The legislation instructs state exchanges to require insurance carriers seeking certification as qualified health plans to submit a justification for any premium increase prior to implementation of the increase. The exchange is then required to take the information into consideration when determining whether to allow the sale of the plan through the exchange. The legislation requires state insurance commissioners to provide data on premium trends and make recommendations to the HHS secretary about whether certain insurance carriers should be excluded from the exchange based on a pattern of excessive premium increases. In addition, the legislation requires the secretary in conjunction with the states to monitor premium increases inside and outside the exchange beginning in 2014. In considering whether to open the exchanges to large employers (more than 100 workers) in 2017, states must consider trends in premium growth outside and inside the exchanges.

Source: The Common Wealth Fund

Penalty for use of Health Savings Account Funds for withdrawal goes from 10 to 20%

Source: NAHU

$500,000 deduction limitation on taxable year remuneration to officers, employees, directors, and service providers of covered health insurance providers.

Source: Kaiser Family Foundation

Require coverage of tobacco cessation programs for pregnant women under Medicaid free of cost-sharing. Effective October 1, 2010.

Source: The Common Wealth Fund

In 2010, effective immeadiately, the HHS secretary and states will establish a process for annual review of unreasonable premium increases. Health insurers will be required to submit to the secretary and the relevant state a justification for an unreasonable increase prior to implementation of the increase. The information will be required to be posted on insurers’ Web sites. The bill appropriates $250 million to the secretary for grants ($1m to $5m) to states between 2010 and 2014 to review and approve carrier premium increases. As a condition of receiving a grant, state insurance commissioners will be required to provide the secretary with information on trends in premium increases in the state and make recommendations to the state insurance exchanges on whether aparticular insurance carriers should be excluded from participation based on a pattern of excessive or unjustified premium increases.

Source: The Common Wealth Fund

New limits will be set for the percent of premiums that insurers can spend on non-medical costs. Beginning in 2010, health plans are required to report the proportion of premiums spent on items other than medical care. Beginning in 2011, health plans in the large group market that spend less than 85 percent of their premiums on medical care and health plans in the small-group and individual market that spend less than 80 percent on medical care will be required to offer rebates to enrollees.

Source: The Common Wealth Fund

Group health plans or insurance companies providing group or individual market coverage are prohibited from rescinding coverage once an enrolled is covered under a plan, except in the case of an individual who has performed an act or practice that constitutes fraud or makes an intentional misrepresentation of material fact. Effective six months after enactment.

Source: The Common Wealth Fund

 Insurers are prohibited from excluding coverage of preexisting conditions for children in the individual market, effective six months after enactment.

Source: The Common Wealth Fund

Requires each state to create an Exchange to facilitate the sale of qualified benefit plans to individuals, including the federally administered multi-state plans and non-profit co-operative plans. A catastrophic only policy would be available for those 30 and younger. In addition the states must create “SHOP Exchanges” to help small employers purchase such coverage. Coverage in the Exchange will only be offered on a pre-tax basis if it is purchased through an employer. The state can either create one exchange to serve both the individual and group market or they can create a separate individual market exchange and group SHOP exchange. States can also apply for a modification waiver from DHHS.

Source: NAHU

Requires states to offer premium assistance and Medicaid wrap-around benefits to Medicaid beneficiaries who are offered employer-sponsored coverage if cost-effective to do so, under terms outlined already in current law.

Source:NAHU