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Plans may not impose an eligibility waiting period greater than 90 days.
Plans may not impose any annual dollar limits on essential health benefits.
Plans may not impose any pre-existing condition limits for any enrollees.
Grandfathered plans that cover children must provide coverage for all adult children up to age 26 regardless of eligibility for other employer-sponsored coverage.
The incentives for wellness participation that an employer may provide increases to 30% of the cost of an employee’s health coverage.
Non-grandfathered, small group insured plans must provide coverage for all essential health benefits, to be defined by federal regulations.*
Non-grandfathered plans may not discriminate against clinical trial participants, as specified by regulations.*
Non-grandfathered insured, small group plans may not impose deductibles higher than $2,000 for individual coverage or $4,000 for family coverage.*
Non-grandfathered plans may not require a participant to pay cost-sharing in excess of the out-of-pocket maximum that applies to HSA-compatible high deductible health plans.*
Non-grandfathered plans may not discriminate against health care providers acting within the scope of their licenses.*
* Indicates grandfathered plans do not have to comply.
American Fidelity Assurance Company does not provide tax or legal advice.