulators established standards and process for reviewing premium increases for unreasonableness (immediate).
  • New rules for all health insurance plans (for plan years beginning after Sept. 23):
    • no lifetime dollar limits
    • restricted annual limits
    • no pre-existing condition exclusions for children
    • dependent coverage extends to adult children under age 26
    • policies may not be rescinded except for fraud or intentional misrepresentation
    • emergency room coverage at non-participating providers at in-network rates
    • patient choice in selecting primary care provider
    • no pre-authorization or referral for obstetrical or gynecological care
  • New health insurance plans to provide preventive services with no out-of-pocket expense.
  • New health insurance plans to have standard appeal process.
  • Tax credits to small low-wage employers for insurance premiums.
  • Temporary re-insurance program for employers who provide early retiree health benefits.
  • Insurance companies to report medical loss ratio portion of premiums.
  • Health plans may not discriminate in favor of highly compensated employees.
  • Federal Website established to allow individuals and small businesses to identify affordable health insurance coverage options.



  • Insurance companies rebate premiums if they didn’t spend enough on medical costs.
  • Community Living Assistance Services and Supports (CLASS) long-term care program established.
  • Grants to small employers for wellness programs.



  • Insurance companies to use standard definitions and uniform explanation of coverage.



  • Consumer Operated and Oriented Plan (CO-OP) program to foster creation of non-profit, member run health insurance entities to offer qualified plans.
  • Insurance companies to use standard eligibility verification and claims status rules.



  • All individuals will be required to carry insurance.
  • Individuals up to 400 percent federal poverty level to receive tax credit for insurance premiums.
  • Employers (more than 50 employees) required to offer health insurance or pay a fee if any employee receives premium subsidies.
  • Small employers eligible for 50 percent subsidy to provide insurance for employees.
  • State-based health insurance exchanges available for individuals and small businesses.
  • Insurance companies must accept all applicants – may not deny coverage based on pre-existing condition or health status (guaranteed issue and renewability).
  • Insurance rates in the exchanges, individual and small group markets may vary only due to age, family size, geography and tobacco use. 
  • Insurance companies must reduce out-of-pocket charges for those up to 400 percent FPL.
  • Insurance companies to use standard electronic fund transfer and health care payment and remittance rules.
  • Group insurance plans may have a waiting period of no more than 90 days.
  • Employers may offer increased rewards for participation in wellness programs.



  • Insurance exchanges to be self-sustaining; assessment or fee may be charged for use.
  • Tax credit available to cover children through an exchange.



  • States may agree to allow coverage to be offered across state lines.
  • Insurance companies to use standard health claim, enrolment, premium payment and referral certification and authorization rules.
  • Small employers (up to 100 employees) to participate in exchanges if not previously included.



  • States may allow large companies (more than 100 employees) to participate in exchanges.



  • Excise tax on insurance companies for high-cost health insurance plans.