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Calendar of Effective Dates of Health Care Reform Law Provisions


  • Small Employer Health Insurance Tax Credit (initial phase)
  • Reinsurance program for age 55 or older retiree health coverage
  • Dependent coverage to age 26 (for dependents not covered by another employer-sponsored plan)
  • No lifetime caps on dollar value of health benefits
  • No pre-existing condition exclusions for children
  • No rescission unless fraud
  • Increase in exclusion for employer-provided adoption assistance
  • Subsidized coverage for pre-existing conditions through national high risk pool
  • $250 rebates for Medicare beneficiaries who reach coverage gap in prescription drug coverage
  • No cost sharing for proven preventive care services
  • State can cover parents or childless adults up to 133 percent of poverty and receive federal matching contributions


  • Grants available for small business wellness programs
  • CLASS program automatic enrollment and voluntary payroll withholding
  • W-2 reporting of the value of employer-sponsored health insurance coverage
  • Restrictions on using funds in health FSA, HRA, HSA or MSA for over-the-counter medicines
  • 20% additional tax on HSA and MSA withdrawls not used for medical expenses
  • Fee on branded prescription drug manufacturers and importers
  • New simplified cafeteria plan for small businesses


  • Information reporting for payments to corporations


  • Automatic enrollment of employees in large employer plans
  • Additional .9% Medicare tax on wages/self-employment income of high earners
  • 3.8% Medicare surtax on investment income of higher income taxpayers
  • $2,500 limit on annual health FSA contributions
  • 10% floor on itemized medical expense deductions
  • Elimination of business deduction for certain retiree prescription drug costs
  • Limit on deductions for compensation paid to insurance company executives (for services performed after 2009)
  • 2.3% excise tax on medical device sales
  • Health plans must simplify administration to reduce paperwork and cost
  • Creation of health care choice compacts between states to allow purchase of health plans across state lines


  • Individual health care minimum essential coverage mandate/penalties/subsidies
  • Employer shared responsibility mandate/penalties (assessments)
  • Individual and small business (SHOP) exchanges available
  • Small Employer Health Insurance Tax Credit (second phase)
  • Free Choice Vouchers start
  • No annual limits on coverage in grandfathered individual and group plans
  • Employee awards for wellness programs permitted
  • Annual fee on health insurance providers (for net premiums written after 2012)
  • Increases in required estimated tax payments for large corporations
  • Limit for waiting periods not to exceed 90 days
  • Limits on cost-sharing amounts for families with low and moderate incomes
  • New rating rules require carriers to accept every individual that applies for coverage
  • Insurers to pool risk of all individual enrollees in all plans inside and outside the exchanges, except grandfathered plans
  • Incentives for insurers in the individual and group markets to accept all risks
  • States to establish an American Health and Small Business Benefit Exchange


  • States can allow businesses with more than 100 employees to purchase coverage through SHOP Exchanges


  • 40% excise tax on high-cost health coverage provided by employers